Research ArticleTINNITUS

Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study

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Science Translational Medicine  07 Oct 2020:
Vol. 12, Issue 564, eabb2830
DOI: 10.1126/scitranslmed.abb2830

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Relief from ringing

There is no universally effective treatment for tinnitus, phantom perceived sound, or ringing in the ears. Conlon et al. studied the effects of bimodal neuromodulation using a device that delivers electrical stimulation to the tongue and sound to the ears. Participants reported reduced symptom severity at the end of 12 weeks of treatment, which persisted for 12 months. Results support the safety and potential utility of bimodal neuromodulation for tinnitus.

Abstract

Tinnitus is a phantom auditory perception coded in the brain that can be bothersome or debilitating, affecting 10 to 15% of the population. Currently, there is no clinically recommended drug or device treatment for this major health condition. Animal research has revealed that sound paired with electrical somatosensory stimulation can drive extensive plasticity within the brain for tinnitus treatment. To investigate this bimodal neuromodulation approach in humans, we evaluated a noninvasive device that delivers sound to the ears and electrical stimulation to the tongue in a randomized, double-blinded, exploratory study that enrolled 326 adults with chronic subjective tinnitus. Participants were randomized into three parallel arms with different stimulation settings. Clinical outcomes were evaluated over a 12-week treatment period and a 12-month posttreatment phase. For the primary endpoints, participants achieved a statistically significant reduction in tinnitus symptom severity at the end of treatment based on two commonly used outcome measures, Tinnitus Handicap Inventory (Cohen’s d effect size: −0.87 to −0.92 across arms; P < 0.001) and Tinnitus Functional Index (−0.77 to −0.87; P < 0.001). Therapeutic improvements continued for 12 months after treatment for specific bimodal stimulation settings, which had not previously been demonstrated in a large cohort for a tinnitus intervention. The treatment also achieved high compliance and satisfaction rates with no treatment-related serious adverse events. These positive therapeutic and long-term results motivate further clinical trials toward establishing bimodal neuromodulation as a clinically recommended device treatment for tinnitus.

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