Translational Research IBimodal Neuromodulation for Tinnitus Treatment About 10-15% of the population suffers from bothersome or debilitating tinnitus, a phantom sound condition coded within the brain. The only clinically recommended treatment for tinnitus based on current clinical guidelines is cognitive behavioral therapy, with increasing evidence for similar types of psychotherapy approaches that can lead to long term benefit of symptoms. Sound therapy approaches can provide benefit to some tinnitus sufferers. The main advantage of sound devices is that they are easy to implement and accessible, unlike psychotherapy approaches that can take many months to be effective; however, sound methods typically have transient therapeutic effects and are still not sufficiently effective for many individuals. An emerging approach that can provide long-term benefit of tinnitus symptoms in an accessible way is bimodal neuromodulation, which combines sound therapy with electrical stimulation of the body (e.g., tongue, ear, neck or face regions). One proposed mechanism of action of how bimodal neuromodulation treats tinnitus is based on Pavlovian conditioning or the concept of paired plasticity. Sound therapy can mask or interfere with the tinnitus percept or enable temporary habituation to the tinnitus symptoms. Electrical body stimulation can amplify or enhance the benefits of sound therapy by reinforcing their therapeutic effects through paired plasticity that can drive potentially long-term changes in the brain. There have been five separate groups across three countries that have consistently demonstrated the ability to reduce tinnitus symptoms with bimodal neuromodulation that can have lasting benefit from several weeks to one year after treatment has stopped; these benefits have shown to be greater and longer lasting compared to what has been observed for sound only approaches in animal and human studies. There are several large-scale randomized clinical trials that have been or are currently being performed to validate bimodal neuromodulation for the treatment of tinnitus that are paving the way towards building acceptance and confidence for this emerging approach, as well as recent real-world data supporting successful integration of bimodal neuromodulation into a clinical setting.
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