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The University of Texas at Dallas

Pathophysiology-Based Treatments for Tinnitus

Tinnitus Talks: Pathophysiology-Based Treatments for Tinnitus

Tinnitus Talks are sponsored by the David Bruton, Jr. Endowed Lecture Series on Communication Disorders at the Callier Center, and UT Southwestern Medical Center's Department of Otolaryngology-Head and Neck Surgery.

Tuesday, May 13, 2014, 6:30 p.m. - 8:00 p.m.
Callier Dallas, 1966 Inwood Road, Dallas, TX 75235, Glorig Auditorium

Featured Speaker: Dirk De Ridder, MD, PhD
Dr. De Ridder leads the new University of Otago academic neurosurgery research unit and is one of the world leading researchers on tinnitus. He is the co-director of the Tinnitus Research Initiative Foundation and scientific advisor for the American Tinnitus Association. Read more

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Contact: Linda Sensibaugh at 214-905-3003 | Tinnitus Evaluation | Tinnitus Clinical Trial

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Program Description

Although much progress has been made, tinnitus remains a scientific and clinical enigma. The condition is very common, and, although many patients are not unduly troubled, others find the disorder life-changing. In this talk we outline current knowledge of tinnitus, and critically assess established and emerging treatment approaches. Read more

Program Objective:

As a result of this talk, participants will be able to:
1. Identify one reason 'why' the brain creates a false auditory percept in the absence of an external stimulus.
2. List two established treatment approaches.
3. List one new tinnitus treatment.

Program Agenda:

  • Welcome and opening remarks by Dr. Sven Vanneste
  • Why the brain creates a false auditory percept in the absence of an external stimulus, and how understanding this can benefit the development of new tinnitus treatments
  • Understanding the Bayesian brain concept
  • Understanding the deafferentation concept
  • What is neuromodulation?
  • Understanding phenomenology
  • Questions

Continuing Education: 1.5 TSHA CEUs

This program has been approved for 1.5 clock hours of continuing education credit by the Texas Speech-Language-Hearing Association (TSHA). TSHA approval does not imply endorsement of course content, specific products or clinical procedures.

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Pathophysiology-Based Treatments for Tinnitus

Non-pulsatile tinnitus can be the result of either of two mechanisms: a deficient noise-canceling mechanism or deafferentation, i.e. auditory deprivation. The question arises ‘why’ the brain creates a false auditory percept in the absence of an external stimulus, and how understanding this can benefit the development of new tinnitus treatments. The answer may reside in the Bayesian brain concept. The Bayesian brain can be conceptualized as a probability machine that constantly makes predictions about the world and then updates them based on what it receives from the senses. Deafferentation leads to topographically restricted prediction errors based on temporal or spatial incongruity. Removing the prediction can theoretically remove the prediction error, as is shown in rats. The deafferentation leads to an increase in topographically restricted uncertainty, which should be adaptively addressed by plastic repair mechanisms in the auditory cortex or via (para)hippocampal involvement depending on the salience of the missing auditory information. When the auditory deprivation arises in a salient period, e.g. when stressful, the lack of input becomes salient and a filling in mechanism ensures uncertainty reduction. In a non-stressful period the sensory deprivation might not be considered salient and therefore accepted without filling in. Thus a second form of treatment could target filling in the missing information, e.g. by using hearing aids, cochlear, brainstem or auditory cortex implants can sometimes be beneficial.

Neuroanatomically, filling in as a compensation for missing information also activates the anterior cingulate and insula, areas also involved in salience, stress and stimulus detection, which can be addressed by invasive and non-invasive neuromodulation.

Context, such as stress, can possibly influence both the noise-canceling mechanism and deafferentation induced plasticity, suggesting that Tinnitus Retraining Therapy or Cognitive Behavior Therapy may be beneficial via both pathways.

The phenomenologically unified percept of tinnitus can be considered an emergent property of multiple, parallel, dynamically changing and partially overlapping subnetworks, each with a specific spontaneous oscillatory pattern and functional connectivity signature. Communication between these different subnetworks is proposed to occur at hubs, brain areas that are involved in multiple subnetworks simultaneously. These hubs can take part in each separable subnetwork at different frequencies, and are ideal targets for invasive or non-invasive neuromodulation treatment. The frequency specificity permits to influence only one network while sparing the others, so that neuromodulation can be performed in a selective way.

Dirk De Ridder, MD, PhD

Dr. Dirk De Ridder leads the new University of Otago academic neurosurgery research unit and is one of the world leading researchers on tinnitus. He is the co-director of the Tinnitus Research Initiative Foundation and scientific advisor for the American Tinnitus Association. He developed the cutting edge technique of electrical auditory cortex stimulation for tinnitus. Dr. De Ridder is investigating tinnitus as a brain problem using neuroimaging techniques and non-invasive and invasive neuromodulatory interventions. He is co-editor of the most recent Textbook of Tinnitus, published by Springer, and has also published more than 150 research articles on tinnitus in key scientific journals.

Dirk De Ridder

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Tinnitus Resources

For tinnitus evaluations: Callier Center Tinnitus and Hyperacusis Evaluation

To participate in a research study: The Dallas Clinical Trial on Vagus Nerve Stimulation for the Treatment of Tinnitus