The Science of Tinnitus

Background: This lecture award was established last year at TRI-2023 in memory of Dr Aage Moller (1932-2022), the beloved researcher, mentor and teacher at University of Texas Dallas. He was internationally regarded as a pioneer in the fields of neuroscience, cognition, neuroplasticity, and the development of an intraoperative neurophysiological monitoring. His distinguished career included numerous publications, awards and honors. Last year, this lecture was presented by Dr Jos Eggermont, At TRI-2023, this lecture was presented by Dr Jos Eggermont, Professor Emeritus, Departments of Physiology and Pharmacology, and Psychology at the University of Calgary, Alberta

As the recipient of this award, Dr Jastreboff has been invited to present this year’s lecture. The talk will focus on where Dr Jastreboff sees the future of tinnitus research, based on his own pioneering work on the Neurophysiological Model of Tinnitus and Tinnitus Retraining Therapy.

One Sentence Summary: The symposium will bring together experts from audiology, neuroscience, and psychology to discuss sound tolerance disorders of loudness hyperacusis and misophonia in the context of tinnitus.

Abstract: Sound tolerance disorders are often comorbid with tinnitus but are poorly understood and their impact on individuals with tinnitus is not well understood. Misophonia is a relatively newly-defined sound tolerance disorder consisting of intense emotional responses to specific sounds, or 'triggers' (Swedo et al., 2022). As a sound tolerance disorder, misophonia has a high comorbidity with tinnitus and hyperacusis (Aazh et al., 2022). In this panel, several experts spanning audiology, neuroscience, and behavioral psychology will moderate discussion on the similarities between misophonia, tinnitus, and hyperacusis, clinical differentiation between these disorders, and currently identified underlying mechanisms.

One Sentence Summary: Speakers will present real-world clinical experience in implementing multimodal treatment for tinnitus.

Abstract: There is a rapid growth in combining various modalities for activating or modulating different networks in the brain for treating a range of neurological and psychiatric disorders. In tinnitus, multimodal treatment is not new. The efficacy of novel approaches which simultaneously activate multiple pathways to target relevant tinnitus circuits have been demonstrated in clinical trials, however, it is important to continue to investigate and collect data on these multimodal approaches as they transition into routine clinic practice and are utilized outside of the controlled environment of clinical studies. This session will provide insight into the effectiveness and safety of different multimodal approaches being implemented for tinnitus treatment during routine delivery of care, with new perspectives in treatment strategies, user customization, and patient experiences to improve therapeutic outcomes. Presentations will include discussions on leveraging different forms of transcranial electrical stimulation; the clinical implementation and outcomes of sound therapy and electrical body stimulation; the effects of non-invasive cortical stimulation and sound therapy; as well as understanding the impact of structured counselling and sound therapy on daily life.

Abstract: As in the clinic, it is important initially to connect with the patients and let them explain where they are at.  Before the connection, have them complete the Tinnitus Primary Functions Questionnaire to determine where they need help, and severity.   Online images can be used to help with the counseling, but the personal interaction is very important.

Abstract: There are differences when running a hearing aid versus a tinnitus audiology clinic. This presentation discusses how to address these differences; the requirements to provide successful and fruitful tinnitus care; and, the engagement with other healthcare providers, clients and prospective clients.

Abstract: Hyperacusis Research, Limited, inc. is a non-profit charity dedicated to the development of effective treatments for hyperacusis and to funding research which will eliminate the underlying mechanisms that cause hyperacusis. Our foundation is dedicated to improving the quality of life for patients who suffer from hyperacusis and hyperacusis related disorders. Central to the mission of our organization is facilitating and supporting biomedical research which will lead to novel and effective therapies for Hyperacusis. We also provide information to those individuals with Hyperacusis that may help with their understanding of this disorder through various websites and organizations affiliated with our cause. Throughout our existence we have partnered with the Hearing Health Foundation. Money raised by our organization has helped fund several scientific research projects which might one day lead us to an effective therapy. The purpose of this presentation at TRI 2024 is to familiarize the audience with our cause.

Abstract: In the Clinic, measuring tinnitus helps the patient understand it is real, and distinguishes the 1) Tinnitus from the 2) Reactions to Tinnitus (The Psychological Model). Loudness and pitch ratings are straightforward, and masking the tinnitus can be useful for directing sound therapy. The Tinnitus Primary Functions Questionnaire determines which areas are needed for counseling….1) Thoughts and Emotions, 2) Hearing, 3) Sleep and/or 4) Concentration, in Tinnitus Activities Treatment. There are many subtypes of tinnitus, that are evident when measuring masking, post-masking effects, and post-masking recovery. There is now a greater appreciation that there are different subgroups of tinnitus patients, and the careful selection of subgroups needed to be applied to drug and other treatment trials.

