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Hearing Journal:
doi: 10.1097/01.HJ.0000445228.60229.6e
Departments: Letters

TINNITUS: ROLE OF THE LIMBIC SYSTEM

Marghzar, Sol AuD

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Share your views with the readers of The Hearing Journal. E-mail letters to HJ@wolterskluwer.com.

Editor:

I read the article “Inhibiting Tinnitus with a Computer-Based Audiological Approach,” by Dr. Leslie W. Dalton Jr. and colleagues (Nov. 2013, pp. 23-27 http://journals.lww.com/thehearingjournal/Fulltext/2013/11000/Inhibiting_Tinnitus_with_a_Computer_Based.3.aspx), with much enthusiasm. The amount of work done by the investigators is very commendable.

Although the results are intriguing, I have two issues with them:

1. Dr. A.H. Lockwood and colleagues demonstrated the significant role of the limbic system in tinnitus annoyance (Neurology 1998;50[1]:114-120 http://www.neurology.org/content/50/1/114.short?sid=422c7fac-0c06-41c4-9062-11a2ad19f456). Other studies have validated this relationship using brain mapping.

2. Most, if not all, current sound therapies incorporate counseling because abandoning the emotional aspects of tinnitus has shown unfavorable treatment outcomes.

The Lancet study mentioned in your article was rather clear on the importance of counseling (Cima RF et al: 2012;379[9830]:1951-1959 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60469-3/abstract). It appears that you equate counseling with psychological intervention.

Sol Marghzar, AuD

Culver City, CA

Dr. Dalton responds: An adequate response would require an article focused on just your two issues, but here is a beginning.

In our magnetoencephalography (MEG) scans, you will note an apparent transference of pre-stimulation MEG activity from anterior sites to central temporal locations that seems to indicate possible activity within the limbic system of our subjects prior to stimulation.

While such a conclusion demands further research, confirmation of the observation would suggest that the per-stimulation provides a release from anxiety, as found with conditioned suppression in Dr. Pawel J. Jastreboff's rat studies.

Regarding your second comment, we did not intend to maintain that emotional aspects of tinnitus were of no importance; they simply were not the focus of our study. As we said in the text, “the emotional side of tinnitus … was not a critical consideration of this investigation.”

We did bring forward a comparison between tinnitus retraining therapy and cognitive behavioral therapy. However, we did not address counseling, nor did we equate counseling with psychological intervention. To be honest, two of the article's authors continue to argue as to the degree of distinction between the two.

It is our hope that our study is a step toward inhibiting tinnitus. In the meantime, those of us facing the huge population of tinnitus sufferers are responsible for using research to reduce the lukewarm reviews our current methodologies continue to receive from sources such as Cochrane Reviews.

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