TINNET as the next step in tinnitus research: Towards evidence-based medicine

The Tinnitus Research Initiative (TRI) has come a long way to bring tinnitus research from several scientific fields together. The European funded TINNET, 'Better Understanding the Heterogeneity of Tinnitus to Improve and Develop New Treatments', can be regarded as the next step. It aims at coordination and standardization in tinnitus research and the enlargement of an already existing database with results from clinical trials. This should lead to a statistically relevant basis for tinnitus research. It promises the opportunity of standardized processes to enable tailor-made assessment for individual patients.

“At the start of the TRI in 2006 as a private initiative, there was only little tinnitus research compared to the number of people suffering from it. This research was isolated and results remained within the separated domains of ENT, audiology, psychology, psychiatry, and etcetera”, Dr. Berthold Langguth, head of the tinnitus center of Regensburg University concludes. TRI had the vision to bring disciplines together and to share results and insights. “Back then”, Langguth remembers, “the general assumption and conclusion were: 'Tinnitus cannot be cured, so learn to live with it'. The people involved in TRI, however, shared the belief that tinnitus should be treatable in principle – for instance with brain stimulation– although this treatment nor any other treatment was not proven yet. Their motto was and still is: 'Together for a cure'.” Since then, a lot has been achieved. For many patients, the suffering from tinnitus has been reduced.

Evidence base

“But tinnitus still is a very heterogeneous illness. It is difficult to treat”, says Langguth, “treatment is for a large part still mainly pioneering, the domain of pilot studies.” As yet, there are no clearly evidence based treatment methods except cognitive behavioral therapy (CBT) – which comes in several forms. Langguth: “But this doesn't affect the tinnitus percept itself, CBT has the goal to facilitate coping with it. While this provides important relief in many cases, it is not yet the solution for every patient suffering from tinnitus. Apart from that, there are many, many approaches with different rationales. Hearing loss compensation, optionally combined with forms of auditory stimulation, is widely accepted, but large controlled studies demonstrating the efficacy of these approaches are needed. Various innovative forms of individualized auditory stimulation offer sounds or music in frequency areas in the neighborhood of the tinnitus frequency. These forms of individualized auditory stimulation can interact with the neuronal mechanisms that generate tinnitus and have shown promising results in pilot studies.” But there is still a lot unclear, Langguth emphasizes: “How large are the clinical effects? Which variant works best with which type(s) of patients? What can we expect from pharmacological treatment or magnetic and electric brain stimulation? Before these newly developed treatments can be implemented in clinical routine, a conclusive statistical basis from large studies would be needed.”

New knowledge

The TINNET initiative was initiated to change this. It has now been approved by the European Cooperation in Science and Technology (COST) Committee of Senior Officials, thus ensuring European funding. “With that, we get the opportunity to lift tinnitus research to the next level. We still largely depend on the outcomes of isolated trials with a couple of dozens of heterogeneous patients, which causes results to partly depend on group configuration. When data from similar trials from dozens of centers or more can henceforth be introduced in the database, this opens a lot of opportunities.” Once detailed data from many persons is gathered, it will allow us to derive new knowledge, says Langguth: “We could understand in more detail what forms of tinnitus do exist and what the differences between the various forms are. The goal would be to create a data-based expert system, which would provide guidance of which treatment has the best chances for success in a given patient: So hopefully in some years, we can ask the database what would be the recommendation for a 56 years old male, who suffers from a tonal tinnitus since a noise trauma two years ago, and the database would tell us, that a combination of drug X and auditory stimulation Y is the most promising first-line treatment for this individual.”

Dr. Berthold Langguth held a speech on the TINNET initiative during the 8th TRI international Conference from 10-13 March in Auckland, New Zealand. COST invites tinnitus researchers from as many European countries as possible to participate in the project.

Leendert van der Ent

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