November 6, 2014
Annals of Long-Term Care
Will Boggs MD

Individuals with tinnitus and tinnitus-related cognitive difficulties may benefit from computer-based cognitive training while taking D-cycloserine, a putative neuroplasticity-sensitizing agent, according to a new trial.

“Brain training programs, like Brain HQ, that exploit neuroplasticity can be used as tinnitus treatment,” Dr. Jay F. Piccirillo from Washington University School of Medicine in St. Louis, Missouri, told Reuters Health by email.

About 70% of the more than 40 million individuals in the U.S. with tinnitus experience difficulty concentrating, Dr. Piccirillo and colleagues write in JAMA Otolaryngology – Head & Neck Surgery, online October 30. And patients with tinnitus have been found to have deficits in working memory, cognitive efficiency, attention control, and processing speeds on neurocognitive testing.

The researchers investigated a novel approach to targeting the neural network changes and cognitive deficits found in tinnitus by using the Brain Fitness Program, a computer-based program, along with D-cycloserine in a randomized trial of 34 patients with severe bothersome tinnitus.

All patients were instructed to work on the Brain Fitness Program one hour per day, two days per week, for five consecutive weeks while taking their assigned medication one hour prior to working on the brain program.

Sixteen patients assigned to receive cognitive training plus D-cycloserine and 14 patients assigned to receive cognitive training plus placebo completed the study and were included in the analysis.

Tinnitus bother scores improved significantly in the D-cycloserine group, compared with the placebo group, but the difference fell short of clinical significance and disappeared after controlling for age and duration of tinnitus.

The Cognitive Failures Questionnaire (CFQ, 0-100) score improved from 41 to 34 (p=0.005) in the D-cycloserine group, but remained the same (43) in the placebo group. After controlling for various confounders, there was a significantly greater improvement in CFQ score in the active-treatment group.

“This finding might be important given the particularly high rate of concerns about cognitive difficulties associated with tinnitus, and this treatment could be particularly useful in a subset of patients with tinnitus,” the researchers say. “Future research is needed to replicate these findings, preferably in a larger sample that might allow detection of additional effects.”

In the meantime, Dr. Piccirillo said, it’s probably too early to try D-cycloserine off-label in your patients with tinnitus. He also believes results might be better with a longer training period and “5 days a week rather than 2 days as we did in the research project.”