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Professor Brendan Conlon

CONSULTANT SURGEON LECTURER (School Office - Medicine)
      
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Professor Brendan Conlon

CONSULTANT SURGEON LECTURER (School Office - Medicine)

 


Project Title
 Treatment Evaluation of Neuromodulation for Tinnitus (TENT-A) NCT02669069
From
27/6/2016
To
31/7/2017
Summary
Tinnitus is a phantom auditory perception coded in the brain that can be bothersome or debilitating, affecting 10 to 15% of the population. Currently, there is no clinically recommended drug or device treatment for this major health condition. Animal research has revealed that sound paired with electrical somatosensory stimulation can drive extensive plasticity within the brain for tinnitus treatment. To investigate this bimodal neuromodulation approach in humans, we evaluated a noninvasive device that delivers sound to the ears and electrical stimulation to the tongue in a randomized, double-blinded, exploratory study that enrolled 326 adults with chronic subjective tinnitus. Participants were randomized into three parallel arms with different stimulation settings. Clinical outcomes were evaluated over a 12-week treatment period and a 12-month posttreatment phase. For the primary endpoints, participants achieved a statistically significant reduction in tinnitus symptom severity at the end of treatment based on two commonly used outcome measures, Tinnitus Handicap Inventory (Cohen's d effect size: -0.87 to -0.92 across arms; P < 0.001) and Tinnitus Functional Index (-0.77 to -0.87; P < 0.001). Therapeutic improvements continued for 12 months after treatment for specific bimodal stimulation settings, which had not previously been demonstrated in a large cohort for a tinnitus intervention. The treatment also achieved high compliance and satisfaction rates with no treatment-related serious adverse events. These positive therapeutic and long-term results motivate further clinical trials toward establishing bimodal neuromodulation as a clinically recommended device treatment for tinnitus. Trial undertaken at Clinical Research Facility St James's Hospital.
Funding Agency
Venture Capital / Private Investment
Project Type
Clinical Trial NCT02669069
Project Title
 Treatment Evaluation of Neuromodulation for Tinnitus - Stage A2 (TENT-A2) NCT03530306
From
20/03/2018
To
18/07/2019
Summary
More than 10% of the population suffers from tinnitus, which is a phantom auditory condition that is coded within the brain. A new neuromodulation approach has emerged that combines sound with electrical stimulation of somatosensory pathways to treat tinnitus, supported by multiple animal studies demonstrating that bimodal stimulation can elicit extensive neural plasticity within the auditory brain. More recently, in a large-scale clinical trial, bimodal sound and tongue stimulation drove significant reductions in tinnitus symptoms during the first 6-weeks followed by a plateau effect during the second 6-weeks of treatment. The objectives of the large-scale randomized and double-blinded study presented in this paper was to further identify which acoustic or tongue stimuli contribute to therapy and whether changing the parameter settings over time could provide additional improvements in symptoms. The primary endpoints involved within-arm and between-arm comparisons for two treatment arms with different bimodal neuromodulation settings based on two widely used and validated outcome instruments, Tinnitus Handicap Inventory and Tinnitus Functional Index. Both treatment arms exhibited a highly statistically significant reduction in symptoms during the first 6-weeks, which was further reduced during the second 6-weeks of treatment by changing the parameter settings (Cohen's d effect size for full treatment period per arm and outcome measure ranged from -0.7 to -1.4). These therapeutic effects were sustained up to 12 months after the treatment ended. There were no significant differences between arms, suggesting that tongue stimulation paired with pure tones and/or with noise stimuli, as well as different inter-stimulus delays, were equivalently effective in treating tinnitus. Two additional arms, including one arm that presented only acoustic stimuli during the first 6-weeks of treatment, further revealed the importance of both the acoustic and tongue components for reducing tinnitus symptoms. Overall, there were no treatment-related serious adverse events and a high compliance rate (83.8%) with 70.3% of participants indicating that they had benefited from the treatment. The discovery that adjusting stimulus components and parameters over time can drive additional therapeutic effects opens up new opportunities for optimizing stimuli and enhancing clinical outcomes for tinnitus patients with bimodal neuromodulation. Trial undertaken at Clinical Research Facility St James's Hospital.
Funding Agency
Venture Capital / Private Investment
Project Type
Cinical Trial

