[Music] my name is dr ben thompson in this presentation i want to explain my own independent research my own investigation into the two newest tinnitus products the neosensory duo which is a wristband and the linear device which is a combination of something on the ears and something that is placed on the tongue for tongue stimulation all right great so first a disclosure is that yes i run the tinnitus telehealth company called pure tinnitus and i help patients using tinnitus retraining therapy i was trained at ucsf medical center in san francisco california which is a big hospital and that's where i completed my residency some other work experience and then i was also trained by the founder of tin industry training therapy paul jasterboff who is a researcher in our field very well known and between those experiences and creating a lot of online educational information the past years of my life have been devoted to tinnitus so hopefully i can share some of that knowledge in a way that helps you today also pure tinnitus the online company that i created is contracted by neosensory to provide tinnitus consultations for the pro version of their product so there is some relationship there and i wanted to be as transparent and upfront about that at the beginning the purpose of this presentation is to explain and educate on these different devices and for who they might be good for and some other information and science that goes behind it all right that's out of the way first let me introduce this topic called bimodal stimulation when we think of this term bimodal stimulation and how it can be used for tinnitus the phrase bimodal essentially breaks down into two modes bimodal two modes of stimulation the classic treatments or therapies for tinnitus are either psychological which addresses the limbic system the emotional charge of the brain very important i see that every day that oftentimes that area that attachment those associations with tinnitus when those are decreased over time tinnitus can shift tinnitus can reduce and this can get better that limbic system connection in the parts of the brain very very important so classic tinnitus treatments are either psychological addressing that aspect or auditory like hearing aids or sound therapy sound machines masking devices ear level sound generators and all that now in recent years coming from numerous research mainly from ireland and from michigan from these two various companies it's focused on can we stimulate the auditory system and another sense at the same time can we stimulate the auditory nervous system the auditory pathway and simultaneously another sense another sensation another nerve signal which ultimately ends up in the brain can we do that all at the same time and what would that do so this research has developed over time and as i said earlier coming from mainly ireland and university of michigan so there's two devices that are available one is only available in europe right now and likely to be come available in the next 12 months in the united states and that is called linear and that is the device that is worn on the tongue i have some pictures here to show you this is the linear device and this has been used in ireland has been used in europe it's available in european countries as you can see here there are headphones that go over the ear and then there's a music player that's held in your hand and the headphones and the music player are synchronized so that when the patient who's undergoing the therapy is listening to sounds coming from the ear and simultaneously having tongue stimulation on their tongue that is creating the bimodal stimulation all right so that's one form of doing this and the other form of bimodal stimulation that i'll talk about today is using the paired stimulation of the skin coming in on the wrist the arm of the skin and also the ears at the same time and that device is called neosensory and this is the wristband so it's called the neosensory duo which is the wristband from this company and they're based in california so those are the two products that i'll talk about today on the screen here you can see that this is a snapshot i took from my youtube channel where i have in-depth reviews of these two products the linear review is 20 minutes long and the neo-sensory product is 14 minutes long so as you can tell very in-depth and a lot to go over a lot to cover so let's start let's let's get right into it lanier is created by a company called neuromod and they're coming out of ireland and if you're here live please leave questions as they come up please take notes we'll be glad to try to help you out with those i have some notes that i'm referencing to make sure i provide the highest quality information most up-to-date information for you guys okay linear is the company that has the tongue stimulation and so hold on a second before i get into all the details about these two different bimodal stimulation devices i want to address something that is the most important thing of this talk that there are certain therapies that i would consider fundamental for tinnitus retraining the brain to have less tinnitus or to think about it the percentage of time we think about it that is on our concentration to reduce that and reduce how annoying the tinnitus is in our perception and then eventually hoping to reduce the volume or shift the volume of that tinnitus to attain that there are certain foundational principles and most often is tinnitus retraining therapy tendonous retraining therapy is a protocol to follow where there's proper individual education on how tinnitus was created what it means based on your history you're hearing there is the sound therapy plan which sometimes uses ear level devices like sound generators or hearing aids and then ongoing professional counseling and support typically by an audiologist sometimes by a psychologist and for a period of about six months of following tinnitus retraining therapy to me that is the fundamental foundation that is so clear to me that that's extremely important is even though we're talking about technology therapies here is that i have helped people many audiologists who are well-trained have helped people without either of these therapies who have gotten better with tinnitus and even at times reduce the volume or the perception of tinnitus so i need to make that very clear is that sometimes we hope that technology or a pill will solve our problem quickly and it's usually a supplemental tool in fact some of the patients that i've worked with who are using the wristband device none of them are using that device in isolation expecting that by itself to change their symptoms so this is important because usually we are attracted to the technology solution but before we