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Self-reported cognitive difficulties better for patients with tinnitus in clinical trial

The JAMA Network Journals

Using the medication D-cycloserine in conjunction with a computer-assisted cognitive training (CT) program to try to improve the bother of tinnitus (persistent ringing in the ears) and its related cognitive difficulties was no more effective than placebo at relieving the bother of the annoying condition although self-reported cognitive deficits improved, according to a study published online by JAMA Otolaryngology-Head & Neck Surgery.

There is no cure for tinnitus and cognitive difficulties are among the most common symptoms. Neuroplasticity is the brain's ability to adapt through reorganization of its structure and synaptic connections. Evidence surrounding neuroplasticity has helped computer programs aimed at recovering cognitive function to grow in popularity.

Researchers James G. Krings, M.D., of the Washington University School of Medicine, St. Louis, and colleagues sought to target the aberrant neural network changes and cognitive deficits found in patients with tinnitus with the help of a computer CT program and a potential neuroplasticity-enhancing medication in a randomized clinical trial that included 30 patients in the analysis. The difference in change in the Tinnitus Functional Index (TFI) score was measured. All patients received CT through the computer program; 16 of 30 patients in the analysis received D-cycloserine and 14 were given placebo.

The median change in the TFI score after the intervention was -5.8 points for the D-cycloserine group compared with baseline and, although this difference was statistically significant, it did not reach a minimally clinically significant difference. However, the study did find in the D-cycloserine group greater improvement in self-reported cognitive deficits associated with tinnitus compared with placebo.

"This finding may 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. Future research is needed to replicate these findings, preferably in a larger sample that might allow detection of additional effects," the authors conclude.


(JAMA Otolaryngol Head Neck Surg. Published online October 30, 2014. doi:10.1001/.jamaoto.2014.2669. Available pre-embargo to the media at

Editor's Note: An author made a conflict of interest disclosure. This research was supported by a grant from the Doris Duke Clinical Research Foundation, as well as support from the Stanford University Medical Scholars Fellowship. Posit Science provided access to the Brain Fitness Program for all participants. Please see article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact corresponding author Jay F. Piccirillo, M.D., call Julia Evangelou Strait at 314-286-0141 or email An author podcast with Dr. Piccirillo will be available on the JAMA Otolaryngology-Head & Neck Surgery website when the embargo lifts:

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