Vagus Nerve Stimulation (VNS) Paired With Tones for Tinnitus

Study Overview
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Brief Summary
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Assess the safety and efficacy of VNS paired with tones for tinnitus using a randomized, controlled, parallel study design.

Detailed Description
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Patients who have moderate to severe tinnitus, at least one year post diagnosis, may enroll. All patients will be implanted and randomized to one of two groups: a group receiving VNS paired with tones and; a group that receives VNS and tones, but with different settings. After device use training, therapy is delivered at home by the patient for 6 weeks. Patients have eight baseline audiometric assessments along with two questionnaire assessments, an assessment after recovery before treatment starts, and tinnitus assessments every two weeks during therapy through the 6 week randomized portion of the study. After the randomized portion, all patients receive VNS paired with tones. Patients will continue to return for quarterly visits and tinnitus assessments through the first year after implant, regardless of their therapy status. Interested patients can continue to receive longer-term treatment after the first year. A goal of up to 30 patients enrolled and implanted across four sites is planned for this study.

Official Title
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A Blinded Randomized Pilot Study Assessing Vagus Nerve Stimulation (VNS) Paired With Tones for Tinnitus vs. VNS With Unpaired Tones

Conditions
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Tinnitus

Intervention / Treatment
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* Device: VNS Treatment
* Device: VNS Control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 22 to 65 years of age Have been diagnosed as suffering from sensorineural tinnitus and at least some tonal quality of the tinnitus Unilateral or bilateral tinnitus Have experienced tinnitus for at least one year and failed at least one tinnitus therapy (such as a counseling or sound therapy procedure. The diagnosis of tinnitus will include an audiological or medical diagnosis in their health records, as well as a patient affirmation of tinnitus greater than 12 months MML >= 7 dB (decibel) Have tinnitus score of 40 or greater on the Tinnitus Handicap Questionnaire; (THQ) No tinnitus treatment for at least 4 weeks prior to study entry. Willing and able to understand and comply with all study-related procedures during the course of the study Exclusion Criteria: Acute or intermittent tinnitus Severe hearing loss in any ear, as defined as more than an 80 dB HL (decibels hearing level) at frequencies from 250 Hz. to 8,000 Hz. Meniere's disease, ear tumors, or evidence of active middle ear disease (such as fluid, infection, tumor, mass) Any other implanted device such as a pacemaker or other neurostimulator; any other investigational device or drug Pregnant or plan on becoming pregnant or breastfeeding during the study period Currently require, or likely to require, MRI or diathermy during the study duration History of adverse reactions to anesthetics (e.g., lidocaine) that in the Investigator's opinion make surgery too risky Beck Depression Inventory (BDI) of 30 or greater Any other form of tinnitus treatments (e.g. Herbal medication, acupuncture or chiropractic medicine) are not allowed during the study. Any drug known to mimic, increase or decrease release or removal of a diffuse neuromodulator, such as norepinephrine, dopamine, serotonin, benzodiazepines, and acetylcholine is not allowed, as well as any psychoactive medications. Significant cardiac history Use of any medication known to cause or increase tinnitus, such as NSAIDS (ibuprofen, naproxen, nabumetone, etc.), aspirin and other salicylates, furosemide (Lasix) and other loop diuretics, mycin antibiotics such as vancomycin, quinine and related drugs, and chemotherapy agents such as cisplatin. Involvement in litigation (e.g., worker's compensation claim and/or receiving disability benefits related to tinnitus and/or hearing loss).

Ages Eligible for Study
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Minimum Age: 22 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: VNS Treatment<br>Vagus nerve stimulation and tones are used 2.5 hours per day for a 6-week period. | Device: VNS Treatment<br>* VNS is given in brief bursts over a 2.5 hour period. The subject also has headphone connected to a computer, and hears audio tones through the headphones that occur during VNS.<br>* Other names: Serenity System;|
| Sham Comparator: VNS Control<br>Vagus nerve stimulation and tones are given daily over a 2.5 hour period, but not in the same way as the experimental group, and in such a way that it is believed to be ineffective but still provide both VNS and tones so that blinding is maintained. | Device: VNS Control<br>* This is the sham-control group; subjects in this group will receive both tones and VNS, but in a manner that is expected to be ineffective.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Serious Adverse Events | Assess the number of serious adverse events during the study, and compare between groups to indicate if there are more in the treatment group than the control group. | 6-weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Adverse Events | Assess the number of adverse events during the study, and compare between groups to indicate if there are more in the treatment group than the control group. | 6-weeks | 
| Change in Minimum Masking Level (MML) in Units of dB (Decibels) | Asses the change in minimum masking level (MML) for both groups and compare between the groups. | 6-weeks (pre-implant to after 6-weeks of VNS) | 
| Percent Change in Tinnitus Handicap Inventory (THI) | Assess the change in THI score for both groups and compare between the groups. The THI is a questionnaire that asks subjects to assess their perception of their tinnitus by rating each question as a Yes (4 points), No (0 points) or Sometimes (2 points). There are 25 questions, scores are summed, so the scale ranges from 0 to 100. Scores are graded as: Grade 1 - Slight (0-16) Only heard in a quiet environment; Grade 2 - Mild (18-36) Easily masked by environmental sounds and easily forgotten with activities.; Grade 3 - Moderate (38-56) Noticed in presence of background noise, although daily activities can still be performed.; Grade 4 - Severe (58-76) Almost always heard, leads to disturbed sleep patterns and can interfere with daily activities.; Grade 5 - Catastrophic (78-100) Always heard, disturbed sleep patterns, difficulty with any activities. | 6-weeks (pre-implant to after 6-weeks of VNS) | 
| Change in Tinnitus Handicap Questionnaire (THQ) | Assess the change in THQ score for both groups and compare between the groups. The THQ is a patient questionnaire with 27 questions with each question having a score from 1 to 100. Scoring includes three factors - Factor 1 (Social, Emotional, Behavioral), Factor 2 (Tinnitus and Hearing), Factor 3 (Outlook). Fifteen questions are included in Factor 1, 8 questions in Factor 2, and 4 questions in Factor 3. A total score is calculated by adding the scores for Factor 1 questions and multiplying by 15/27, adding the scores for Factor 2 and multiplying by 8/27, and adding the scores for Factor 3 and multiplying by 4/27. This is then summed for the total score. Total score ranges from 0 to 100, with higher scores indicating more severe tinnitus. | 6-weeks (pre-implant to after 6-weeks of VNS) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Tinnitus, Medical Device, Randomized, Vagus Nerve Stimulation