jump ahead with that i need to make sure someone has followed the protocol that works for around eighty percent of patients with their tinnitus all right thank you i need to make that really clear that's really important okay now let's start by talking about the linear device okay so this is the linear device this is made and manufactured by a company called neuromod and they're out of ireland and this device uses bimodal neural modulation by stimulation of the trigeminal nerve via tongue stimulation again the trigeminal nerve via tongue stimulation auditory stimulation in the ear simultaneously which happens through the headphones that is based on the hearing test based on the audiogram the linear device has a tongue tip and it has the headphones the protocol is that you wear it for one hour a day and for example it's recommended you can use it for a half hour in the morning and a half hour in the evening the training program is a six week use period and then your audiologist would review the progress with you and determine what needs to happen from there so overall it's something that's used for less than two months bimodal stimulation of the tongue affecting the trigeminal nerve and the ears affecting the auditory nerve simultaneously the clinical trial or the clinical study that was completed had over 300 participants and some notes i have is that first it's relatively hard to independently control and have a pure double blind test because it's hard to control for tongue and ear stimulation essentially how do you fake tongue stimulation obviously you would feel it either it's there or it's not so there's some challenges there with the developing a pure double-blind gold standard study on this but they had three groups synchronized stimulation group one group two asynchronous stimulation meaning playing the tongue and the ear sound at different times or changing the tones and some variations there they used two different outcome measures and they showed improvement in symptom severity after around three months and the notes that i have from the webinar that i attended through that company was that 80 of treatment compliant participants showed continued improvement one year later 80 said that they would recommend linear to others with tinnitus that's pretty important and 65 said that they benefited from using the device so some common questions with this when will it be available in the us well it's currently in the fda approval process and they are hoping it will be available by the end of 2021 but don't be surprised if that comes available in 2022. it is available in select countries in europe right now does insurance cover it probably not definitely not the beginning but potentially down the road can it be done remotely or in person those are some good questions a recent audiogram a recent hearing test would be needed to program the device then adjustments could theoretically happen via telehealth online does it work for hyperacusis sound sensitivity if you have hyperacusis or sound sensitivity i know that sometimes that can be even more debilitating than loud tinnitus so this device is not designed for hyperacusis per se but the results suggest that it may work for you if you have hyperacusis as well now for tinnitus without hearing loss yes you can use the linear device without a diagnosed hearing loss it's still worth trying most likely because an audiogram has limitations there's another more specific test called the autoacoustic emission test and that specific test looks at the outer hair cell function in the cochlea and it's more specific at understanding what went wrong in the ear is there any decline or changes to the microscopic cells inside of the ear so this is a common question a lot a big point where people can get stuck on and then go down these rabbit holes of trying alternative treatments herbal supplements acupuncture all these things that may have some validity independently but looking down these dark rabbit holes of trying to solve their tinnitus because they may be told your hearing is normal well i made a full video on that essentially you're hearing maybe in the normal range but if we look closer into this oae test which most audiology clinics have you can ask for you'll see some decline which might be changes or different hearing than it used to be that can create the chain of events that leads to tinnitus so that is a quick summary of the linear device all right now let's talk about the neosensory duo formerly known as formerly called the neosensory buzz this is a wristband that you wear on your wrist and this is another way to present bimodal stimulation for tinnitus this device is available in the united states and let's talk about what it is and what you need to know the two modes of stimulation would be hearing and feeling through the somatosensory system so through the skin our biggest organs some say the skin so it's going to be feeling beeps and hearing beeps at the same time there is a training program which the company recommends for two months so it's essentially a rental process where you rent this wristband for two months and you use an app the app presents tones a series of ascending and descending tones of different pitches and at the same time that you're hearing the tones because they're played through a phone you're also feeling the tones because they're being played through your skin and this is a very interesting product because understanding this to me it represents showing the brain something at a subconscious level our thoughts our stories our waking hours we live in the conscious part of the brain when our brain is off when we're going to sleep the conscious part of our brain is turned off but our brain's still existing we're still hearing sounds while we're sleeping we're still breathing keeping our heart rate going keeping our breathing going getting oxygen in our system the brain is working always to help us the brain is constantly processing information 24 7. so is that conscious and the subconscious parts of the brain now the automatic reactions from the limbic system etc of the brain are mainly happening at a subconscious level this means if you were to work with a tinnitus specialist who was able to explain how habituation works how you recover to tinnitus how the whole system works together you can understand it at a cognitive level and that will definitely have some help definitely have some effect in making habituation happen as quickly as it can but it doesn't necessarily force or make habituation happen at a fast fast fast rate so there's some dissonance there where people i work with for example understand the plan understand what to do they're doing it they're following tennis retraining therapy they're also using mindfulness holistic