ReviewDeep brain stimulation in tinnitus: Current and future perspectives

- To date there is no treatment which substantially reduces perception of tinnitus.
- In tinnitus several forms of pathological central neuronal activity are found.
- Deep brain stimulation (DBS) is able to counteract localized pathological activity.
- Preclinical and clinical studies indicate that DBS can reduce tinnitus.
- Selection of the most suitable brain structure for DBS is still under debate.

Chronic tinnitus, also known as ringing in the ears, affects up to 15% of the adults and causes a serious socio-economic burden. At present, there is no treatment available which substantially reduces the perception of this phantom sound. In the past few years, preclinical and clinical studies have unraveled central mechanisms involved in the pathophysiology of tinnitus, replacing the classical periphery-based hypothesis. In subcortical auditory and non-auditory regions, increased spontaneous activity, neuronal bursting and synchrony were found. When reaching the auditory cortex, these neuronal alterations become perceptually relevant and consequently are perceived as phantom sound. A therapy with a potential to counteract deeply located pathological activity is deep brain stimulation, which has already been demonstrated to be effective in neurological diseases such as Parkinson's disease. In this review, several brain targets are discussed as possible targets for deep brain stimulation in tinnitus. The potential applicability of this treatment in tinnitus is discussed with examples from the preclinical field and clinical case studies.