Any future pharmaceutical solution or gene therapy intervention for tinnitus is likely to have certain side effects. For example, psychotropic effects or effects on blood pressure and other organs. The aim of this project is to explore the extent to which the patients may be willing to endure side effects as the result of a tinnitus intervention.
To apply contact us via https://hashirtinnitusclinic.com/contact-us/
Background:
Tinnitus is the perception of sound (e.g., ringing, buzzing, whistle, humming, clicks, etc) in the absence of acoustic stimuli external to the body. Tinnitus can lead to emotional distress, cognitive dysfunction, autonomic arousal, behavioural changes, and functional disability, in which case it is called tinnitus disorder. The prevalence of tinnitus in the adult population is estimated to be about 14%.
Currently there is no pharmaceutical solution that shown to reliably alleviate or stop the tinnitus. There are several studies assessing the effect of N-methyl-d-aspartate (NMDA) and dopamine D(2) antagonists, selective serotonin reuptake inhibitors (SSRIs), γ-aminobutyric acid (GABA) agonists, zinc dietary supplements, antidepressants such as nortriptyline or sertraline, and anticonvulsant carbamazepine on tinnitus (Salvi et al., 2009).
On the other hand, some patients complain that certain medications make their tinnitus worse, and that tinnitus has a catastrophic impact on their life. For example, a patient at Hashir International Institute said:
“I took Mirtazapine and then Lorazepam. These medications increased my tinnitus. I feel they did. I am now on Quetiapine and Diazepine. I feel that they are making it worse too. So, if these can make my tinnitus worse, there must be something that can make it better.
It just has got worse in the last three months. It has gone up and up and up and up. Even two or three days ago it went up. I can hear it now. Just a Zizizzzzzzzzz. And that’s not the worst one. If that was not on, I could hear the woo woo woo woo. I just want it to stop. There has to be something that you can give me. Some medication that I can try. Because I am trying to kill myself with it. I am sick of it. I don’t want to be alive anymore. I just wake up and it is there. It is torturing me every second of the day. I am suffering. Please help me!”(Aazh and Moore, 2022)
The exact underlying mechanism that gives rise to tinnitus is not fully understood. There are some physiological theories and research findings that provide a direction for future pharmacological studies on tinnitus treatment. For example, it has been reported that even a minor change in the excitation of afferent auditory nerves due to a cochlear damage or other forms of hearing loss can trigger neural gain that through a potential qualitative shift in GABAergic activity that can lead to perception of tinnitus (Krauss et al., 2016). It is possible that genes such as Cyclooxigenase 1 and 2 contribute to tinnitus generation (Elgoyhen et al., 2014). Some experimental studies on animals suggest involvement of potassium channels and the glutamatergic system in tinnitus perception (Langguth et al., 2019).
Research idea:
Any future pharmaceutical solution or gene therapy intervention for tinnitus is likely to have certain side effects. For example, psychotropic effects or effects on blood pressure and other organs. It is not clear the extent to which the patients may be willing to endure side effects as the result of a tinnitus intervention. Moreover, it is not clear what kind of therapeutic effect on tinnitus should be expected or is desirable from the patients’ perspective with regard to any future pharmaceutical solutions or gene therapy interventions. For instance, do patients want the medications to make their tinnitus disappear for a period of time? If yes, then what duration of time is acceptable to them? Do patients want those future medications to change the pitch, loudness or tempo of their tinnitus? If yes, then in what way? Or do they want future medications to make it easier for them to cope with tinnitus as opposed to changing the tinnitus itself?
This information can help to better understand patient’s expectations from future tinnitus treatments and guide researchers who are involved in developing pharmaceutical solutions or gene therapy interventions for tinnitus.
Study design: Questionnaire-based survey among a population of patients with tinnitus.
Student objectives:
Literature search focusing on: (1) current medications tested for tinnitus, (2) patient’s perspectives about side effects of medications or gene therapy interventions in general, and (3) studies that explore patients’ views about tinnitus management or “cure”.
Study Design: (1) formulate research questions using PICO, (2) design a preliminary questionnaire based on the literature search, (3) decide on methodology including qualitative/quantitative methods, study population, sample size, sampling method, and statistical analysis.