principles they're seemingly doing everything that works and a month in two months in they're not feeling quite like much has changed and keep going keep going that's why it's recommended to stay with a professional for six months so just wanted to introduce those topics because one important thing from tendons retraining therapy to impress upon the brain is that tinnitus is an internal sound by itself it has no threat it has no destructive meaning make sure you have your medical test but it's likely not a brain tumor not something that's going to hurt you and it's an internal sound it's not an actual threat like the sound of a predator or a snake or a tiger outside of our head and when the brain fully understands that the limbic system response which is the automatic reaction to it can calm down and can reduce and when that really happens there's typically progress felt by the individual feeling better thinking about tinnitus less not as bothered or annoyed by it and down the road months months later sometimes getting softer to the sound reducing in volume so that understanding that tinnitus is an internal sound is so important and what this wristband device is doing through this training program is it's showing the brain what high pitch tones high-pitched sounds most people's thinness is high-pitched wearing this wristband and listening to about 10 to 20 minutes a day of this training app through the phone it's very passive when we say it's passive i mean it's influencing the the subconscious parts of the brain it's passive it's a passive learning thing and this shows the brain that tinnitus the high-pitched sound in the head or the ears it's an internal sound and the wristband verifies every sound that's played in the external world the wristband has microphones on it so that means the wristband picks up by sound and it turns it into vibrations instantly that's sort of cool but you might say how does that really help with tinnitus well when the brain can match oh that tone sound through the training program in the app is matching with stimulation on the wrist at the same time then it gives the brain a chance to connect oh in the gaps while i'm not hearing the tones through the training program and i'm not feeling the vibration in those gaps the brain's perceiving or hearing tinnitus the buzzy charge the electrical brain charge sound the high-pitched ringing of the auditory system in the brain so that is the theory behind how this is going to help reduce tinnitus by affecting those relationships and an interesting question is does the sound therapy matter because the tones the training program for the neo-sensory product is relatively simple so one question myself audiology community has is does the sound therapy need to be complicated or can it be so simple like this so that's an introduction into the neo-sensory duo the wristband product which is formerly called neosensory buzz for tinnitus and how it works i want to read some information from the company that i was given about the research so far to try to make this as evidence-based as possible with a caveat that both of these products both of these technologies that i talked about today are relatively new it's not at the level where we can say you must try this this is guaranteed to work to help you it's not there but it's the best thing we have so we're looking into it more and trying to understand as much as we can all right so the typical performance for someone who improves with the neosensory duo product is around 15 points on the tinnitus functional index which is a questionnaire some of the subjects around 15 percent or non-responders in the clinical trials are the studies the internal studies that neo-sensory did and that correlated well with the linear study which found that 11 of their participants were non-responders to bimodal therapy so participants who didn't improve and those who didn't improve almost form these two different groups but it's not clear as to why yet it could be different causes of tinnitus it could be sustained activation of anxiety in the psychology which could be affecting the system other points of view are are still being studied on this now for some overall similarities between the neosensory duo wristband and the linear device the bimodal device with the tongue and the headphones from the company neuromod and the linear product the overall similarities that they're both using science of bimodal stimulation they're both stimulating different non-auditory parts of the nervous system to connect it with the auditory stimulation hence showing the brain at different levels of the brain that the tinnitus signal is internal and there are these ways to verify external sounds those are the similarities there another similarity is that both of these are using a around a two month six to eight week time window for the initial analysis of is this working and potentially that would be the training program in itself neither of these products are designed to be used forever or designed to be used for longer than a year even year level sound generators which help with tinnitus in tennis re-training therapy after one year after a year and a half many people do stop using them because they don't need them anymore so very clear with all this knowledge that there is some retraining going on and when the brain can show that neuroplasticity the plasticity of the neurons the changes of the neurons in a healthy way that once it's changed in a healthy way you don't need the technology anymore so those are some similarities between the products between the technologies and it took me a while to learn all this i'm still learning on these technologies but i feel that it's important for the audiology professional community to especially those who are tinnitus experts tentative specialists to learn all this as quickly as possible because many people watching this will have questions and we want to help you guys as soon as possible and essentially counsel you on what is reasonable for your expectations of where you're at what can you expect for the months year to come what is in your control what can you actively do to improve and what is out of your control what is something that's worth investing your time and energy into and what might be a distraction or keeping you stuck so my hope is that this presentation has given you an introduction and potentially a lot of educational information on what these two technologies are the theory behind how it works and answering some of the common questions of if it's right for you as the caveat i also did two full independent reviews of these products on my youtube channel which you can find if you're looking for more or you can reach out to us via our email and our team can help you
2021-06-19