A significant proportion of the population suffers from tinnitus, a bothersome auditory phantom perception that can severely alter the quality of life. Numerous experimental studies suggests that a maladaptive plasticity of the auditory and limbic cortical areas may underlie tinnitus. Accordingly, repetitive transcranial magnetic stimulation (rTMS) has been repeatedly used with success to reduce tinnitus intensity. The potential of transcranial direct current stimulation (tDCS), another promising method of noninvasive brain stimulation, to relieve tinnitus has not been explored systematically. In a double-blind, placebo-controlled and balanced order design, 20 patients suffering from chronic untreatable tinnitus were submitted to 20 minutes of 1 mA anodal, cathodal and sham tDCS targeting the left temporoparietal area. The primary outcome measure was a change in tinnitus intensity or discomfort assessed with a Visual Analogic Scale (VAS) change-scale immediately after tDCS and 1 hour later. Compared to sham tDCS, anodal tDCS significantly reduced tinnitus intensity immediately after stimulation; whereas cathodal tDCS failed to do so. The variances of the tinnitus intensity and discomfort VAS change-scales increased dramatically after anodal and cathodal tDCS, whereas they remained virtually unchanged after sham tDCS. Moreover, several patients unexpectedly reported longer-lasting effects (at least several days) such as tinnitus improvement, worsening, or changes in tinnitus features, more frequently after real than sham tDCS. Anodal tDCS is a promising therapeutic tool for modulating tinnitus perception. Moreover, both anodal and cathodal tDCS seem able to alter tinnitus perception and could, thus, be used to trigger plastic changes.

Fifty patients with otosclerosis and tinnitus were studied for the course of the tinnitus after stapes surgery. Tinnitus disappeared in 64% of the cases, improved in 16%, was unchanged in 14%, and worsened in 6%. The reduction in tinnitus was more favorable after a small fenestra stapedotomy than after a partial stapedectomy with removal of the posterior half of the footplate. An unfavorable postoperative course of tinnitus did not appear to be linked to the postoperative audiometric result. In our study the subjective evaluation of pitch and loudness of the tinnitus did not provide significant information regarding its prognosis.

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Objectives: This study has two aims. First, we analyze the results of dynamic computerized posturography (Equitest) achieved by patients who have undergone acoustic neuroma removal or vestibular neurotomy. The examination is performed during the preoperative assessment and at several postoperative consultations. Secondly, after analyzing the results, we evaluate the interest of this type of examination for such patients during preoperative assessment and postoperative follow-up. Patients: 25 patients underwent acoustic neuroma removal and 8 vestibular neurotomy from June 1996 until September 1997. All patients included in the study underwent dynamic posturography follow-up. The schema proposed was an examination before surgery and then 10 days and 1 and 3 months after the operation. Not all patients underwent all examinations (it is a retrospective study). Method: Retrospective case review. Results: 50% of the patients (n = 8) who underwent vestibular neurotomy achieved a normal score at the sensory organisation test (SOT) of the Equitest within the first 6 postoperative weeks. 60% of the patients (n = 25) undergoing acoustic neuroma removal developed a central vestibular compensation 3 months after surgery. Two patients developed an inadequate balance strategy with excessive visual dependence detected by the SOT. Conclusions: According to our experience, the SOT is a useful examination during the follow-up period of patients who have undergone neurootologic surgery. It provides information about the progress of postoperative central vestibular compensation. The dynamic posturography also detects inadequate balance strategies, therefore, allowing a personalized vestibular reeducation adapted to each patient.