Member- Sep 9, 2022
- 40
- Tinnitus Since
- 09/2022
- Cause of Tinnitus
- ultrasonic dental cleaning
Quick disclaimer: I'm a software engineer, not a biologist, so, by all means, I'm a lawman, this post comes from an admittedly ignorant point of view, which I'm willing to change. Yet, regardless, I think I have the right to have concerns, and, as such, I'll do my best to write a high-quality critical post explaining my thoughts. My criticism is directed towards the state of tinnitus research, and why I firmly believe a solution to our problem is well within reach of existing technology, yet we're definitely not walking in the right direction, and, if nothing changes, we'll not see any relief within this decade.
First of all, let's be rational about a point: Tinnitus is NOT a brain disease. I'm not sure why there is such a huge momentum in that direction, but that is only detrimental to our goals. The overwhelming majority of sufferers report that tinnitus started due to ear related issues, and there is no evidence nor any logical argument to support that "it starts on the ear, and then moves into the brain". The reason this hypothesis is so popular is beyond my comprehension. There is no other disease that starts with physical damage and then becomes brain centered, even after physical resolution. In fact, the opposite is common: patients with phantom finger syndrome report pain relief once they have the lost member transplanted, for example. Let's be clear: there is zero precedent for such a biological mechanism. It is not a thing that happens. All the models supporting that tinnitus is a brain disease have simple, logical explanations under the hypothesis that it is merely an ear issue, but these seem to be somehow completely overseen. For example, it is true that some people report both improvement or exacerbation of tinnitus after auditory nerve section. But how is that surprising, or indicative of a brain disease? If someone's tinnitus was caused by over-activity of ear hair cells, then severing auditory nerves would stop it. If, on another individual, it was caused by central compensation to under-activity of these ear hair cells, then severing the nerves would exacerbate it. Both of these are perfectly consistent with tinnitus being an ear issue. None requires a brain-centered explanation. And, most importantly, both would be solved once the ear functioned normally again. This suggests healing the ear, not the brain, should be the focus. Am I missing something obvious here? Another argument for the brain as the cause is the occurrence of tinnitus without hearing loss. Yet, this can be explained by simply remembering that people are different. Some are even immune to AIDS. It would be surprising to no-one if some people were, simply, not prone to tinnitus, regardless of ear health. This doesn't indicate that tinnitus is a brain disease in any logical way.
Yes, it is true that tinnitus causes detectable brain changes, but so does anything that affects you. If you had a knife stuck in your arm, you'd be in constant, insufferable pain, and that would be strongly detectable in any brain exam, fMRI or ECG. That doesn't imply a knife is a brain issue, and, most importantly, trying to fix it by rewiring the pain circuits in the brain would be such an utterly stupid approach that no serious doctor would suggest it with a straight face. Yet, that seems to be exactly how we're approaching tinnitus. Why? Perhaps because the damaged tissue is too small to be detected, so people jump to the conclusion that it is on the brain? Perhaps because researching the brain is cooler, and wields more prestige? Let's be very clear: Tinnitus is ear tissue damage, and this obsession for treating tinnitus as a brain is counterproductive, because it moves time and money into an endless attempt to understand the complex workings of the auditory cortex, which is not only extremely hard (as in, Quantum-computer, Mars-mission hard), but is also as utterly unnecessary, since, let's be honest, almost all tinnitus sufferers would have the issue resolved if their ear hair cells functioned normally again. It is almost certain that the brain simply renormalize, in the same way that patients with phantom finger syndrome do. Don't get me wrong; models of tinnitus, including hyperactivity models, filling-in, predictive coding, and all the like, are valuable for the sake of understanding how the human brain works. That is an exciting line of research, that wields insightful answers. But for the sake of treating people suffering from tinnitus, here, today, that's utterly irrelevant. Tinnitus is tissue damage, the brain will renormalize if the related tissue does, and we should be focusing on that.
So, what can solve the issue? Basically nothing that seems to be attempted here, and that is what motivated me to make this post, because it is frustrating to see so much effort throw into things that clearly will not work. If you go to the treatments section of this forum, you'll find an ocean of ideas that are attempted regardless of clearly standing no chance of doing anything at all. In order:
- Cannabidiol: how on Earth will this fix lost hair cells? I understand this can be a psychological relief, but that's about it.
- Antidepressants: would you fix a stuck knife by treating anxiety?
- Clonazepam: would you fix a stuck knife by treating anxiety?
- Transcranial Magnetic Stimulation: would you fix the pain caused by stuck knife by rewiring the brain?
- TRT, Lenire, etc.: would you fix a stuck knife by gently massaging the area to help your brain ignore the pain?
- Steroids: I mean, fair, that could help once you remove the knife, but unlike muscle and skin, ear hair cells don't regrow
I mean, these treatments aren't bad per se, they might be helpful with anxiety, sleep etc., but they're objectively not addressing the problem, and what is specially frustrating is the complete lack of anything that stands a chance of doing so. And, the thing is, there are technologies that could actually help, and these technologies exist, today, or could be created with some effort! The two most logically promising approaches would be to either stimulate ear hair growth via gene therapy, stem cells, small molecules or something similar; or, alternatively, emulating the lost cells via a direct implant that was an order of magnitude smaller and more precise than hearing loss implants. The point is, both of these are plausible solutions, and are under the reach of current technology. The later is even more of a cellular-scale engineering problem than a medical problem. Yet, other than FX-322, there seems to be nothing being done in their directions. We're not making progress!
