Sound Therapy Techniques As mentioned earlier, the treatment of tinnitus does not rely on one drug or one technique, but on a variety of methods, which the author here divides into two categories: one is the inheritance of traditional methods, and the other is the use of innovative techniques. In terms of the general trend of development, the traditional methods are not only not fading away, but becoming more vital; the new techniques seem to be promising, although they still need long-term practical verification and continuous improvement. First, the use of external sound to treat tinnitus, or masking, or sound therapy, has been around for more than 2,000 years, starting from Aristotle’s time. Objectively speaking, this seemingly clumsy and simple method of treatment has survived many challenges, but is still one of the few treatments available today that caters to a significant number of people with tinnitus. In terms of the sound sources used for tinnitus treatment, there are two categories: sound therapy based on various acoustic characteristics, including conventional masking therapy, low-intensity sound therapy (habituation therapy), low pitched sound treatment, HiSonic therapy, and white noise therapy. Clinical audiologists wish to take full advantage of the various intrinsic characteristics of sound and provide a variety of sounds that are rigorously acoustically treated to treat tinnitus, depending on the patient’s tinnitus condition. Some of these treatments are based on controlling the relationship between sound intensity and tinnitus intensity, such as Jack Vernon of the Oregon Hearing Center in the United States, who suggests a total masking approach in which the intensity of the stimulated sound masks the intensity of the patient’s tinnitus. Pawel Jastreboff of Emory University, USA. Some of them involve changing the frequency of the sound, etc. The results of the effectiveness and clinical validation of the above methods vary, with some studies suggesting between 50% and 70%. Unlike synthetic sound therapy methods, another method uses natural sounds to treat tinnitus, including music, etc. The most representative one is the “neuromonics tinnitus management” method introduced in Australia. Davis in Australia proposes a program based on personalized digital music signals for tinnitus treatment, which is implemented through a so-called Neuromonics Processor. It outputs different music signal sounds according to the clinical diagnosis of the tinnitus patient and is performed in steps according to different treatment stages. The key to this technology is the division of the entire physical therapy session into 5 stages: comprehensive testing, fitting and commissioning of the processor, pre-conditioned reflex training, active therapy and stabilization therapy. It basically follows the theory of combining the traditional acoustic masking method and the tinnitus habituation treatment method into one. Patients are usually required to use it for two hours a day for six months. In the pre-conditioning phase, the patient relies on masking to reduce the irritability of the tinnitus, mainly through the use of personality-designed musical sounds, which are effective for 2 months. In the active phase, the patient is treated with intermittent sound signals of reduced intensity to help him or her gradually adapt to the tinnitus and reduce the sensitivity to it (so-called tinnitus desensitization), which is usually done over a period of 4 months. Already 2,000 patients have been treated, with a claimed clinical effectiveness of over 65%. Modern technology is represented by the widespread use of digital technology. Although the basic principles of treating tinnitus with sound have not changed much over the years, the vocal body or the vehicle of sound has changed dramatically due to digital technology. In the early days, analog technology was mainly used to deliver the various therapeutic signals mentioned above. From the trend of the last decade or so, the hardware devices for tinnitus treatment have basically risen to digital devices. There are two types of sound therapy hardware that are widely used today. One is a tinnitus therapy device that is pre-programmed with various types of sound signals that can be used by the physician or patient, ranging from a masking device that resembles a canal hearing aid to a cassette tinnitus masking device that resembles an MP3, from a pre-programmed sound CD to a device that takes the form of various household objects, such as a tinnitus therapy sound player or a tinnitus therapy alarm clock. Another type of tinnitus treatment device is a custom-made device, which is a device tailored to the clinical diagnosis of the tinnitus patient and according to certain sound treatment principles. Such devices include the above-mentioned digital signal player for neuroacoustic therapy and the recently launched eMasker individual tinnitus therapy device developed by Microdee Digital Hearing and Speech Laboratory in Canada. It is reported that this device can be used in conjunction with the Hearnit Tinnitus Diagnostic Instrument to digitally input sound signals, whether synthetic or natural, that are proven to be effective for individual patients based on clinical tests. The eMasker allows patients to use these signals effectively at home or in other settings and receive treatment. The use of smartphones for tinnitus treatment is an inescapable topic when introducing the convergence of traditional methods and innovative technologies. Data shows that 1 billion smartphones were sold worldwide in 2009, of which 170 million were sold in China, and are growing at a rate of 7% per year. Apple App Store applications are now approaching 400,000 pieces, a significant portion of which are medical and health care software, including