Neuromodulation for tinnitus treatment: an overview of invasive and non-invasive techniques

Abstract

Tinnitus is defined as a perception of sound without any external sound source. Chronic tinnitus is a frequent condition that can affect the quality of life. So far, no causal cure for tinnitus has been documented, and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus’ impact on the quality of life. Neuromodulation, a novel therapeutic modality, which aims at alternating nerve activity through a targeted delivery of a stimulus, has emerged as a potential option in tinnitus treatment. This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options. The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine. Non-invasive methods such as repetitive transcranial magnetic stimulation, transcranial electrical stimulation, neurofeedback, and transcutaneous vagus nerve stimulation were included, as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation. Some of these neuromodulation techniques revealed promising results; nevertheless, further research is needed, especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce. Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus. Therefore, in the future, individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.

概 要

耳鸣被定义为非外部声音产生的听觉感知, 慢性耳鸣是一种影响生活质量的常见病症。 目前为止, 尚无任何针对耳鸣诱因的治疗方法, 大部分的药理和心理治疗方法都旨在减少耳鸣对生活 质量的影响。 神经调节是一种新型的治疗方式, 该方法通过定向刺激来改变神经活动, 已经成为耳鸣治疗的一个潜在选择。 本文就当前神经调节技术治疗耳鸣做了简要概述, 主要目的是为相关人士提供更新的知识介绍, 特别是在这个新兴医学领域的专业工作者。 本文介绍了包括经颅磁重复刺激、 经颅电刺激、 神经反馈和经皮迷走神经刺激等非侵入性方法, 以及植入的迷走神经刺激和侵入性脑刺激等侵入性方法。 虽然一些研究已经展示了神经调节技术的良好应用前景, 但是相关的研究还需要加强, 尤其是关于神经调节的病理生理学原理, 即这些神经调节技术如何发挥作用以及神经调节所引起的神经元变化。 多项研究表明, 不同个体的大脑活动状态和神经连接网络都参与了对耳鸣的产生和感知。 因此, 未来个性化定制的神经调节策略可能是一个有前景的耳鸣治疗方法, 从而更显著、 更持久地改善这个常见病症状。