A novel treatment for tinnitus and tinnitus-related cognitive difficulties using computer-based cognitive training and D-cycloserine

IMPORTANCE: Tinnitus affects more than 40 million people in the Unites States, and cognitive difficulties are among the most commonly associated symptoms. OBJECTIVE: To test the feasibility and preliminarily the effectiveness of using a putative neuroplasticity-enhancing drug, D-cycloserine, to facilitate a computer-assisted CT program for improving tinnitus bother and related cognitive difficulties. DESIGN, SETTING, AND PARTICIPANTS: Double-blind, randomized clinical trial at an outpatient academic medical center of 34 participants aged 35 to 65 years with subjective, unilateral or bilateral, nonpulsatile tinnitus of at least 6 months' duration. INTERVENTIONS: Five weeks of twice-weekly computer-based CT with either 250 mg D-cycloserine or placebo orally prior to computer CT sessions. MAIN OUTCOMES AND MEASURES: Difference in the change in Tinnitus Functional Index (TFI) score between the 2 groups. RESULTS: After excluding 1 participant lost to follow-up, 1 who withdrew, 1 who did not complete 90% of sessions, and 1 outlier, 30 participants were included in the analysis. The D-cycloserine plus CT group showed a significant improvement in median TFI score (-5.8 [95%CI, -9.4 to -1.1]) and self-reported cognitive deficits (-4.5 [95%CI, -11.5 to -1.0]), but the placebo group did not (-1.0 [95%CI, -11.7 to 4.9] and -2.0 [95%CI, -5.1 to 2.0], respectively). After controlling for age and duration of tinnitus, there was no significant difference in TFI score change between the 2 groups (P = .41). After confounders were controlled for, the D-cycloserine group demonstrated a significantly greater improvement in self-reported cognitive deficits as compared with the placebo group (P = .03). No serious adverse events were reported. CONCLUSIONS AND RELEVANCE: Use of a computer-based CT program with a putative neuroplasticity-sensitizing drug, D-cycloserine, was feasible and well tolerated. With the limited sample size, the adjuvant use of D-cycloserine was no more effective than placebo at improving tinnitus bother. The finding that D-cycloserine use was more effective than placebo at improving self-reported cognitive difficulties could be important given the high rate of concern for cognitive deficits in patients with tinnitus. D-cycloserine and other putative neuroplasticity-facilitating agents could be investigated in the future as a strategy to enhance neuroplasticity-based tinnitus treatments. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01550796.