tinnitus treatment. According to my incomplete statistics, there are nearly 30 tinnitus therapy software available for iPhone or iPad, four of which are developed in China, including Tinnitus Manager, Sound Therapy, TinniTest and Tinnitus Little Dictionary, which have been downloaded and applied in dozens of countries around the world. When it comes to new technologies for sound therapy, I think the research at the University of Texas Institute for Behavioral and Brain Sciences is worth mentioning because this research is dedicated to eradicating tinnitus, not just rehabilitating it, which is significantly different from most current treatments. While studying the pathogenesis of tinnitus, Dr. Kolgaard of the University of Texas Graduate School of Behavioral and Brain Sciences found that point stimulation of the vagus nerve has some therapeutic effect, also in the laboratory, using signals of different frequencies and intensities to stimulate the vagus nerve in animals as a way to change the animal’s brain’s attention to tinnitus until it no longer perceives it at all. The initial success in the lab has given researchers greater hope. Dr. Kolgad has just received a $1.7 million research grant from the National Institutes of Health. A portion of the funds is being used to improve the vagus nerve stimulation signal and is expected to begin further experiments in patients; another portion is being used to develop specialized equipment for tinnitus treatment. To this end, the University of Texas has established a startup company dedicated to the development of a device for the treatment of tinnitus. The company, called MicroTransducer, is made up entirely of students and faculty from the university and hopes to use the University of Texas’ research to develop a device similar to a needle to stimulate the vagus nerve. Other sources of tinnitus treatment In addition to using sound as the primary treatment signal, there are other sources of therapy, such as low level laser therapy, transcranial magnetic stimulation (TMS) and microcurrent therapy. microcurrent therapy. Among the low level laser therapies, a technology that uses laser to treat tinnitus is entering clinical trials, and this device, called LaserHear, is effective for sensorineural hearing loss and tinnitus. work, emitting both red and green light, which can also be observed by the naked eye. The red laser is said to aid in the intracellular reduction of over-oxygenated blood flow and nutrients, and to induce the work of the cellular “power stations”, or mitochondria, which release ATP, an organic compound containing high-energy phosphate bonds. ATP and increased blood flow increase the metabolic rate at the cellular level, allowing cilia to reach their maximum regenerative potential, and may even stimulate new cell proliferation and inhibit apoptosis. ATP can be taken orally as a tablet or injected intramuscularly or intravenously as a solution. Based on these principles, the laser ear device attempts to improve cochlear blood flow by using light stimulation to increase ATP production. On the other hand, the green laser acts mainly at the neuronal level, where it helps to restore neurons, the eighth cranial nerve and the communication of information between the brain. The treatment is based on the hypothesis that if blood flow, ATP production and metabolic rate can be increased, neurons will be able to communicate more effectively with the brain, thus treating sensorineural hearing loss and tinnitus. Studies by the device manufacturer have shown that more than 50 patients have been treated with LaserHear, and both subjective and objective tests have shown good results, but a large number of clinical trials are needed to verify the final results. Another non-acoustic signal used to treat tinnitus is the magnetic signal. It is known that the world’s first transcranial magnetic stimulator was developed by Barker in 1985. The use of magnetic signals to stimulate nerves in the brain without attenuation through the skull is known as transcranial stimulation (TMS). Depending on the stimulation signal, there are three types of stimulation modes: single transcranial magnetic stimulation (sTMS), paired transcranial magnetic stimulation (pTMS), and repetitive transcranial magnetic stimulation (RTMS). TMS (repetitive transcranial magneticstimulation, rTMS). Transcranial repetitive stimulation has been used to treat psychiatric disorders, including depression, obsessive-compulsive disorder, and mania, and is approved by the U.S. FDA for the treatment of depression. The first use of this technique for tinnitus treatment began around 1993. As a new technique for the possible treatment of tinnitus, transcranial repetitive stimulation has recently continued to receive attention around the world, and research on it is being conducted intensively in China. However, current clinical results have been mixed, with some studies reporting a 50% effect and others finding a less than significant effect. A recent report published in the March 2011 edition of Otolaryngology-Head and Neck Surgery by the University of Washington Hearing Center shows that a total of 14 patients participated in a double-blind trial to verify the clinical effectiveness of transcranial low-frequency repetitive stimulation techniques. Over a two-week period, the investigators used low-frequency repetitive transcranial stimulation signals to treat tinnitus and then used the Tinnitus Disability Scale to verify the effectiveness of the treatment. The report showed no significant change after treatment, with patients feeling no significant effect and the mean score on the scale dropping by just one point. Of course, as mentioned earlier, transcranial stimulation is a new treatment method and its safety and efficacy need to be proven in a