Surgical treatment by electrical stimulation of the auditory cortex for intractable tinnitus

Tinnitus is a public health issue in France. Around 1% of the population is affected and 30,000 people are
handicapped in their daily life. The treatments available for disabling tinnitus have until now been
disappointing. We are reporting on the surgical treatment by electrical stimulation of the auditory cortex of
a female patient affected by disabling tinnitus that resisted classical treatments. The tinnitus appeared suddenly
10 years ago after a left ear tympanoplasty. The acouphenometry measures revealed a bilateral tinnitus,
predominant on the right side, constant, with high frequency (6000 Hz). Transcranial magnetic stimulation
(TMS) was performed at first with several supraliminal and infraliminal protocols. This showed promising
results. Anatomic and functional magnetic resonance imaging (fMRI) of the auditory cortex before and after
repetitive TMS (rTMS) demonstrated a modification of the cortical activity and where the ideal location for
a cortical electrode might be, to straddle primary and secondary auditory cortex.After these investigations, two
quadra polar electrodes (Resume, Medtronic Ltd, Hertfordshire, UK), connected to a stimulating device
implanted under the skin (Synergy, Medtronic Ltd), were extradurally implanted. The surgical procedurewas
similar to the one performed for analgesic cortical stimulation. No surgical complications were reported. The
activation of the stimulator provided a reduction of 65%of the tinnitus impact, with a persistent effect on the
right side. The feasibility of the cortical stimulation in symptomatic treatment of tinnitus was proven by this
preparatory work. The middle- and long-term therapeutic