Over 100 clinicians, researchers and people with tinnitus met at the Sheffield Hallam University campus for the BTA Annual Conference, which was opened by the BTA Chairman, Roy Bratby, who welcomed all delegates and hoped that the meeting will be an opportunity for successful and productive discussion.

The morning session started with a presentation by Faten Aldhafeeri, a researcher from Liverpool University, who talked about “An investigation into the involvement of the limbic system in tinnitus”. In her research she is using functional magnetic resonance imaging (MRI) and structural MRI to look for structural and functional brain changes in the different parts of the limbic system that may be associated with tinnitus. The preliminary results showed an exaggerated activity in the limbic system of patients with tinnitus in the areas such as the amygdala, parahippocampal gyrus and parts of the frontal cortex. Another analysis showed a reduced cortical thickness in various areas of the brain involved in emotions such as the pre-central gyrus, parietal lobe, middle temporal gyrus and orbital gyrus. Further research is going to concentrate on patients who cope well with their tinnitus and try to investigate whether there are different patterns of limbic system activation in that group compared to more severe cases.

The next presentation by Phillip Gander, a Postdoctoral Research Fellow at the National Biomedical Research Unit in Hearing in Nottingham, showed us the results of a survey of NHS audiology departments across England, and their provision of tinnitus care. 138 specialists from all over England responded to the survey, which focused on audiology services and covered two main themes: the referral pathway and tinnitus management. The results of the survey showed that all audiology departments meet the 18-week target recommended by the Department of Health and most tinnitus patients wait no more than 4 weeks to be seen by a specialist. Areas that can still be improved in the referral pathway are: appropriate and effective GP referral, access to suitable psychological support for those who need it, and awareness and education on referral to audiology services. Two key problems in the area of patient management that the survey identified and that need to be addressed are variability in patient management and lack of outcome measures. Lack of consensus in patient management provides flexibility but also has drawbacks. The lack of outcome measures make it difficult to assess the effectiveness of different tinnitus treatments.

The last of the morning talks was presented by Roland Schaette, the BTA Senior Research Associate at the UCL Ear Institute in London, who gave us an update of his tinnitus research. There is agreement amongst researchers that tinnitus can be caused by disrupted spontaneous activity in the brain as a result of cochlear damage. However, it is not clear what the mechanism may be in tinnitus sufferers who have normal hearing. Roland’s research showed that cochlear damage can be present even in patients who have normal hearing thresholds. Experiments in mice with temporary noise-induced hearing loss demonstrated that, even though hearing thresholds returned to normal over a period of time, more than 50% of high intensity auditory nerve fibres remained disconnected from the hair cells. In human patients, such damage can be determined by measuring auditory brainstem responses to sound, as in tinnitus patients with normal hearing the amplitude of the responses was smaller in comparison to controls. Roland postulated that such ‘sub-lethal’ cochlear damage can lead to tinnitus and that there is a possibility that tinnitus might always be accompanied by cochlear damage, even in patients with normal hearing thresholds.

After many interesting and inspiring discussions during lunchtime, the afternoon session was taken over by clinicians and first was Don McFerran, Consultant ENT Surgeon at Colchester Hospital University NHS Foundation Trust, who gave us an overview and an update on the progress in finding a cure for tinnitus. In his presentation entitled “A pill for tinnitus. What progress have we made?” he looked at pharmaceutical advances in finding a medication for tinnitus. He pointed to the various difficulties in drug treatment research for tinnitus, such as heterogeneous groups of patients, possible subgroup activity, dosage and the difficulties of measuring tinnitus. Don gave us a historical review of substances and drugs used for treatment of tinnitus including psychoactive drugs, anti-epileptics, diuretics, melatonin, lidocaine and drugs targeted at different receptors. He showed that drug research for tinnitus is active; unfortunately there are not as many ongoing drug clinical trials for tinnitus (18) as for other chronic diseases (eg diabetes-over 6000). On the other hand, drug research for tinnitus is much better coordinated and improved knowledge of pathogenesis is helping the selection of potentially suitable drugs. However, there still has not been a breakthrough and there is yet no pharmacological solution for the treatment of tinnitus.

The topic changed for the next talk entitled, “Where does the noise come from?” as Terry Buffin, retired Consultant Audiological Physician, showed evidence for connections between the auditory and somatosensory systems in tinnitus. Somatosensory tinnitus is a very interesting condition as patients can change the loudness or the pitch of their tinnitus by performing certain body movements. Terry presented us with patients’ testimonies describing changes in the sound characteristics during eye and head movements, jaw clenching and posture changes that may be a demonstration of the imbalance between the orthodox auditory pathway and the orientation system.

For the last talk of the day, Ivor Donaldson, retired Consultant Otolaryngologist presented the first Jack Shapiro Memorial Lecture. In his talk “Back to the future: Tinnitus from a historical perspective”, Ivor took us on a journey in time and looked at evidence of tinnitus and tinnitus treatment over the ages as well as presenting future directions in tinnitus research such as systematic studies of electric stimulation of the brain, studies of neurotransmitters, computer modelling of the auditory pathway, neuroimaging, biochemistry and cell biology.

Overall this was an excellent conference and a great opportunity for meeting all those from all around the UK who are interested in tinnitus research and management.

Thank you to Dr Magdalena Sereda for producing the report to a very tight deadline. This article originally appeared in Quiet, Autumn 2010