BF: Given what we know, are there any neuroactive or psychoactive drugs that could be effective for tinnitus relief?
FH: There are presently no validated medications for tinnitus—nothing that can permanently silence the perception of tinnitus. Research is ongoing so there may be some drugs in the development pipeline. Anti-depression and anti-anxiety medications are routinely prescribed for those with severely bother- some tinnitus. These psychoactive drugs are used to lessen the patient’s emotional reaction of tinnitus, not to silence the tinnitus signal itself.
Psychoactive Drug: Any chemical compound that affects brain function and alters perception, mood, cognition, and/or behavior. Psychoactive drugs may include prescription medications (antidepressants), recreational drugs, or more common stimulants like alcohol and caffeine.
BF: You’ve described a multi-faceted pathology for tinnitus that includes both the ear and different parts of the brain. It sounds like this requires a cross-disciplinary treatment approach. How should patients proceed?
tinnitus. As I mentioned before, we are collecting data on neural networks affected by tinnitus. We are also collecting data on possible therapies for tinnitus. We are looking at patients’ and audiolo- gists’ expectations for tinnitus treatment, whether they are similar or different, and how this may affect tinnitus management. And, in our latest project, we are investigating the interaction of hyperacusis and tinnitus in individuals with normal hearing thresholds. Several of these projects are
FH: My lab has several ongoing projects related to
BF: What is your next tinnitus-related research project?
In addition to seeing a trained healthcare professional, I think patients should—and very often do—control the management of their own tinnitus. A major step in gaining control and managing tinnitus is access to good, curated information about the condition. This is why organizations like ATA play a hugely impor- tant role in supporting better treatment outcomes.
who can do a baseline hearing analysis and ensure that there aren’t any more serious physiological issues (a tumor or hypertension, for example) causing their tinnitus. Patients may then be referred to other specialists—an ENT, neurologist and/or therapist— as necessary.
FH: I would suggest patients start with an audiologist,
BF: You’ve described a multi-faceted pathology for tinnitus that includes both the ear and different parts of the brain. It sounds like this requires a cross-disciplinary treatment approach. How should patients proceed?
Psychoactive Drug: Any chemical compound that affects brain function and alters perception, mood, cognition, and/or behavior. Psychoactive drugs may include prescription medications (antidepressants), recreational drugs, or more common stimulants like alcohol and caffeine.
tinnitus—nothing that can permanently silence the perception of tinnitus. Research is ongoing so there may be some drugs in the development pipeline. Anti-depression and anti-anxiety medications are routinely prescribed for those with severely bother- some tinnitus. These psychoactive drugs are used to lessen the patient’s emotional reaction of tinnitus, not to silence the tinnitus signal itself.
FH: There are presently no validated medications for
BF: Given what we know, are there any neuroactive or psychoactive drugs that could be effective for tin- nitus relief?
FH: Again, it’s been my pleasure. I’m excited to help advance our knowledge of tinnitus.
BF: It sounds like quite a challenge. Thank you for the research you’re doing in the field and for taking time to share with the Tinnitus Today readership.
and say within 10 years. But the caveat is that we may only fully understand the pathophysiology for a specific subgroup of tinnitus patients. Again, there is a great deal of diversity within the tinnitus popula- tion and there are multiple types and pathways of tinnitus. The problem we are dealing with is more complicated than identifying a single mechanism; we really need to identify and explore an array of pathologies that describe the full spectrum of tinnitus subgroups.
FH: I think we are fairly close. I will go out on a limb
BF: How close do you think we are we to fully under- standing the pathology of tinnitus in the brain?
Another unanswered question relates to how certain tinnitus therapies impact the brain. When an intervention works, what exactly is happen- ing in the brain? What does it say about neural mechanisms of tinnitus? Deciphering this interplay will help us understand better why interventions do not work for some patients. It will also help us refine treatments to optimize their efficacy.
You have touched on one of them in the beginning: why do some people with hearing loss develop tinnitus and others do not. The other big question, in my opinion, is what are the general ”sub-types of tinnitus and “sub-groups” within the patient pop- ulation. There may be several types of tinnitus, each with unique pathways, manifestations, and different potential remedies. The question is, how do we iden- tify and manage these sub groups? Should we define each type solely based on behavioral characteristics? Or do different sub-groups have fundamentally different neural mechanisms?
FH: There are several big questions out there.
BF: What are the big unanswered questions we still don’t know about the brain and tinnitus?
supported—or have been supported—by ATA research grants.
FH: I would suggest patients start with an audiologist, who can do a baseline hearing analysis and ensure that there aren’t any more serious physiological issues (a tumor or hypertension, for example) causing their tinnitus. Patients may then be referred to other specialists—an ENT, neurologist and/or therapist— as necessary.
In addition to seeing a trained healthcare professional, I think patients should—and very often do—control the management of their own tinnitus. A major step in gaining control and managing tinnitus is access to good, curated information about the condition. This is why organizations like ATA play a hugely impor- tant role in supporting better treatment outcomes.
BF: What is your next tinnitus-related research project?
FH: My lab has several ongoing projects related to tinnitus. As I mentioned before, we are collecting data on neural networks affected by tinnitus. We are also collecting data on possible therapies for tinnitus. We are looking at patients’ and audiolo- gists’ expectations for tinnitus treatment, whether they are similar or different, and how this may affect tinnitus management. And, in our latest project, we are investigating the interaction of hyperacusis and tinnitus in individuals with normal hearing thresholds. Several of these projects are
supported—or have been supported—by ATA research grants.
BF: What are the big unanswered questions we still don’t know about the brain and tinnitus?
FH: There are several big questions out there. You have touched on one of them in the beginning: why do some people with hearing loss develop tinnitus and others do not. The other big question, in my opinion, is what are the general ”sub-types of tinnitus and “sub-groups” within the patient pop- ulation. There may be several types of tinnitus, each with unique pathways, manifestations, and different potential remedies. The question is, how do we iden- tify and manage these sub groups? Should we define each type solely based on behavioral characteristics? Or do different sub-groups have fundamentally different neural mechanisms?
Another unanswered question relates to how certain tinnitus therapies impact the brain. When an intervention works, what exactly is happen- ing in the brain? What does it say about neural mechanisms of tinnitus? Deciphering this interplay will help us understand better why interventions do not work for some patients. It will also help us refine treatments to optimize their efficacy.
BF: How close do you think we are we to fully under- standing the pathology of tinnitus in the brain?
FH: I think we are fairly close. I will go out on a limb and say within 10 years. But the caveat is that we may only fully understand the pathophysiology for a specific subgroup of tinnitus patients. Again, there is a great deal of diversity within the tinnitus popula- tion and there are multiple types and pathways of tinnitus. The problem we are dealing with is more complicated than identifying a single mechanism; we really need to identify and explore an array of pathologies that describe the full spectrum of tinnitus subgroups.
BF: It sounds like quite a challenge. Thank you for the research you’re doing in the field and for taking time to share with the Tinnitus Today readership.
FH: Again, it’s been my pleasure. I’m excited to help advance our knowledge of tinnitus.
Summer 2014 | Tinnitus Today 21
SCIENCE & RESEARCH
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