Details Date
Peer review editorial Board offices held The Laryngoscope; Editorial review pannel for Acta Otolaryngologica; International Journal of Audiology External examiner Final Med Exam UCD External Thesis Examiner RCSI
Details Date From Date To
Irish Otolaryngology Society
Institute of Otolaryngology
Association for Research in Otolaryngology
Royal Academy of Medicine in Ireland
Royal Society of Medicine
Conlon B, Langguth B, Hamilton C, Hughes S, Meade E, Connor CO, Schecklmann M, Hall DA, Vanneste S, Leong SL, Subramaniam T, D'Arcy S, Lim HH., Bimodal neuromodulation combining sound and tongue stimulation reduces tinnitus symptoms in a large randomized clinical study, Science translational medicine., 12, (564), 2020, p1 - 15, Notes: [Front cover story], Journal Article, PUBLISHED
Conlon B, Hamilton C, Meade E, Leong SL, O Connor C, Langguth B, Vanneste S, Hall DA, Hughes S, Lim HH., Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial, Brain, 2021, Journal Article, SUBMITTED
Hamilton C, D'Arcy S, Pearlmutter BA, Crispino G, Lalor EC, Conlon BJ, An Investigation of Feasibility and Safety of Bi-Modal Stimulation for the Treatment of Tinnitus: An Open-Label Pilot Study, Neuromodulation, 19, (8), 2016, p832 - 837, Notes: [13 citations (Google scholar)], Journal Article, PUBLISHED
Conlon BJ, Aran JM, Erre JP, Smith DW., Attenuation of aminoglycoside-induced cochlear damage with the metabolic antioxidant alpha-lipoic acid, Hearing Research, 128, (1-2), 1999, p40 - 44, Notes: [128 citations (Google scholar)], Journal Article, PUBLISHED
Conlon BJ, Gibson WP, Electrocochleography in the diagnosis of Meniere's disease, Acta Oto-Laryngologica, 120, (4), 2000, p480 - 483, Notes: [117 citations google scholar], Journal Article, PUBLISHED
Conlon BJ, Gibson WP, Meniere's disease: the incidence of hydrops in the contralateral asymptomatic ear, Laryngoscope, 109, (11), 1999, p1800 - 1802, Notes: [53 citations (Google scholar)], Journal Article, PUBLISHED
Conlon BJ, Perry BP, Smith DW., Attenuation of neomycin ototoxicity by iron chelation., Laryngoscope, 108, (2), 1998, p284 - 287, Notes: [77 citations (Google scholar)], Journal Article, PUBLISHED
Lang B, Hintze J, Conlon B., Coronavirus disease 2019 and sudden sensorineural hearing loss., Jounral of laryngology and Otology, 134, (11), 2020, p1026 - 1028, Journal Article, PUBLISHED
Conlon B, Hamilton C, Hughes S, Meade E, Hall DA, Vanneste S, Langguth B, Lim HH., Noninvasive Bimodal Neuromodulation for the Treatment of Tinnitus: Protocol for a Second Large-Scale Double-Blind Randomized Clinical Trial to Optimize Stimulation Parameters, Journal of Medical Internet Research (Research Protocols), 8, (9), 2019, pe13176 , Journal Article, PUBLISHED  DOI
D'Arcy, S., Hamilton, C., Hughes, S., Hall, D.A., Vanneste, S., Langguth, B., Conlon, B., Bi-modal stimulation in the treatment of tinnitus: A study protocol for an exploratory trial to optimise stimulation parameters and patient subtyping, BMJ Open, 7, (10), 2017, Journal Article, PUBLISHED
  

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Award Date
Gold Medal. Royal Academy of Medicine in Ireland 2019
Gold Medal Irish Temporal Bone Dissection course 2002
Graham Fraser Fellowship in Otology 1998
Gussi Meghian Memorial Fellowship 2000
Ehicon Foundation Travel Fellowship 1999
Duke University Research Fellowship 1996
Irish Otolaryngology Society 1st Prize Best Presentation 1997
Current primary area of research involves investigation and development of treatment interventions for tinnitus. Tinnitus is the perception of sound in the absence of an external source of the sound. It is essentially a phantom auditory sensation that is coded in the brain. Subjects suffering from tinnitus commonly complain of a persistent ringing in there ears or head. This condition affects up to 15% of the population with 1% of the population describing their tinnitus as catastrophic. Effective treatment interventions for tinnitus have remained elusive and largely revolve around psychological interventions including cognitive behavior therapy aiming to reduce symptom impact. Over the past 10 years I have clinically lead a research group that has attempted to develop a novel treatment approach for tinnitus treatment. This research has been based around the recent convergence of findings across numerous animal and human studies demonstrating that bimodal neuromodulation can significantly improve tinnitus symptoms and drive neuroplastic changes within the brain. This research has included the development of a bimodal neuromodulation device combining electrical stimulation of the tongue with auditory stimulation of the cochlea. Clinical evaluation of the device is ongoing following an initial pilot trial 2012, and three further clinical trials. We recently published results of our TENT A1 trial (Treatment Evaluation of Neuromodulation for Tinnitus) in the Journal Science Translational Medicine. This paper demonstrated that bimodal neuromodulation can significantly reduce tinnitus symptoms scores in a large population cohort. These effects were maintained one year after completion of treatment, strongly implicating effective neuroplastic changes within the brain. We continue to research variations in stimulation parameters in order to determine optimum stimuli to achieve maximum therapeutic benefit. We are further exploring further the potential applications of this neuromodulatory approach in the management of other neurological conditions. Other areas of research interest include the diagnosis, treatment, management and evaluation of Menieres disease. I also have research interest in causes and prevention of ototoxic deafness.