Internal Jugular Vein Compression Collar for Novel Symptomatic Treatment of Venous Pulsatile Tinnitus

University of North Carolina, Chapel Hill20 enrolled

Overview

This study seeks to pilot an evaluation of whether an external jugular vein compression collar approved by the US Food and Drug Administration (FDA) for contact sports can provide symptomatic relief of venous pulsatile tinnitus. Furthermore, the study will evaluate quality of life impacts of the device and adherence by users.

Background: Tinnitus is a medical condition with a wide variety of causes that is characterized by the perception of sound, often described as ringing or buzzing, without an external stimulus. Venous pulsatile tinnitus is a specific subtype of tinnitus with limited treatment options: some cases can be treated with surgical correction of an underlying vascular defect, others are entirely idiopathic. The clinical diagnostic hallmark of venous pulsatile tinnitus is relief of symptoms with light compression of the ipsilateral external jugular vein by the physician. Internal jugular vein compression collars, FDA approved devices currently used to prevent brain injuries in contact sports, function by this exact same method. Therefore, it is believed that these collars can treat pulsatile tinnitus. Study Design: This is a non-blinded, interventional, prospective single cohort pilot study that will recruit 20 patients diagnosed with pulsatile tinnitus at the UNC Meadowmont Ear Nose and Throat (ENT) clinic (see methods for inclusion/exclusion criteria). Volunteers will compare tinnitus intensity before and after administration of the collar, take the collar home and evaluate its symptomatic efficacy over a 2-4-week period, and return to clinic to complete data on quality of life and longitudinal impacts. This data will be analyzed for significance. Expected Outcomes: It is expected that collar administration will offer immediate symptomatic relief, illustrated as significant improvement on the tinnitus intensity scale during their initial clinic visit Symptomatic improvement will be sustained while wearing the collar, measured by sustained improvement in the tinnitus handicap inventory over the course of the study. Lastly, the collar will improve quality of life as measured by patient reported outcome scales administered pre and post participation.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Pulsatile Tinnitus

Interventions

Internal Jugular Vein Compression CollarDEVICE

The current FDA approved internal jugular vein compression collar, marketed as the Q collar, is manufactured by Q30 Innovations Home. It is designed to be worn around the neck of individuals aged 13 and older. It functions by lightly compressing the internal jugular vein's bilaterally, safely increasing intracranial volume and intracranial pressure. The FDA approved neck collar device is made of a thermoplastic elastomer that is specifically fitted to an individual to provide mild internal jugular vein compression. The product was developed and confirmed with ultrasonography to confirm appropriate fit and compression of the vein based on an athlete's neck circumference.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria * Male or female age 18 years and older * Diagnosis of venous pulsatile tinnitus * Patient at UNC ENT Meadowmont Clinic Exclusion Criteria * Increased presence of acid in the body or excessive blood alkalinity * Open head injury (including in or around the eye) within the past six months * Pseudotumor cerebri (false brain tumor) * Presence of brain or spinal shunt * Known seizure disorder * Known airway obstruction * Increased likelihood of blood clotting (coagulation) * Skin injury, rash, or other abnormality on or around the neck * age \<18 * unable to provide written consent, * history of neurological deficits, * previous cerebral infarction (blockage or narrowing in the arteries supplying blood and oxygen to the brain) * severe head trauma * medical contraindications to restriction of blood outflow via the internal jugular veins * glaucoma (narrow angle or normal tension - increased pressure in the eyes), * hydrocephalus (increased fluid on the brain) * recent penetrating brain trauma (within 6 months), * known carotid hypersensitivity * known increased intracranial pressure * idiopathic intracranial hypertension * known intracranial vascular malformation (e.g. aneurysm, arteriovenous malformation, cavernoma) * central vein thrombosis * not tolerating initial fitting of collar. * Known pregnancy (this is not a direct contraindication but is being made out of an abundance of caution) * Inability to speak or comprehend English

Locations (1)

UNC Meadowmont ENT Clinic

Chapel Hill, North Carolina, United States

Outcomes

Primary Outcomes

Change From Baseline in Pulsatile Tinnitus Symptom Intensity

Assessing the difference in pulsatile tinnitus symptom intensity without the collar vs. with the collar as evaluated by a 10 point Likert scale ranging 0-10 where 0 is no symptoms and 10 is maximal symptom intensity. Participants were allowed to use the collar for up to 30 days as often or as little as desired on a weekly basis but no longer than 2 hours continuously in accordance with the collar's FDA clearance. Participants completed a survey for each day of use reporting the intensity of their symptoms before wearing the collar and while wearing the collar. The difference between these symptom intensities with and without the collar is a single data point. Each data point was aggregated across all participants and across all days of use. From these aggregated data, the median and interquartile range were calculated. Therefore, the outcome is the median difference in intensity before and during wear of every day of collar use by every participant.

Time frame: From immediately before collar placement to less than or equal to two hours of wearing the collar for each day of use.

Secondary Outcomes

Change From Baseline in Tinnitus Quality of Life From Collar Usage

Determine if quality of life changes appreciably while using the collar and participating in the study as measured by the tinnitus handicap inventory (THI), a 25-item validated survey that evaluates the degree of impact a patient's tinnitus has on their quality of life. It is scored on a scale of 0-100, where 0 represents no handicap and 100 represent catastrophic handicap.

Time frame: Baseline, 5 weeks later upon completion of study participation

Temporality of Collar Usage Effect on Symptom Intensity

Participants were allowed to use the collar for up to 30 days as often or as little as desired on a weekly basis but no longer than 2 hours continuously in accordance with the collar's FDA clearance. Participants completed a survey containing a 0-10 point Likert scale of tinnitus intensity (where 0 is no symptoms and 10 is maximal symptom intensity) for each day of use reporting the intensity of their symptoms before wearing the collar and while wearing the collar. The difference between these symptom intensities with and without the collar is a single data point. These data points were grouped by week (week 1, week 2, week 3, week 4) across participants and the median for each reported. These medians were compared statistically to determine if the effect of the collar on symptom intensity changed by week.

Data from ClinicalTrials.gov

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