Journal Reading: "Direct Current Stimulation of The Ear in Tinnitus Treatment: A Double-Blind Placebo-Controlled Study"

JOURNAL READING
Direct current stimulation of the ear in tinnitus

treatment: a double-blind placebo-controlled study
Marzena Mielczarek Jurek Olszewski
PRESENTED BY
RULLY SYAHRIZAL AKHMAD
NEVA ALFIRA
RAHMAT ZAKKY MAULANA
YUSDANI
PRECEPTOR
Dr. dr. Ahmad Rofii, Sp. THT KL
ABSTRACT
The objectives of the study are assessment of the influence of
direct current electrical stimulations of the ear in tinnitus
treatment, comparison of the results with placebo group and
evaluation of hearing after electrical stimulations.
The study comprised 120 tinnitus and sensorineural hearing loss
patients
The application of direct current electrical stimulation of the
hearing organ, with current frequencies similar to tinnitus
requencies (selective electrical stimulation), was an efficient
method in severe tinnitus treatment.
Keyword : Tinnitus, Electrical stimulation , Direct current ,

Placebo
INTRODUCTION
Subjective tinnitus is defined as a phantom perception of sound
with the absence of external stimulation.
Despite intense, advanced research conducted all over the world,
the factor directly responsible for subjective tinnitus perception is
still not clear.
On the basis of functional MRI is known that this perception is not
only purely auditory phenomenon but also limbic-related central
nervous system areas take part
Since its etiology is unclear and taking into account the
heterogeneity of the tinnitus patients group, there is still no
satisfactory method of treatment.
INTRODUCTION, contd
Furthermore, cognitive-behavioral therapy or different
forms of stimulations (acoustic or electrical) have most
promising effects
Numerous hypotheses on the etiology of tinnitus may
suggest that there is no single mechanism of its onset.
In many cases cochlea is an ignition site of tinnitus. That
is why, in patients with tinnitus and a cochlear hearing
loss (tinnitus spectrum often overlaps with the area of
hearing loss) electrical stimulation (e.s.) can be applied
as a treatment
MATERIALS AND METHODS
Study design: a double-blind placebo-controlled study.
The study comprised 120 patients suffering from
tinnitus and sensorineural hearing loss (n = 184 tinnitus
ears) divided into two groups.
TREATED WITH E.S. OF SUBJECTED TO

THE HEARING ORGAN. PLACEBO E.S.
(n = 119 tinnitus ears (n = 65 tinnitus ears

80 tinnitus patients 40 tinnitus patients
38 females and 42 24 females
males) and 16 males),
The group one was created by first 80 patients admitted to
department to diagnose and treat tinnitus. Group two was created
by the following 40 patients.
In order to decrease potential heterogeneity of the groups only the
patients with tinnitus duration longer than 1 year, as well as with
accompanying hearing loss, were qualified to present research.
Before the beginning of the therapy, we conducted the ENT
examination, hearing tests (pure tone audiometry, speech
audiometry, impedance audiometry, auditory brainstem responses,
otoacoustic emissions) and radiological diagnosticsif necessary
(head and cervical spine computer tomography/nuclear magnetic
resonance)
The patients completed questionnaires (designed by the authors
based on the Tinnitus Handicap Inventory) involving 20 questions
concerning tinnitus.
The maximum score was 40, which meant that tinnitus is an
enormous problem. On the other hand, receiving 0 points meant
that tinnitus is not a disturbing ailment.
The person conducting hearing evaluation and administering the
questionnaires was unaware of the fact that e.s. Or placebo e.s. had
been provided.
E.s. was performed with the use of a custom-made
apparatus supplied with four batteries of 1.5 V. The
device has an on/off button, frequency and current
intensity buttons.
The external ear canal was filled with 0.9 % saline
solution.
The active, silver probe was immersed inside external
ear canal, avoiding contact with the skin of the canal.
The passive electrode was placed on the forehead after
skin abrasion with a suitable sterile abrasive electrode
paste and clean gauze.
The two electrodes were placed to obtain the transmission of the
current throughout the hypothetical plane (longitudinal axis) of
cochlea.
Direct rectangular, positive polarization current was applied via the
active electrode. The frequency of the current was equal to the
frequency of the rectangular impulse.
The duration of the rectangular pulse (the period) depended on
the frequency. For 250 Hz, one period lasted 4 min (2-min pulse
and 2-min pause). The voltage was constant and equals 3 V.
Evaluation of tinnitus and hearing (in pure tone audiometry) was
conducted before, directly after, 30 and 90 days after 15
applications of e.s. in groups one and two. Subjective assessment of
the results considered a case history and the questionnaire.
Change from permanent tinnitus (when patient reported to hear it
every day, all the day) to temporary tinnitus (when appeared
temporarily or the patient reported to have some periods without
tinnitus) was considered an improvement.
Regarding questionnaires, the increase in the total points (by at
least 20 %) was onsidered deterioration, whereas their decrease
an improvement.
Statistical testing for dependent (correlated) observations, we used
the Students t test for correlated samples (in case of both normal
distribution samples) or the Wilcoxon test (when at least one
sample had non-normal distribution), for independent
(uncorrelated) observations the MannWhitney U test (when at
least one sample had non-normal distribution).
RESULTS
recognized subjective and audiometric improvements of hearing (in pure
tone audiometry) in group one, at the end of the control period. After the
treatment, patients reported subjectively improved hearing in group one in
36 ears (30.2 %), in group two in 14 ears (21.5 %). No deterioration of
hearing was reported. In audiometric evaluation after the cycle of e.s. in
group one, statistically significant improvement of hearing was registered:
for frequencies between 1,000 and 4,000 Hz (by on average 4.35 dB).
There was no statistically significant deterioration of hearing in both
groups. At the end of the control period, the improvement of hearing
remained constant in group one
DISCUSSION
Skarzynski et al. and Bochenek et al. Proved the usefulness of non-
invasive alternative extratympanic ear canal e.s., as a test in
prediction of post-operative profits before cochlear implantation.
Tyler et al. summarize the state of the art knowledge of extra- and
intracochlear e.s. in tinnitus. The authors state that the optimal
parameters of stimulation are likely different
for different subjects
As far as an improvement is concerned, our outcomes are
comparable to the results of non-invasive e.s. Conducted by other
authors. The total number of tinnitus disappearance is more
apparent in presented research; however, the tendency to decrease
with time is observed.
Konopka in his study on the influence of direct current on the
hearing organ of guinea pigs demonstrated no pathologic effect on
auditory pathway based on the evaluation of summation potentials,
cochlear microphonics and auditory brainstem potentials.
CONCLUSSION
The application of direct current
electrical stimulation of the hearing organ,
with current frequencies similar to
tinnitus frequencies (selective electrical
stimulation), was an efficient method in
severe tinnitus treatment.
The Researchers did not observed a
harmful effect of direct currenton hearing
organ.
THANK YOU

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JOURNAL READING

Direct current stimulation of the ear in tinnitus

Marzena Mielczarek Jurek Olszewski

Keyword : Tinnitus, Electrical stimulation , Direct current ,

TREATED WITH E.S. OF SUBJECTED TO

(n = 119 tinnitus ears (n = 65 tinnitus ears

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