Vagus Nerve Stimulation (VNS) Paired With Tones for Tinnitus

Patients who have moderate to severe tinnitus, at least one year post diagnosis, may enroll.
All patients will be implanted and randomized to one of two groups:

- a group receiving VNS paired with tones and;

- a group that receives VNS and tones, but with different settings.

After device use training, therapy is delivered at home by the patient for 6 weeks. Patients
have eight baseline audiometric assessments along with two questionnaire assessments, an
assessment after recovery before treatment starts, and tinnitus assessments every two weeks
during therapy through the 6 week randomized portion of the study. After the randomized
portion, all patients receive VNS paired with tones. Patients will continue to return for
quarterly visits and tinnitus assessments through the first year after implant, regardless of
their therapy status. Interested patients can continue to receive longer-term treatment after
the first year. A goal of up to 30 patients enrolled and implanted across four sites is
planned for this study.

Inclusion Criteria:

1. 22 to 65 years of age

2. Have been diagnosed as suffering from sensorineural tinnitus and at least some tonal
quality of the tinnitus

3. Unilateral or bilateral tinnitus

4. Have experienced tinnitus for at least one year and failed at least one tinnitus
therapy (such as a counseling or sound therapy procedure. The diagnosis of tinnitus
will include an audiological or medical diagnosis in their health records, as well as
a patient affirmation of tinnitus greater than 12 months

5. MML >= 7 dB (decibel)

6. Have tinnitus score of 40 or greater on the Tinnitus Handicap Questionnaire; (THQ)

7. No tinnitus treatment for at least 4 weeks prior to study entry.

8. Willing and able to understand and comply with all study-related procedures during the
course of the study

Exclusion Criteria:

1. Acute or intermittent tinnitus

2. Severe hearing loss in any ear, as defined as more than an 80 dB HL (decibels hearing
level) at frequencies from 250 Hz. to 8,000 Hz.

3. Meniere's disease, ear tumors, or evidence of active middle ear disease (such as
fluid, infection, tumor, mass)

4. Any other implanted device such as a pacemaker or other neurostimulator; any other
investigational device or drug

5. Pregnant or plan on becoming pregnant or breastfeeding during the study period

6. Currently require, or likely to require, MRI or diathermy during the study duration

7. History of adverse reactions to anesthetics (e.g., lidocaine) that in the
Investigator's opinion make surgery too risky

8. Beck Depression Inventory (BDI) of 30 or greater

9. Any other form of tinnitus treatments (e.g. Herbal medication, acupuncture or
chiropractic medicine) are not allowed during the study.

10. Any drug known to mimic, increase or decrease release or removal of a diffuse
neuromodulator, such as norepinephrine, dopamine, serotonin, benzodiazepines, and
acetylcholine is not allowed, as well as any psychoactive medications.

11. Significant cardiac history

12. Use of any medication known to cause or increase tinnitus, such as NSAIDS (ibuprofen,
naproxen, nabumetone, etc.), aspirin and other salicylates, furosemide (Lasix) and
other "loop" diuretics, "mycin" antibiotics such as vancomycin, quinine and related
drugs, and chemotherapy agents such as cisplatin.

13. Involvement in litigation (e.g., worker's compensation claim and/or receiving
disability benefits related to tinnitus and/or hearing loss).