Ethics: Submit application for ethical approval from university.
Registration: Pre-register the study: https://aspredicted.org/
Field test: finalise the design of the questionnaire based on interviewing some patients, conduct the survey, collect the data, analyse, interpret, and prepare the final dissertation report.
Dissemination: Present the results in relevant conferences/webinars and contribute to preparing a manuscript to be submitted to a peer-reviewed journal.
Relevant information:
Prerequisite:
Students taking this project are expected to have (1) excellent command / highly proficient in spoken and written English, (2) motivation to have encounters with patients experiencing tinnitus disorder and to learn about their problems caused by their tinnitus, (3) knowledge of research methodologies comprising: qualitative, quantitative and mixed method studies, (4) knowledge of study designs comprising: cross sectional studies, surveys, case control, cohort, randomised clinical trials, and systematic reviews, (5) practical skills of performing systematic search of research literature, (6) practical skills of performing basic statistical analysis.
Scientific support:
Subject expert supporting the student(s) taking this project is Dr Hashir Aazh PhD who is the director of Hashir International Specialist Clinics and Research Institute for Misophonia, Tinnitus & Hyperacusis based in Guildford and London. He has a degree in Audiology, masters in Rehabilitative Audiology and a PhD in Public Health and Policy from London School of Hygiene and Tropical Medicine (LSHTM), University of London. He has trained and supervised over a thousand of audiologists and psychologists in his International Tinnitus Masterclasses and published over 60 peer-reviewed research papers in the field of audiology. He is Honorary Hearing Research Consultant at the Royal Surrey NHS Foundation Trust and has served as Managing Editor of the journal Noise and Health, Associate Editor of the International Journal of Audiology, and the Secretary of the British Society of Audiology. He is the founder of the biennial International Hyperacusis and Misophonia Conference. His new book entitled “Living Well with Tinnitus: A self-help guide using cognitive behavioural therapy” was published in October 2022 in London and in early 2023 in New York. Hashir is a pioneer in audiologist-delivered cognitive behavioural therapy (CBT) for management of misophonia, tinnitus and hyperacusis and a recent independent ranking of biomedical experts recognised him as the number one expert in hyperacusis in Europe (2nd in the world) between 2013-2023.
Financial award for scientific societies:
Students will be eligible to apply for the American Tinnitus Association (ATA) Travel and Conference Award that is dedicated to help graduate students attend a conference to present tinnitus-related papers, posters, or other material. For more information see: https://www.ata.org/apply-for-ata-grants/
Educational opportunities:
Students will benefit from gaining access to clinical/educational resources available to clinicians at Hashir International Institute.
Student will have free access to 2nd International Conference on Pharmacology and Gene Therapy for Tinnitus (virtual event) https://hashirtinnitusclinic.com/event/
Students will have free access to Patient Education Programme: https://hashirtinnitusclinic.com/patient-education-programme/
Key reading resources:
References:
Aazh, H. & Moore, B.C.J. 2022. Living Well with Tinnitus: A Self-Help Guide Using Cognitive Behavioural Therapy. Little, Brown Book Group.
Elgoyhen, A.B., Langguth, B., Nowak, W., Schecklmann, M., De Ridder, D. et al 2014. “Identifying Tinnitus-Related Genes Based on a Side-Effect Network Analysis.” CPT Pharmacometrics Syst Pharmacol, 3, e97.
Krauss, P., Tziridis, K., Metzner, C., Schilling, A., Hoppe, U. et al 2016. “Stochastic Resonance Controlled Upregulation of Internal Noise after Hearing Loss as a Putative Cause of Tinnitus-Related Neuronal Hyperactivity.” Front Neurosci, 10, 597.
Langguth, B., Elgoyhen, A.B. & Cederroth, C.R. 2019. “Therapeutic Approaches to the Treatment of Tinnitus.” Annu Rev Pharmacol Toxicol, 59, 291-313.
Salvi, R., Lobarinas, E. & Sun, W. 2009. “Pharmacological Treatments for Tinnitus: New and Old.” Drugs Future, 34, 381-400.
To apply contact us via https://hashirtinnitusclinic.com/contact-us/
