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Objectives: Radiofrequency Ablation (RFA) is a widely used technique for treatment of nasal obstruction due to inferior turbinate hypertrophy. This study aims to evaluate short and long-term outcome after RFA. Secondly, predictive factors for this outcome were evaluated. Methods: A prospective clinical study was performed in 65 patients to evaluate short-term outcome and predictive factors (Study A). To evaluate long-term outcome and predictive factors we performed a second clinical study in 124 patients (Study B). Patients scored nasal symptoms on a 1 to 5 points visual analogue scale (VAS) and filled in questionnaires about their comorbidity, previous nasal surgery, and medication use. Results: Study A : There was significant short-term (6-8 weeks after RFA) improvement in nasal obstruction (VAS −1.3, P <.001), trouble exercising (VAS −1.5, P <.001), trouble sleeping (VAS −0.9, P <.001), snoring (VAS −1.1, P <.001), and hyposmia (VAS −0.6, P =.004). Smoking (R 2 =.065, P =.047) was a predictor for less optimized and previous use of decongestive nasal spray (R 2 =.135, P =.005) for better short-term outcome. Study B : Nasal obstruction significantly decreased in the long term (1-5 years after RFA) compared to VAS before RFA (VAS −1.5, P <.001), but slightly increased compared to VAS 6 to 8 weeks after RFA (VAS +0.3, P =.036). Allergy (R 2 =.066, P =.006), asthma (R 2 =.068, P =.005), and previous use of corticosteroid nasal spray (R 2 =.050, P =.016) were associated with a less optimized and older age (R 2 =.217, P <.001) with better long-term outcome. Conclusion: RFA is an efficient treatment for nasal obstruction, and improves sleeping, exercising, snoring, and hyposmia. Predictors for good short-term outcome were previous use of decongestive nasal spray and no smoking. Predictors for a less optimized long-term outcome were allergy, asthma, and previous use of corticosteroid nasal spray. Older age was associated with better long-term outcome. [ABSTRACT FROM AUTHOR]

Background: Chronic tinnitus can have an immense impact on quality of life. Despite recent treatment advances, many tinnitus patients remain refractory to them. Preclinical and clinical evidence suggests that deep brain stimulation (DBS) is a promising treatment to suppress tinnitus. In rats, it has been shown in multiple regions of the auditory pathway that DBS can have an alleviating effect on tinnitus. The thalamic medial geniculate body (MGB) takes a key position in the tinnitus network, shows pathophysiological hallmarks of tinnitus, and is readily accessible using stereotaxy. Here, a protocol is described to evaluate the safety and test the therapeutic effects of DBS in the MGB in severe tinnitus sufferers. Methods: Bilateral DBS of the MGB will be applied in a future study in six patients with severe and refractory tinnitus. A double-blinded, randomized 2 × 2 crossover design (stimulation ON and OFF) will be applied, followed by a period of six months of open-label follow-up. The primary focus is to assess safety and feasibility (acceptability). Secondary outcomes assess a potential treatment effect and include tinnitus severity measured by the Tinnitus Functional Index (TFI), tinnitus loudness and distress, hearing, cognitive and psychological functions, quality of life, and neurophysiological characteristics. Discussion: This protocol carefully balances risks and benefits and takes ethical considerations into account. This study will explore the safety and feasibility of DBS in severe refractory tinnitus, through extensive assessment of clinical and neurophysiological outcome measures. Additionally, important insights into the underlying mechanism of tinnitus and hearing function might be revealed. Trial registration: ClinicalTrials.gov NCT03976908 (6 June 2019). [ABSTRACT FROM AUTHOR]

Background: Tinnitus is a disorder of the nervous system that cannot be adequately treated with current therapies. The effect of neuromodulation induced by deep brain stimulation (DBS) on tinnitus has not been studied well. This study investigated the effect of DBS on tinnitus by use of a multicenter questionnaire study. Methods: Tinnitus was retrospectively assessed prior to DBS and at the current situation (with DBS). From the 685 questionnaires, 443 were returned. A control group was one-to-one matched to DBS patients who had tinnitus before DBS (n = 61). Tinnitus was assessed by the tinnitus handicap inventory (THI) and visual analog scales (VAS) of loudness and burden. Results: The THI decreased significantly during DBS compared to the situation prior to surgery (from 18.9 to 15.1, P < .001), which was only significant for DBS in the subthalamic nucleus (STN). The THI in the control group (36.9 to 35.5, P = 0.50) and other DBS targets did not change. The VAS loudness increased in the control group (5.4 to 6.0 P < .01). Conclusion: DBS might have a modulatory effect on tinnitus. Our study suggests that DBS of the STN may have a beneficial effect on tinnitus, but most likely other nuclei linked to the tinnitus circuitry might be even more effective [ABSTRACT FROM AUTHOR]

