Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study

TLDR

Tinnitus, a phantom auditory perception affecting 10–15 % of people, currently lacks clinically recommended drug or device treatments, although animal studies suggest that pairing sound with somatosensory stimulation can induce brain plasticity for relief. The study aimed to evaluate a noninvasive bimodal neuromodulation device delivering sound to the ears and electrical tongue stimulation in a randomized, double‑blind, exploratory trial of 326 adults with chronic tinnitus. Participants were randomized into three arms with distinct stimulation settings, and clinical outcomes were assessed during a 12‑week treatment period and a subsequent 12‑month post‑treatment follow‑up. The device produced statistically significant reductions in tinnitus severity (Cohen's d ≈ –0.9 on the Tinnitus Handicap Inventory and –0.8 on the Tinnitus Functional Index), sustained improvements over 12 months, high compliance and satisfaction, and no serious adverse events, supporting further trials to establish it as a recommended treatment.

Abstract

Tinnitus is a phantom auditory perception coded in the brain that can be bothersome or debilitating, affecting 10 to 15% of the population. Currently, there is no clinically recommended drug or device treatment for this major health condition. Animal research has revealed that sound paired with electrical somatosensory stimulation can drive extensive plasticity within the brain for tinnitus treatment. To investigate this bimodal neuromodulation approach in humans, we evaluated a noninvasive device that delivers sound to the ears and electrical stimulation to the tongue in a randomized, double-blinded, exploratory study that enrolled 326 adults with chronic subjective tinnitus. Participants were randomized into three parallel arms with different stimulation settings. Clinical outcomes were evaluated over a 12-week treatment period and a 12-month posttreatment phase. For the primary endpoints, participants achieved a statistically significant reduction in tinnitus symptom severity at the end of treatment based on two commonly used outcome measures, Tinnitus Handicap Inventory (Cohen's d effect size: -0.87 to -0.92 across arms; P < 0.001) and Tinnitus Functional Index (-0.77 to -0.87; P < 0.001). Therapeutic improvements continued for 12 months after treatment for specific bimodal stimulation settings, which had not previously been demonstrated in a large cohort for a tinnitus intervention. The treatment also achieved high compliance and satisfaction rates with no treatment-related serious adverse events. These positive therapeutic and long-term results motivate further clinical trials toward establishing bimodal neuromodulation as a clinically recommended device treatment for tinnitus.