Surgical brain modulation for tinnitus: the past, present and future

Area of Science:

• Neurology
• Neurosurgery
• Auditory Neuroscience

Background:

• Tinnitus, often an auditory phantom phenomenon, shares mechanisms with chronic pain.
• Traditionally managed by ENT specialists, its brain-based nature now involves neurologists and neurosurgeons.
• Understanding tinnitus benefits from insights into the somatosensory (pain) system.

Purpose of the Study:

• To review neuromodulatory treatments for tinnitus, integrating literature with single-center invasive neuromodulation experiences.
• To compare tinnitus neuromodulation with treatments for chronic pain syndromes.
• To outline past, present, and future functional neurosurgical approaches for tinnitus.

Main Methods:

• Literature review of neuromodulatory approaches for tinnitus.
• Analysis of single-center experience with invasive neuromodulation.
• Comparison with neuromodulatory treatments for chronic pain.

Main Results:

• Past treatments included destructive procedures like lobotomies.
• Current neurostimulation trials target auditory cortex, frontal cortex, thalamus, and amygdalohippocampus, with suppression rates from 10-70%.
• Promising future targets include anterior cingulate, MGB, PAG/TLC, dorsal cochlear nucleus, C2, and trigeminal nerve.

Conclusions:

• Tinnitus neuromodulation is conceptually similar to pain management for neurosurgeons and pain physicians.
• A multidisciplinary approach is recommended for tinnitus management.
• Further investment in neuromodulation for tinnitus is warranted due to its prevalence and impact.