Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS

Jacquemin, Laure; Shekhawat, Giriraj Singh; Heyning, Paul Van de; Mertens, Griet; Fransén, Erik; Rompaey, Vincent Van; Topsakal, Vedat; Moyaert, Julie; Beyers, Jolien; Gilles, Annick

doi:10.1177/1545968318787916

Cited by 36 publications

(37 citation statements)

References 41 publications

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“…In general, our study population is similar to tinnitus populations in other studies with regard to age and average tinnitus loudness and annoyance [7,14-16].…”

Section: Discussionsupporting

confidence: 73%

The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

Michiels

Harrison²,

Vesala³

et al. 2019

Interact J Med Res

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Background Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise.

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“…In general, our study population is similar to tinnitus populations in other studies with regard to age and average tinnitus loudness and annoyance [7,14-16].…”

Section: Discussionsupporting

confidence: 73%

The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

Michiels

Harrison²,

Vesala³

et al. 2019

Interact J Med Res

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“…Memory (Chua et al, 2017;Hill et al, 2017Hill et al, , 2018Naka et al, 2018;Nikolin et al, 2015;Price et al, 2016), Pain (Borckardt et al, 2012;Flood et al, 2016) and Tinnitus (Henin et al, 2016;Jacquemin et al, 2018). Despite this, direct comparisons between conventional tDCS and HD-tDCS is limited into their differing effect on CSE, cortico-cortical excitability and response variability.…”

Section: Introductionmentioning

confidence: 99%

The effects of transcranial direct current stimulation on corticospinal and cortico-cortical excitability and response variability: conventional versus high-definition montages

Pellegrini

Zoghi

Jaberzadeh

2020

Preprint

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Response variability following transcranial direct current stimulation (tDCS) highlights need for exploring different tDCS electrode montages. This study compared corticospinal excitability (CSE), cortico-cortical excitability and intra-individual variability following conventional and HD anodal (a-tDCS) and cathodal (c-tDCS) tDCS. Fifteen healthy young males attended four sessions at least one-week apart: conventional a-tDCS, conventional c-tDCS, HD-a-tDCS, HD-c-tDCS. TDCS was administered (1mA, 10-minutes) over the primary motor cortex (M1), via 6x4cm active and 7x5cm return electrodes (conventional tDCS) and 4x1 ring-electrodes 3.5cm apart in ring formation around M1 (HD-tDCS). For CSE, twenty-five single-pulse transcranial magnetic stimulation (TMS) peakto-peak motor evoked potentials (MEP) were recorded at baseline, 0-minutes and 30-minutes post-tDCS. For cortico-cortical excitability, twenty-five paired-pulse MEPs with 3-millisecond (ms) inter-pulse interval (IPI) and twenty-five at 10ms assessed short-interval intracortical inhibition (SICI) and intracortical facilitation (ICF) respectively. MEP standardised z-values standard deviations represented intra-individual variability. No significant differences were reported in CSE between conventional and HD a-tDCS, but significant differences between conventional and HD c-tDCS 0-minutes post-tDCS. Intra-individual variability was significantly reduced in conventional tDCS compared to HD-tDCS for a-tDCS (0-minutes) and c-tDCS (30-minutes). No significant changes were reported in SICI and ICF. These novel findings highlight current technical issues with HD-tDCS, suggesting future tDCS studies should utilise conventional tDCS to minimise intraindividual variability, ensuring tDCS after-effects are true changes in CSE and cortico-cortical excitability.

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“…A decrease of 13 points on the total TFI score is considered as a clinically relevant difference [32]. Based on previous studies, we expect mean TFI scores at baseline of approximately 50 [28].…”

Section: Discussionmentioning

confidence: 99%

Sequential dual-site High-Definition transcranial Direct Current Stimulation (HD-tDCS) treatment in chronic subjective tinnitus: study protocol of a double-blind, randomized, placebo-controlled trial

Cardon

Rompaey

Jacquemin

et al. 2019

Preprint

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Background Chronic tinnitus is a highly prevalent symptom, with many patients reporting considerable effects of tinnitus on quality of life. No clear evidence-based treatment options are currently available. While counseling-based methods are valuable in some cases, they are not sufficiently effective for all tinnitus patients. Neuromodulation techniques such as high-definition transcranial direct current stimulation (HD-tDCS) are proposed to have positive effects on tinnitus severity but, to date, these effects have not been proven conclusively. The proposed trial will investigate the hypothesis that chronic tinnitus patients receiving HD-tDCS will report a positive effect on the impact of tinnitus on daily life, as compared to patients receiving sham stimulation. Methods This study proposes a randomized, double-blind, placebo-controlled trial with parallel group design. A total of 100 chronic tinnitus patients will be randomly allocated to an experimental group or a sham group, with allocation stratified according to gender and tinnitus severity. Patient and researcher will be blinded to the patient’s allocation. Patients will undergo six sessions of sequential dual-site HD-tDCS of the left temporal area and the right dorsolateral prefrontal cortex. Evaluations will take place at baseline, immediately following treatment, and at three and six months after the start of the therapy. The primary outcome measure is the change in Tinnitus Functional Index (TFI) score. Secondary outcome measures include audiological measurements, cortical auditory evoked potentials, the Repeatable Battery for the Assessment of Neuropsychological Status adjusted to test Hearing impaired individuals (RBANS-H), and supplementary questionnaires probing tinnitus severity and additional symptoms. By use of a linear regression model, the effects of HD-tDCS compared to sham stimulation will be assessed. Discussion The objective of this study is to evaluate whether HD-tDCS can reduce the impact of tinnitus on daily life in chronic tinnitus patients. To date, published trials on the effects of HD-tDCS on tinnitus suffer from a lack of standardization, and few randomized controlled trials exist. The proposed study will be the first adequately powered trial to investigate the effects of sequential dual-site HD-tDCS on tinnitus severity.

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Effects of Electrical Stimulation in Tinnitus Patients: Conventional Versus High-Definition tDCS

Abstract: TDCS and HD tDCS resulted in a clinically significant improvement in TFI in 32% of the patients, with the 3 stimulation positions having similar results. Future research should focus on long-term effects of electrical stimulation.

Cited by 36 publications

References 41 publications

The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey

The effects of transcranial direct current stimulation on corticospinal and cortico-cortical excitability and response variability: conventional versus high-definition montages

Sequential dual-site High-Definition transcranial Direct Current Stimulation (HD-tDCS) treatment in chronic subjective tinnitus: study protocol of a double-blind, randomized, placebo-controlled trial

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