 |
|||||||||||||||
 |
|
 |
|||||||||||||
 |
|||||||||||||||
 |
|||||||||||||||
|
Therapeutic Prolonged Residual Inhibition Of Tinnitus Following An Acoustic Masking Signal: Preliminary Results And Possible Mechanisms.
Dr Peter Winkler MB, BS, FRCS, FRACS, FAICD. ( This paper was published at the IXth International Tinnitus Seminars in Goteborg Sweden in June 2008 and then at Frontiers in Otolaryngology in Australia where it won a poster prize. ) Introduction. A series of digitally synthesised low frequency complex acoustic waveforms (TIPA) has been engineered to specifically produce prolonged residual inhibition (RI) of tinnitus. The sounds were developed during a 5 year search using trial and error on patient volunteers in the author’s solo E.N.T. Specialist practice. Methods. TIPA is a series of 3 complex sounds played in a sequence lasting for 12 minutes. The patient listens to the sound using conventional high definition headphones. The sound is delivered to the patient at the minimum masking level and the same sound is used irrespective of tinnitus pitch. When the sound ceases the patient assesses the tinnitus loudness on a scale of 1 to 10 with 10 being the loudness of the tinnitus before the masking signal. The RI is recorded as the amount of reduction of tinnitus loudness. Thus RI of 100% means that the tinnitus is completely absent i.e. complete RI. This method is used as there is some confusion in the literature quantifying partial RI. The patient is then followed up to determine the duration of the RI. 20 patients with severe longstanding unremitting tinnitus, unresponsive to previous treatment were selected in order of presentation to the clinic for this trial. Results. It was decided that a minimum therapeutically useful response is 50% RI lasting more than 3 hours after a 12 minute signal exposure. This would be sufficient to provide sleep without tinnitus disturbance. Of the 20 patients, 11 experienced RI better than the minimum therapeutic level. The results were: 2 patients had 100 % RI for 24 hours; 3 patients had 100% for 12 hours; 1 had 100% for 4 hours; 2 had 70% for 4 hours and 1 each had 80% for 7 hours, 50% for 12 hours and 50% for 7 hours (Fig1). One of these patients demonstrated potentiation of RI by a second masker presentation while still experiencing 100% RI. This produced continuous 100% RI for 5 consecutive days using a daily 12 minute signal. Patients subsequently treated with repeated exposures to TIPA are demonstrating significant cumulation of effect. One very severe sufferer developed 60% RI for 6 consecutive days with no further signal exposure 2 months after commencing treatment. Discussion. Although Residual Inhibition is a common phenomenon it has remained a clinical curiosity due to its short action. There is no real understanding of its mechanism. The patient responses to TIPA, particularly the consistency of duration and potentiation by a second masker make it very tempting to postulate that a neurotransmitter is involved. There is also evidence of a synergistic action between differing wave forms and frequencies. However the duration of RI after TIPA is so long that a chemical mediator would need to be of a neurotrophic type rather than a conventional transmitter. Neurotrophic factors are considered to have actions involving functional plasticity of the nervous system. Delayed onset of RI in the acoustic neuroma patient below suggest that a trophic factor may may be involved. A 50 year old male with unilateral tinnitus and normal hearing was treated with TIPA. He experienced initial 30% RI for 5 hours and then suddenly developed 100% RI 24 hours later which lasted 7 hours. He produced the same result on a second test. This is extremely unusual as RI is invariably maximum immediately upon cessation of the masker. His routine MRI then found a 5mm ipsilateral intracanalicular acoustic neuroma which was treated expectantly. This delay of RI parallels the delay of ABR in acoustic neuroma and suggests the possibility of an inhibitory transmitter traveling along the auditory nerve. Conclusion. The concept that RI can be successfully prolonged by modifying the waveforms and frequencies of the acoustic masking signal is novel. The TIPA signal is now being used to treat tinnitus patients and preliminary results of repeated use are showing cumulative effects and increased duration of the reduction in tinnitus loudness. TIPA is a registered trademark and patented. --------------------------------------------------------------------------------------------------------- The following paper was published at the Third International Tinnitus Seminars in Stresa Italy in June 2009. EARLY EXPERIENCES WITH THE TIPA TINNITUS DEVICE. Dr Peter Winkler MB, BS, FRCS, FRACS, FAICD E.N.T. SURGEON. SYDNEY. AUSTRALIA. INTRODUCTION The TIPA Tinnitus Device is a hand held rechargeable battery powered player which produces the TIPA sound signal. This signal was first published at the IXth International Tinnitus Seminars in Sweden in April 2008. The TIPA signal is a series of complex, digitally engineered, non sinusoidal very low frequency sounds that have been found to produce prolonged residual inhibition in tinnitus patients. There are three different signals each lasting 3 minutes and are played in the sequence 1,2,1,3. Subjective clinical testing has shown that the sounds are synergistic in their ability to prolong residual inhibition (RI) if played in this order. This is an empirical observation and the underlying physiologic mechanisms are unknown. METHODS The TIPA signal was developed over a 5-year period using trial and error subjective testing in the author’s solo ENT practice. Patients who experienced RI on initial testing were supplied with the TIPA Device as soon as it received Australian regulatory approval. RESULTS Patient JL a 63-year-old farmer had constant unremitting, extremely disturbing tinnitus. His audiogram shows noise induced loss. Initially he experienced 12 hours of complete RI by using the signal morning and evening for 12 days. He continued to use the device and by March 2009 his complete RI would last 24 hours after a single 12-minute exposure at midday. As well as having his life vastly improved he also reported that his chronic headaches had disappeared. Patient LM a 77-year-old female retiree with presbyacusis and unremitting tinnitus achieves 3 hours of complete RI every night after a single 12-minute exposure to the device. She previously had sleep disturbance from her tinnitus but is now able to get to sleep while her tinnitus is absent. Patient MC a 45-year-old male health care worker has had constant unremitting bilateral tinnitus since he was a teenager and has a normal audiogram. He usually experiences complete RI from the TIPA Device lasting 48 hours, however using the device again before the tinnitus returned he was able to achieve a two-week tinnitus free period. He subsequently experienced 4 days of complete RI following a single TIPA signal. There is growing clinical experience from these patients that repeated use of the TIPA Device produces increasing levels of relief from the tinnitus. The RI produced by the TIPA Device appears to be cumulative with regular use. CONCLUSION The concept that digital manipulation of the spectrum of a masking signal can be of therapeutic benefit in tinnitus patients by prolonging residual inhibition is novel. The fact that a tinnitus patient can be improved by such a simple measure has changed patients’ lives. The response of patient JL constitutes a therapeutically induced full remission of severe tinnitus and the patient has provided a testimonial. A study is now being conducted to determine the incidence of this level of response in the tinnitus population. The testimonial can be seen on the website www.tipatinnitus.com |
 |
 |
|
 |
|
| Site Map |