Invasive Brain Stimulation

There exist no FDA- or CE-approved pharmacological treatments for tinnitus. Based on network science, tinnitus is proposed to be an emergent property of dynamically changing interacting networks. It is related to a balance between three cardinal networks: the lateral “loudness” pathway, the medial “suffering” pathway, and the noise canceling pathway. Invasive and non-invasive neuromodulation are an option for tinnitus management. Invasive neuromodulation consists of implanting electrodes in or on the brain or nerves. Implants have been performed in all three cardinal pathways: auditory cortex (lateral pathway), dorsal anterior cingulate cortex and caudate (medial pathway), dorsolateral prefrontal cortex, parahippocampal area (noise canceling pathway), as well as in the thalamus and subthalamus. Despite the theoretical science network suggestions, no multitarget implants have been performed. Vagus nerve stimulation, with or without paired sound stimulation, has also been performed with some success. However, invasive neuromodulation requires further research before it can become a routine part of tinnitus management.