Pharmacotherapy for severe, disabling, subjective, idiopathic tinnitus: 2005-2006.

We present a tinnitus-targeted therapy (TTT), a combined treatment of medication and instrumentation focusing on pharmacotherapy. It embodies ongoing clinical experience (since 1977) in an excess of 8,500 patients with subjective idiopathic tinnitus of the severe disabling type (SIT). All have visited the Tinnitus Clinic of the Downstate Medical Center at the State University of New York (DMC/SUNY) and the Martha Entenmann Tinnitus Research Center, Inc. Since 1989, as a result of our evolving experience with single-photon emission computed tomography (SPECT) of brain, we have defined tinnitus as a sensory disorder of auditory perception exhibiting an aberrant auditory signal produced by interference in the excitatory-inhibitory process or processes involved in neurotransmission. This definition is considered to be dynamic: It embodies the integration of clinical observations and advances reported from neuroscience and nuclear medicine. These investigations have sought to identify an underlying mechanism of tinnitus production and have assisted in the establishment of the medical significance of tinnitus. In general, the goal of tinnitus therapy in 2005-2006 is to attempt to provide tinnitus relief for all clinical types of subjective idiopathic tinnitus (SIT). Although no cure for SIT exists currently, available protocols for diagnosis and treatment increase the efficacy of therapeutic modalities for attempting tinnitus relief. The strategies of TTT are based on the clinical translation of fundamentals of sensory physiology, extrapolation of underlying neurochemistry from nuclear medicine imaging results with SPECT in SIT patients, hypotheses of mechanisms of tinnitus production, and the innovative application of drug therapies designed for indications other than tinnitus. Such strategies have contributed to the development of a new discipline, tinnitology, an integrated multidiscipline of basic science, neuroscience, and clinical medicine attempting to understand an aberrant auditory phenomenon, unrelated to an external source of sound, and how it becomes transformed into one of affect. The goal of increasing accuracy of the SIT diagnosis is the impetus for increased efficacy of therapeutic modalities recommended for tinnitus relief.