Primary and Secondary Auditory Cortex Stimulation for Intractable Tinnitus

Abstract

Introduction: Recent research suggests tinnitus is a phantom phenomenon based on hyperactivity of the auditory system, which can be visualized by functional neuroimaging, and transiently modulated by transcranial magnetic stimulation (TMS). We present the results of the first implanted electrodes on the primary and secondary auditory cortex after a successful TMS suppression. Methods and Materials: Twelve patients underwent an auditory cortex implantation, 10 for unilateral and 2 for bilateral tinnitus, based on >50% suppression applying TMS. Results were analyzed for pure tone tinnitus and white noise tinnitus. Results: TMS results in 77% pure tone tinnitus and 67% white noise reduction. Electrical stimulation via an implanted electrode results in a mean of 97% pure tone tinnitus and 24% white noise suppression. Mean Visual Analogue Scale score decreases from 9.5 to 1.5 for pure tone and from 8.8 to 6.8 for white noise postoperatively. Discussion: Pure tone tinnitus might be the conscious percept of focal neuronal hyperactivity of the auditory cortex. Once visualized, this hyperactivity can be modulated by neurostimulation. Conclusion: The preliminary results of the first implantations suggest that patients with unilateral pure tone tinnitus are good surgical candidates for electrode implantation and permanent electrical stimulation of the auditory cortex, provided that the tinnitus is of recent origin and can be suppressed by TMS.

Involvement of cortico-subcortical circuits in normoacousic chronic tinnitus: A source localization EEG study

“…Moreover, an increased intracortical facilitation, involving glutamatergic interneurons, over the motor cortex has been demonstrated using TMS (Langguthetal., 2005). An indirect proof has also been the demonstration that inhibitory repetitive transcranial magnetic stimulation over the primary auditory cortex could be useful in tinnitus treatment (Eichhammer et al, 2003;De Ridder et al, 2006;Langguth et al, 2006). This latter result, together with the fact that our data showed increased excitability of the auditory cortex even in the absence of stimulus, as it has also been shown in schizophrenic subjects with auditory hallucinations (Kompus et al, 2011), demonstrates the active role of the auditory cortex in tinnitus, even in normoacousic subjects with normal MRI and no apparent deafferentation.…”

“…Our data suggest a hyperexcitabihty of the thalamo-cortical circuits involving the left inferior temporal and parietal lobules, as revealed by the resting-state and ERPs analyses. These results could be used to personalize treatment options in these subjects, especially using repetitive transcranial magnetic stimulation, which has shown benefits in tinnitus sufferers (Plewnia et al, 2003;De Ridder et al, 2006;Vanneste et al, 2011;Lehner et al, 2013). Indeed, the results we obtained in the opened eyes condition could be of particular interest to improve rTMS protocols in tinnitus.…”

Use of Cortical Stimulation in Neuropathic Pain, Tinnitus, Depression, and Movement Disorders

“…Some sources of somatic sounds, like vascular lesions and palatal myoclonus, can be addressed directly [37]. While some benefits are seen with antidepressants [38], masking [39,40], and retraining therapies [41], cortical stimulation has been investigated as a possible treatment for the patients with subjective or neurophysiologic tinnitus not responding to aforementioned strategies [42,43].…”

Protocole de prise en charge neurochirurgicale des acouphènes invalidants : à propos de trois cas

“…Au deuxième jour postopératoire, nous avons mis en route le stimulateur, en adoptant des paramètres de stimulation proposés dans la littérature existante (Nguyen et al, 2000 ;Nguyen et al, 1999 ;De Ridder et al, 2006 ;Litre et al, 2009).…”