The International Tinnitus Journal

Raising the Voltage of Vagal Nerve Stimulation in Patients with Tinnitus

Henk M. Koning*

Background: Aberrant neural activity within central auditory pathways can cause the symptoms of tinnitus. The dorsal cochlear nucleus (DCN) enhances auditory-somatosensory integration in tinnitus conditions, leading to increased spontaneous and sound-driven neural activity. Electric stimulation of the cranial nerves can stop this neural activity and make tinnitus less bothersome by stimulating the cochlear nucleus through somatosensory input. Objectives: We wondered which voltage of PRF gave the best clinical results in tinnitus patients and want to observe the changes in pupillometric measures for the different voltages. Methods: This study was conducted as a retrospective study in our center. Tinnitus patients treated with PRF of the vagal nerve in the period between October 2023 and November 2024 (n = 79) were the subjects. Patients could choose between 42, 55, or 70 Volt of PRF. Results: PRF of the vagal nerve reduced the intensity of tinnitus in 45-58% of the patients with mild side-effects. Performing this technique with 70 V had a higher success-rate (58%) with no side-effects. We advise using 70 V PRF of the vagal nerve in order to reduce the intensity of tinnitus, especially if there is hearing loss at 250 Hz in the preoperative audiogram. The difference in BPD caused by vagal nerve stimulation (VNS) correlated with the result of this therapy. In tinnitus patients who undergo PRF of the vagal nerve, the difference in BPD caused by therapy should be positive or slightly negative for a positive result of therapy, especially when patients are treated with 55 V. Conclusion: Electrical stimulation of somatosensory input to the dorsal cochlear nucleus by pulsed radiofrequency of the vagal nerve can change the way the brain works in ways that are related to tinnitus and reducing the loudness of this sound. We advise using 70 volt during this technique for a better reduction of the intensity of tinnitus, especially if there is hearing loss at 250 Hz in the pre-operative audiogram. Vagal nerve stimulation caused a difference in basal pupil diameter, which correlated with the outcome of this therapy.