TINNITUS TREATMENT AND RESEARCH MEDITERRANEAN INSTITUTE. MULTIDISCIPLINARY MANAGEMENT OF THE TINNITUS

Michel PAOLINO, Vénéra GHULYAN-BEDIKIAN, Henri ESCOJIDO, Fabien PAOLINO HP CLAIRVAL, MARSEILLE, France

Our objective was to try to help the tinnitus sufferers as well as possible to leave their insulation, their distress, their feeling of impotence opposite to this disabling symptom. With this ambition we created the IMERTA – Tinnitus Treatment and Research Mediterranean Institute. It is a multidisciplinary institute based on a very powerful technical plate which consists of 3 poles: a pole of reception and evaluation;
a pole of decision concerted on the therapeutic strategy and a pole of fundamental and clinical research.

In our institute the patients undergo a meticulous examination to pose, when that is possible, the topographical diagnostic and in the best of the case the etiological diagnostic. The hearing of the patients will be estimated by pure tone and high frequency audiometries. Various assessments are proposed to the patients: an ENT and temporo-mendibular articulations assessments, audio impedancemetry, tinnitometry, otoacoustic emissions and auditory evoked potentials, morphological and functional MRI, biological assessments, cervical rachis radiography, Doppler clinical and instrumental cardiovascular examination, psychological evaluation, as well as a neurological examination when it is necessary.

The results of evaluation are used to define a therapeutic strategy and to adapt to each case a personalized therapeutic sequence. We propose medical treatments, behavioral and cognitive therapy, musicothérapie, alternative medicines (acupuncture, osteopathy), sound and sonic therapies (TRT, TSS), acoustic stimulations, repetitive transcranial magnetic stimulations. Our institute gathers 18 doctors in 9 specialities, 2 researchers, 2 audioprothesists, 1 technician and 2 secretaries. Since her creation 5 months ago, 300 patients consulted our institute and we answered 1200 e-mails. In addition, 1,5 months ago of time for a first visit and 2 months of time to carry out an investigation program. 50
hearing aids of any type were adapted on the spot and as much in the other large French cities. 5 TMS are carried out each week. The database which grows rich gradually makes it possible an epidemiological tinnitus
study. The technical plate of our institute also makes it possible to develop
various clinical and fundamental researches.

One of our objectives is to study the short-term and long-term efficiency as well as the neurobiological mechanisms of different therapeutic approaches in chronic and disabling tinnitus treatment. In addition, we consider a tonotopic research on the primary auditory cortex thanks
to fMRI and the stimulations reproducing with more closes the tinnitus frequential spectrum. We also consider work on curative sequential acoustic stimulations.