A novel treatment for tinnitus and tinnitus-related cognitive difficulties using
computer-based cognitive training and D-cycloserine.
Author(s): Krings JG(1), Wineland A(2), Kallogjeri D(2), Rodebaugh TL(3), Nicklaus J(2),
Lenze EJ(4), Piccirillo JF(2).
Affiliation(s): Author information:
(1)Department of Otolaryngology-Head and Neck Surgery, Washington University
School of Medicine, St Louis, Missouri2Doris Duke Clinical Research Fellowship,
Washington University School of Medicine, St Louis, Missouri3Stanford Medical
Scholars Fellowship, St. (2)Department of Otolaryngology-Head and Neck Surgery,
Washington University School of Medicine, St Louis, Missouri. (3)Department of
Psychology, Washington University in St Louis, St Louis, Missouri. (4)Department
of Psychiatry, Washington University School of Medicine, St Louis, Missouri.
Publication date & source: 2015, JAMA Otolaryngol Head Neck Surg. , 141(1):18-26
IMPORTANCE: Tinnitus affects more than 40 million people in the Unites States,
and cognitive difficulties are among the most commonly associated symptoms.
OBJECTIVE: To test the feasibility and preliminarily the effectiveness of using a
putative neuroplasticity-enhancing drug, D-cycloserine, to facilitate a
computer-assisted CT program for improving tinnitus bother and related cognitive
difficulties.
DESIGN, SETTING, AND PARTICIPANTS: Double-blind, randomized clinical trial at an
outpatient academic medical center of 34 participants aged 35 to 65 years with
subjective, unilateral or bilateral, nonpulsatile tinnitus of at least 6 months'
duration.
INTERVENTIONS: Five weeks of twice-weekly computer-based CT with either 250 mg
D-cycloserine or placebo orally prior to computer CT sessions.
MAIN OUTCOMES AND MEASURES: Difference in the change in Tinnitus Functional Index
(TFI) score between the 2 groups.
RESULTS: After excluding 1 participant lost to follow-up, 1 who withdrew, 1 who
did not complete 90% of sessions, and 1 outlier, 30 participants were included in
the analysis. The D-cycloserine plus CT group showed a significant improvement in
median TFI score (-5.8 [95% CI, -9.4 to -1.1]) and self-reported cognitive
deficits (-4.5 [95% CI, -11.5 to -1.0]), but the placebo group did not (-1.0 [95%
CI, -11.7 to 4.9] and -2.0 [95% CI, -5.1 to 2.0], respectively). After
controlling for age and duration of tinnitus, there was no significant difference
in TFI score change between the 2 groups (P = .41). After confounders were
controlled for, the D-cycloserine group demonstrated a significantly greater
improvement in self-reported cognitive deficits as compared with the placebo
group (P = .03). No serious adverse events were reported.
CONCLUSIONS AND RELEVANCE: Use of a computer-based CT program with a putative
neuroplasticity-sensitizing drug, D-cycloserine, was feasible and well tolerated.
With the limited sample size, the adjuvant use of D-cycloserine was no more
effective than placebo at improving tinnitus bother. The finding that
D-cycloserine use was more effective than placebo at improving self-reported
cognitive difficulties could be important given the high rate of concern for
cognitive deficits in patients with tinnitus. D-cycloserine and other putative
neuroplasticity-facilitating agents could be investigated in the future as a
strategy to enhance neuroplasticity-based tinnitus treatments.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01550796.
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