Tinnitus is the perception of a "phantom sound" and has a high prevalence. Although many therapies have been investigated within the last decades, there is still no effective standard therapy. Animal studies and human functional imaging studies revealed that tinnitus perception is associated with many complex changes in multiple brain structures. There is growing evidence that brain stimulation might be able to interrupt the local altered neuronal activity and hereby inhibit tinnitus perception. In this editorial review, an update is given on the most promising targets for brain stimulation. Promising structures for stimulation are the dorsal cochlear nucleus, the inferior colliculus and the medial geniculate body of the thalamus. For cortical stimulation, the auditory cortex is considered as a target. Nevertheless, the field is waiting for evidence from well-designed clinical trials, based on supporting evidence from experimental/mechanistic research, to support or discourage the application of brain stimulation in tinnitus. [ABSTRACT FROM AUTHOR]

Introduction: Tinnitus can be a disabling symptom, as it can lead to insomnia, anxiety, depression and even suicide in severe cases. Currently, there is no effective standard therapy. Neuromodulation is a promising treatment modality in tinnitus, especially for chronic and severe cases. Although the exact neural substrate for tinnitus is unconfirmed, multiple animal and human imaging studies related tinnitus to hyperactivity and hypersynchrony within auditory brain structures. Objectives: We hypothesized that high-frequency stimulation (HFS) of the central auditory pathway will influence abnormal tinnitus related neuronal activity and hereby disrupt tinnitus perception. Here, we assessed the effect of deep brain stimulation (DBS) of either the dorsal cochlear nucleus (DCN), inferior colliculus (IC) or medial geniculate body (MGB) in a rat model of chronic noise-induced tinnitus. Materials and Methods: A within-subject design was used in order to minimize the number of animals and reduce the error variance. A total of 30 male Sprague Dawley rats were assigned to three target groups: DCN, IC and MGB and underwent bilateral DBS electrodes implantation at the start of the experiment. Tinnitus was induced by unilateral noise exposure. Hearing thresholds were determined before and after noise trauma by measurements of auditory brainstem responses. Gap-induced pre-pulse inhibition of the acoustic startle response (GPIAS) testing was used to assess presence of tinnitus during four main conditions: 1) baseline DBS off, 2) baseline DBS on, 3) post noise trauma DBS off and 4) post noise trauma DBS on. Standard stimulation was HFS and two additional stimulation paradigms were tested after tinnitus induction in all subjects of the MGB group, namely after HFS (DBS off after 30 minutes of HFS) and during low-frequency stimulation (LFS). Anxiety-related side effects of HFS were evaluated in the elevated zero maze and open field. Results: ABR measurements demonstrated preserved hearing thresholds of the side that was protected from noise trauma. GPIAS for tinnitus assessment showed a significant chronic tinnitus development after noise-trauma at the 16 kHz and 20 kHz frequency bands. HFS did not lead to a change in gap:no-gap ratios at baseline, but caused a significant decrease of the gap:no-gap ratios of 16 kHz and 20 kHz after tinnitus induction in all targets. In the MGB group, a persistent effect on tinnitus suppression was found directly after HFS was turned off, but no effect was found of LFS on the gap:no-gap ratios of the acoustic startle response. No anxiety-related side effects were found during DBS. Conclusion: These results suggest that neuronal hyperactivity in the auditory pathway can be normalized with HFS in different levels of the auditory pathway. Optimal stimulation parameters need to be investigated, as well as the effect of stimulation on hearing function. Clinically, compared to the DCN and IC, the MGB would be best accessible with stereotaxy and might therefore be an applicable DBS target if an invasive treatment is considered in severe and refractory tinnitus patients. [ABSTRACT FROM AUTHOR]

Tinnitus is a common condition with great variability in the intensity of symptomatology. In recent years, more and more insights have been gained into the mechanism of tinnitus and its relationship with hearing loss and other factors such as stress. Depending on the symptoms and clinical findings, a patient may be referred to an ENT specialist or audiologist. For the majority of patients, re-assurance and providing good information is sufficient. For others improving hearing and possibly cognitive behavioral therapy remains the most important pillars for treatment of tinnitus. A number of experimental treatments are currently underway which offer hope for the future.