large number of trials. The above findings are not enough to rule out the feasibility of transcranial repetitive magnetic stimulation, and a longer period of time is needed to see if this technique has a future. Research and development of drugs for tinnitus In terms of drug therapy, despite the efforts of experts over the past decades, little has been achieved. The biological, chemical or Chinese medicines used to treat tinnitus have not been effective. Strictly speaking, there are no effective drugs available for tinnitus. However, this does not diminish the interest of the pharmaceutical industry in developing drugs to treat tinnitus. Data show that there are at least a dozen new tinnitus drugs in various stages of trials worldwide, some still in animal trials, others already in Phase II clinical trials, and some already in Phase III clinical trials with noteworthy results. For example, neramexane, an oral tinnitus drug developed by the German company Motz, has been in Phase III clinical trials since 2008. The results of a recently concluded randomized, double-blind clinical trial in the United States showed that the drug was effective in patients with moderate to severe tinnitus. The trial, completed in the United States, involved 431 tinnitus patients at doses ranging from 25 to 75 mg over a 16-week treatment period. During this period, the patients’ response was tested regularly every 4 weeks. When compared to the control group, the doses of 50-75 mg were effective and the drug was generally safe, although the results also showed that vertigo was a side effect of the drug. According to the international assessment of innovative medicines, this oral tinnitus drug received a new drug innovation value of 6 points and is classified as a pioneer drug. Apparently the aggressiveness in the development of new tinnitus drugs is related to the huge potential market, which is currently considered by the industry to be about RMB 3 to 4 billion. The patent for this drug was also filed in China as early as 2008 and was made public in August 2010. Meanwhile, natural plant-based medicines for tinnitus have been under development, such as the Chinese patent medicine Zuo Ci Wan for Deafness and Ginkgo biloba extract, which have been reported to have some therapeutic effects. Recently, the Italian pharmacological journal Panminerva Medica published the results of a study on a tinnitus treatment drug, a sap extracted from the bark of the French pine tree, which is known to improve blood circulation in the inner ear for the treatment of tinnitus. Obstructed blood flow is one of the causes of tinnitus. However, there are no effective drugs to solve these problems so far. However, according to experiments conducted by scientists at the University of Chieti-Pescara in Italy, they made a drug called Pycnogenol from pine bark sap, which was used to treat 82 patients with tinnitus. These patients were between the ages of 35 and 55 and suffered from tinnitus in only one ear, which is moderate. Diagnostic imaging showed that the tinnitus in these patients was, for the most part, due to blood vessel obstruction. In a 4-week controlled treatment trial, the patients’ inner ear microcirculation was somewhat improved and tinnitus symptoms were significantly reduced after taking the Pycnogenol drug. The results of the tinnitus questionnaire also confirmed the therapeutic effect of this drug. Hearing aids for tinnitus Hearing loss and tinnitus are very closely related, although the prevalence of tinnitus is higher than that of hearing loss, although 80% of patients with hearing loss also have varying degrees of tinnitus. Therefore, hearing aids have been used to treat tinnitus for many years. Recently, however, hearing aids for tinnitus treatment seem to have become mainstream. For example, with the popularity of open ear hearing aids, ear canal speaker hearing aids and deep canal hearing aids, tinnitus hearing aids have become an important part of the many clinical functions of hearing aids. Technically speaking, the essence is the integration of hearing aids and tinnitus maskers, and thanks to the high level of sophistication of digital technology, the functions of sound therapy have become even richer. For example, a Danish hearing aid company has introduced the Zen hearing aid with a built-in music playback function, which slowly plays music through the hearing aid to relax the patient and achieve therapeutic effects. Another Danish company has introduced Live hearing aids with a 17-band setting that plays a high-fidelity surround sound signal that can play different frequencies, equivalent to a tinnitus sound generator (TSG). Patients with tinnitus hearing loss can turn on this function to hear amplified sound and treat tinnitus at the same time. A German hearing aid company has also introduced a similarly functioning hearing aid, called Wave, which can be used for habituation therapy. If you ask a thousand people to describe what tinnitus sounds like, you will probably get a thousand different answers, not only because everyone feels differently, but also because the sound itself is unpredictable and difficult to define. This is one of the difficulties of tinnitus treatment. In fact, the previous presentations have clearly confirmed this point: there is no universal tinnitus solution for tinnitus, according to the American Academy of Audiology. Each method may be effective for some people, but it is difficult to spread. It will take a long time for both traditional and innovative techniques to be accepted by the majority of tinnitus patients. Happily, advances in science and technology have created possibilities, and locally successful treatment options may open a faster pathway for this, which is why audiologists are not passing up any opportunity to treat tinnitus.