Panellists: Panel: Myrian Westcott, Fatima Husain, Julia Campbell, David Eddins, Sylvie Hébert

Publications about hyperacusis and other sound tolerance disorders have grown exponentially in the last decade. Unfortunately, the definitions, criteria, and tools for diagnosis and management are still scarce. In this round table, experts will share their experience with patients presenting with such symptoms and how they proceed to study, diagnose and manage them. Attendees will be invited to join the discussion and ask questions.

One Sentence Summary: The development of a new set of outcome measures – which are statistically rigorous, transparent, and reflect patient expectations – is required to meaningfully assess the success of tinnitus trials and interventions.

Abstract: Most clinical trials for tinnitus use the Tinnitus Functional Index (TFI) or Tinnitus Handicap Inventory (THI) to measure success. Both of these are standardized questionnaires taken at various points before, during, and after an intervention. But how reliable and valid are these metrics as outcome measures? What are the right and wrong applications of these metrics? And what do they truly represent in terms of patient outcomes in the real world? Specifically, some of the downsides of using the TFI/THI are: - From a statistical perspective, TFI/THI should be used to determine sample sizes, not necessarily to measure improvement. - Thresholds for 'clinical significance' do not reflect a sizable improvement and thus can lead to misleading communication and marketing of trial results. - Certain aspects of tinnitus that patients care about, such as the variability of one's tinnitus, are not reflected in the TFI/THI. - We know from patient engagement (e.g. surveys) that patients expect a tinnitus intervention to reduce the loudness of their tinnitus. Continuing use of the TFI/THI, which mostly reflect distress, detracts from the need to target and measure loudness reduction. - It is questionable, overall, whether TFI/THI meaningfully reflect patient improvement, vis-à-vis for instance simply asking the patient "how much did this intervention help you?" In sum, the development of a new set of outcome measures is required to meaningfully assess the success of tinnitus trials and interventions. These outcome measures need to be statistically rigorous, transparent, and reflect patient expectations.

Abstract: Traditional evidence-based approaches have so far failed to develop any FDA or CE approved treatments after many years of tinnitus research. Thus, a new strategy is required.

Can we learn from the concept of war to develop better tinnitus treatments? In combined arms warfare the complementary strengths of the air force, ground troops and navy are used in concert to exert a maximal effect. Translating combined arms tactics to tinnitus we should adapt a multimodal approach. This means combining different ways to attack tinnitus, a combination of auditory, pharmacological, neuromodulatory, and psychology approaches, rather than limiting oneself to a unimodal approach. And within each modality multiple approaches may be combined, for example medication cocktails, hearing aids plus sound therapy, electrical stimulation combined with magnetic plus light-based neuromodulation. The pharmacological approach has been proven highly successful in fighting AIDS. By using 4 different drugs that each work on a different mechanism survival has increased from 5 years with 1 drug, to 20 years with 2, 40 with 3 and a normal life expectancy with 4 drugs.

The war on tinnitus concept leads to many novel multimodal treatment possibilities that need to be explored scientifically and clinically, in order to finally silence tinnitus.

Abstract (Arnaud Norena): In this presentation, I will present the hypothesis, as well as the data collected in patients, suggesting that the middle ear (especially the middle ear muscles) and the multimodal plasticity can account for specific sub- types of tinnitus and hyperacusis.  I will also present the tools and approaches that can be used to assess the middle ear function, including a sensor pressure device that we have developed to objectify the tensor tympani contraction.

Abstract (Myriam Westcott): I will present a clinical perspective with case studies on the role of Tensor Tympani Syndrome (TTS) in hyperacusis and tinnitus patients. TTS symptoms have been associated with acoustic shock, are prevalent in most hyperacusis patients but also in tinnitus patients, and can frequently be sound-induced. The presentation, evaluation and effective treatment of TTS symptoms in a clinical setting has revealed insights into TTS triggers, the underlying somatic, neurological and psychological pathways and more broadly into hyperacusis mechanisms and tinnitus reactivity. This highlights the importance of TTS diagnosis and treatment, and the therapeutic benefit of identifying and demystifying the associated pathways.

