s i x T h i n T e R n AT i o n A l T i n n i T u s R e s e A R c h i n i T i AT i v e c o n F e R e n c e

During the Sixth Annual Tinnitus Research Initiative Conference, held in Bruges, Belgium in June, ATA Scientific Advisory Committee (SAC) member Dirk De Ridder, M.D., Ph.D., and ATA-funded researcher Berthold Langguth, M.D., Ph.D., took time to sit down with ATA and tell us a little more about how they first became interested in tinnitus. Both doctors have been researching and treating tinnitus since 2002 and have become leaders in the field. Here, they shed light on the current state of research and what still needs to be done.

Tinnitus Research: The Scientists Side of a Cure

ATA: Thanks to you both, Dr. Langguth and Dr. De Ridder, for taking time to share some thoughts on tinnitus with ATAs supporters. To begin, what first attracted you to the field of tinnitus? BL: I was developing a model of neuroplasticity in the brain, which I thought had a role to play in certain pathologies, such as tinnitus. The funny thing is, back then I thought it would be an easy model because you were dealing with just one perception the perception of sound. Now, of course, we realize how many aspects tinnitus has, and how many parts of the brain are involved. I thought that the auditory system would be simple to address, unlike the visual system or the somatosensory system. And being a surgeon, we look at things in a very mechanistic way wheres the problem, how can you fix it? But as we all found out, tinnitus seems to be resistant to the simple mechanistic approaches we all started with. ATA: So you believe tinnitus could be a solvable problem? DDR: Yes, sure. Otherwise, you would only shrug your shoulders and say, This can never be solved. But I dont believe that. BL: I agree with that. Neuroplasticity is what first attracted me to the field, but here I am, 10 years later, still working on tinnitus. What has kept me working in the field is the need. When we started, we discovered that tinnitus patients were very motivated. They wanted to participate in clinical trials any clinical trials. I realized there was a huge need for better treatments because what was being offered was not very efficient. However, its not like other diseases, like Alzheimers, in which you have tissue damage and neuronal degeneration. Tinnitus is much more complex, but at this point, I do not see a barrier that would prevent us from finding a cure. ATA: Is tinnitus research progressing more rapidly now, compared to 10 years ago?
Dirk De Ridder, M.D., Ph.D. and Berthold Langguth, M.D., Ph.D.

DDR: I was interested in the application of the procedure of microvascular decompression surgery, and then I looked at where the results of that kind of surgery were poorest. ATA: Poorest? DDR: Yes, because I wanted to know why this type of surgery didnt work for tinnitus. Like Berthold, 26
Tinnitus Today | Summer 2012

DDR: Yes it is definitely more rapid. It has become more multi-disciplinary. Ten years ago the primary investigators of tinnitus were auditory scientists, focusing on the cochlea. There was some clinical research, on a relatively low methodological level, with a limited number of clinical trials. BL: Clinical trial methodology has improved with newer scientific methods that have evolved, and also the focus of research has shifted. Ten years ago at best, you had a few auditory neuroscientists working in the field. Today there are more, but we still need additional minds working on this problem.

DDR: What is dramatically different now compared with 10 years ago, is that tinnitus research was not considered a real study topic, whereas now the field of tinnitus research has at least some respectability. Our professional colleagues no longer ask, Why would you waste time on a condition that is not well defined, that you cannot objectively measure? There are thousands of people who are studying pain, equally hard to define and measure, and yet that is a more respectable field of study. The same is now true for tinnitus. ATA: Is there anything else about the field of tinnitus that deserves mention? BL: A positive aspect of the tinnitus field is that currently there is a lot of collaboration. Without large amounts of funding, it is imperative that people who have the desire to improve tinnitus research and treatments work together. Even if investigators may not share the same exact research goals, there is a huge overlap of interest for better treatments for tinnitus. DDR: Because the field is relatively small compared with other diseases and conditions, a clinical finding

can be quickly translated to animal research, and then back to humans in the clinic. For example, when we started to work with combined vagus nerve and auditory stimulation, following the Kilgard approach, the treatment was developed in animals and when we translated it to humans and had some extra questions. Within a month, we had answers by new animal experiments. This kind of quick reaction is almost impossible in a larger field because each researcher has organized his/her research for the next three to five years. With tinnitus, we can translate our research faster for clinical treatments depending on the importance of the finding. This is an excerpt from a longer interview with Drs. De Ridder and Langguth where they share detailed observations about the current state of tinnitus research. To read the full interview, please visit ATA.org/TRI-2012. Berthold Langguth, M.D., Ph.D., is Chair of the Executive Committee of TRI. He is also a Neurologist and Professor of Psychiatry at the Bezirksklinikum, University of Regensburg, Germany. Dirk De Ridder, M.D., Ph.D., also serves on the Executive Committee of TRI. He is a Professor of Neurosurgery at the University of Antwerp, Belgium.