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Objectives The goal of this study was to compare treatment outcomes for chronic bothersome tinnitus after Tinnitus Retraining Therapy (TRT) versus standard of care treatment (SC) and to determine the longevity of the effect over an 18-month period. Study Design A randomized controlled trial comparing TRT to SC for chronic tinnitus. Methods Adults with subjective, stable, bothersome chronic tinnitus associated with hearing loss amenable to aural rehabilitation with hearing aids were recruited. The Tinnitus Handicap Inventory (THI) was the primary outcome measure and the Tinnitus Functional Index (TFI) the secondary outcome measure of tinnitus severity and impact. Data were collected at screening, entry (0 months), and 6, 12, and 18 months after the beginning of treatment, using an integrated digitized suite of evaluation modules. TRT consisted of directive counseling and acoustic enrichment using combination hearing aids and sound generators; SC consisted of general aural rehabilitation counseling and hearing aids. Results Significant improvement in tinnitus impact occurred after both TRT and SC therapy, with a larger treatment effect obtained in the TRT group. Lasting therapeutic benefit was evident at 18 months in both groups. THI initial scores were unstable in 10% of enrolled participants, showing moderate bidirectional fluctuation between screening and baseline (0 month) assessment. Conclusion Adults with moderate to severe tinnitus and hearing loss amenable to amplification, benefit from either TRT or SC treatment when combined with hearing aid use. TRT benefit may exceed that of SC. The global improvement in tinnitus severity that accrued over an 18-month period appeared to be robust and clinically significant. Level of Evidence I [ABSTRACT FROM AUTHOR]

Tinnitus is an auditory percept without an environmental acoustic correlate. Contemporary tinnitus models hypothesize tinnitus to be a consequence of maladaptive plasticity-induced disturbance of excitation-inhibition homeostasis, possibly convergent onmedial geniculate body (MGB, auditory thalamus) and related neuronal networks. The MGB is an obligate acoustic relay in a unique position to gate auditory signals to higher-order auditory and limbic centres. Tinnitus-related maladaptive plastic changes of MGB-related neuronal networks may affect the gating function of MGB and enhance gain in central auditory and non-auditory neuronal networks, resulting in tinnitus. The present study examined the discharge properties of MGB neurons in the sound-exposure gap inhibition animal model of tinnitus. MGB single unit responses were obtained from awake unexposed controls and sound-exposed adult rats with behavioural evidence of tinnitus. MGB units in animals with tinnitus exhibited enhanced spontaneous firing, altered burst properties and increased rate-level function slope when driven by broadband noise and tones at the unit's characteristic frequency. Elevated patterns of neuronal activity and altered bursting showed a significant positive correlation with animals' tinnitus scores. Altered activity of MGB neurons revealed additional features of auditory system plasticity associated with tinnitus, whichmay provide a testable assay for future therapeutic and diagnostic development. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: This study evaluated the effectiveness of gabapentin in treating chronic tinnitus in two populations: participants with tinnitus with associated acoustic trauma and participants with tinnitus without associated acoustic trauma. The hypothesis was that gabapentin would decrease both subjective and objective features of tinnitus in the trauma group but would be less effective in the nontrauma group., Study Design: Prospective, placebo-controlled, single-blind clinical trial., Methods: Pure-tone audiograms and personal histories were used to categorize tinnitus etiology as either secondary to acoustic trauma or not associated with acoustic trauma. Participants were restricted to those with moderate to severe tinnitus for at least 1 year. All participants received gabapentin in a graduated ascending-descending dose series extending over 20 weeks (peak dose of 2,400 mg/d)., Results: There was a significant improvement in tinnitus annoyance for the trauma group (P = .05). Other subjective aspects of tinnitus were not significantly affected in either group. Between-subject variability of therapeutic response was considerable. Nevertheless, in consideration of subjective loudness ratings, 4 of 19 nontrauma participants and 6 of 20 trauma participants showed an improvement of 20% or better. In consideration of psychoacoustic loudness estimates, 3 of 19 nontrauma and 6 of 20 trauma participants showed an improvement of 20 dB HL or greater. Evenly dividing each group into high and low responders revealed significant improvement in loudness at 1,800 and 2,400 mg/day for the trauma high-response subgroup (P = .007). No significant improvement was obtained for other subgroups., Conclusion: Gabapentin is effective in reducing subjective and objective aspects of tinnitus in some individuals, with the best therapeutic response obtained in individuals with associated acoustic trauma.