Summary: Individuals with tinnitus often report that their tinnitus has been triggered by stress or that it is modulated by it. The evidence supporting these self-reports, however, is not very strong. In this talk, I will present an overview of the study findings on stress and tinnitus. More specifically, I will concentrate on the physiological correlates of stress, that is, the Hypothalamic-Pituitary-adrenal axis (HPA) and the Autonomic Nervous System. I will also present some new work from the laboratory that aims to expand the way the relationship between stress and tinnitus is studied

Abstract: This workshop will summarize the foundation and method of misophonia treatment in conjunction with tinnitus based on the neurophysiological model of tinnitus.  General rules of an assessment, main points explained to patients and everyday challenges to consider in the treatment of tinnitus, hyperacusis and misophonia will be discussed.

Abstract: Learn more about Neosensory's ground breaking bimodal solution for tinnitus as we dive into the latest research and clinical protocols as well as how to identify candidates, and to leverage all our solutions to treat hearing loss and tinnitus in a clinical setting.

One Sentence Summary: The symposium will bring together experts from audiology, neuroscience, and psychology to discuss sound tolerance disorders of loudness hyperacusis and misophonia in the context of tinnitus.

Abstract: Science shows us that several physical symptoms or dysfunctions may be present in patients with tinnitus. In this symposium, we aim to give a broad view of which physical symptoms might influence patients' tinnitus and how we can treat them. Because physical symptoms are very common, also in people without tinnitus, the second aim of this symposium is to give insight into the prevalence of a series of physical symptoms in a tinnitus population compared to the general population. Treatment of the cervical spine or temporomandibular area is possible in many different ways and can have a positive effect on tinnitus severity. Therefore, the third aim of this symposium is to give insight into different therapies that can be applied in patients with somatosensory tinnitus and to show the effectiveness of these therapies on patients' tinnitus severity. The other way around, we know several patients with somatosensory tinnitus who were cured of their tinnitus after cervical spine or temporomandibular treatment. The final goal of this symposium is to present the characteristics of these patients and the type of treatment that provided succor.

Abstract: Oticon has been at the forefront of integrating tinnitus sound support into its diverse range of hearing aid models since 2014. This workshop aims to illuminate the advanced features embedded within Oticon's Tinnitus Sound Support. Participants will also gain insight into the comprehensive suite of resources developed to empower both clinicians and patients in the effective management of tinnitus. This workshop will explore Tinnitus Sound Support in the Genie 2.0 programming software. Attendees will receive guidance in navigating the software's capabilities, specifically focusing on the customization of tinnitus relief sounds. With four broadband noises and three calming, ocean-like sounds, clinicians can fine-tune these options to suit the individual needs of each patient, fostering a personalized and effective intervention for ear-level sound support. There will also be a demonstration of Oticon's innovative Companion App, which puts some control directly in the hands of users. Participants will discover how this user-friendly app enables real-time adjustments, providing individuals with the flexibility to tailor their tinnitus relief sounds on the go. By the end of this workshop, participants will leave with a deepened understanding of Oticon's Tinnitus Sound Support, proficiency in using the Genie 2.0 programming software, and insights into leveraging the Companion App for enhanced user experiences. They will also be provided hardcopies of clinician and patient tinnitus management resources. Oticon's commitment to empowering clinicians and patients in the realm of tinnitus management will be evident through this engaging and informative session.

Abstract: Tinnitus, a common global health issue affecting life quality and mental well-being, has a new solution: Lenire. This at-home device, the first to receive FDA approval for tinnitus treatment, uses bimodal neuromodulation to alleviate symptoms. Following a large-scale, FDA-compliant clinical trial where 83% of participants recommended it, Lenire has shown consistent positive outcomes in both clinical and real-world settings, marking a significant advancement in tinnitus treatment.

Summary: Since 1971, ATA has been dedicated to raising awareness of tinnitus patient struggles and improving patient outcomes by funding research and improving access to healthcare professionals proficient in tinnitus management. This presentation delves into ATA research grant opportunities for investigators pioneering novel research areas, and resources for clinicians seeking to improve their clinical expertise in tinnitus patient care.

Panellists: TBA

Since tinnitus is a symptom that can arise from different etiologies (e.g., noise trauma, aging, brain injury), in this session experts will discuss whether there is enough evidence to distinguish subtypes of tinnitus, and why it would be wise to do so. Different point of views from both clinicians and researchers will be presented and the attendees will be invited to join the discussion and ask questions.