Multitarget surgical neuromodulation: Combined C2 and auditory cortex implantation for tinnitus.

Tinnitus, as a phantom sound can express itself as a pure tone and as a noise-like sound. It is notoriously difficult to treat, and in medically, psychologically and audiologically intractable tinnitus patients sometimes intracranial electrodes overlying the auditory cortex are implanted. In this case report, we describe a patient who had a complete resolution of the pure tone component of his tinnitus by an auditory cortex implant, without any beneficial effect on the noise-like aspect of his tinnitus, even after changing the stimulation design to burst stimulation, which is known to treat noise-like tinnitus better than tonic stimulation. After an initial successful treatment of his noise-like component with transcutaneus electrical nerve stimulation, a wire electrode is inserted subcutaneously and connected to his internal pulse generator. With the dual stimulation his pure tone tinnitus remains abolished after 5 years of stimulation and his noise-like tinnitus is improved by 50%, from 8/10 to 4/10. This case report suggests that multi-target stimulation might be better than single target implantation in selected cases.