Now, I realize some of the things I said are probably naive, while others may be obvious to most of you. Regardless, these things are not obvious to me; it seems like most of these points make sense, yet are, for some reason, overseen by everyone here. If that's the case, I'd love to hear what is wrong with my line of thought. And, if not, I wonder why we're doing it so wrong, and what could be done to push the field to the right direction.
First of all, let's be rational about a point: Tinnitus is NOT a brain disease. I'm not sure why there is such a huge momentum in that direction, but that is only detrimental to our goals. The overwhelming majority of sufferers report that tinnitus started due to ear related issues, and there is no evidence nor any logical argument to support that "it starts on the ear, and then moves into the brain". The reason this hypothesis is so popular is beyond my comprehension. There is no other disease that starts with physical damage and then becomes brain centered, even after physical resolution. In fact, the opposite is common: patients with phantom finger syndrome report pain relief once they have the lost member transplanted, for example. Let's be clear: there is zero precedent for such a biological mechanism. It is not a thing that happens. All the models supporting that tinnitus is a brain disease have simple, logical explanations under the hypothesis that it is merely an ear issue, but these seem to be somehow completely overseen. For example, it is true that some people report both improvement or exacerbation of tinnitus after auditory nerve section. But how is that surprising, or indicative of a brain disease? If someone's tinnitus was caused by over-activity of ear hair cells, then severing auditory nerves would stop it. If, on another individual, it was caused by central compensation to under-activity of these ear hair cells, then severing the nerves would exacerbate it. Both of these are perfectly consistent with tinnitus being an ear issue. None requires a brain-centered explanation. And, most importantly, both would be solved once the ear functioned normally again. This suggests healing the ear, not the brain, should be the focus. Am I missing something obvious here? Another argument for the brain as the cause is the occurrence of tinnitus without hearing loss. Yet, this can be explained by simply remembering that people are different. Some are even immune to AIDS. It would be surprising to no-one if some people were, simply, not prone to tinnitus, regardless of ear health. This doesn't indicate that tinnitus is a brain disease in any logical way.
Yes, it is true that tinnitus causes detectable brain changes, but so does anything that affects you. If you had a knife stuck in your arm, you'd be in constant, insufferable pain, and that would be strongly detectable in any brain exam, fMRI or ECG. That doesn't imply a knife is a brain issue, and, most importantly, trying to fix it by rewiring the pain circuits in the brain would be such an utterly stupid approach that no serious doctor would suggest it with a straight face. Yet, that seems to be exactly how we're approaching tinnitus. Why? Perhaps because the damaged tissue is too small to be detected, so people jump to the conclusion that it is on the brain? Perhaps because researching the brain is cooler, and wields more prestige? Let's be very clear: Tinnitus is ear tissue damage, and this obsession for treating tinnitus as a brain is counterproductive, because it moves time and money into an endless attempt to understand the complex workings of the auditory cortex, which is not only extremely hard (as in, Quantum-computer, Mars-mission hard), but is also as utterly unnecessary, since, let's be honest, almost all tinnitus sufferers would have the issue resolved if their ear hair cells functioned normally again. It is almost certain that the brain simply renormalize, in the same way that patients with phantom finger syndrome do. Don't get me wrong; models of tinnitus, including hyperactivity models, filling-in, predictive coding, and all the like, are valuable for the sake of understanding how the human brain works. That is an exciting line of research, that wields insightful answers. But for the sake of treating people suffering from tinnitus, here, today, that's utterly irrelevant. Tinnitus is tissue damage, the brain will renormalize if the related tissue does, and we should be focusing on that.
So, what can solve the issue? Basically nothing that seems to be attempted here, and that is what motivated me to make this post, because it is frustrating to see so much effort throw into things that clearly will not work. If you go to the treatments section of this forum, you'll find an ocean of ideas that are attempted regardless of clearly standing no chance of doing anything at all. In order:
- Cannabidiol: how on Earth will this fix lost hair cells? I understand this can be a psychological relief, but that's about it.
- Antidepressants: would you fix a stuck knife by treating anxiety?
- Clonazepam: would you fix a stuck knife by treating anxiety?
- Transcranial Magnetic Stimulation: would you fix the pain caused by stuck knife by rewiring the brain?
- TRT, Lenire, etc.: would you fix a stuck knife by gently massaging the area to help your brain ignore the pain?
- Steroids: I mean, fair, that could help once you remove the knife, but unlike muscle and skin, ear hair cells don't regrow
I mean, these treatments aren't bad per se, they might be helpful with anxiety, sleep etc., but they're objectively not addressing the problem, and what is specially frustrating is the complete lack of anything that stands a chance of doing so. And, the thing is, there are technologies that could actually help, and these technologies exist, today, or could be created with some effort! The two most logically promising approaches would be to either stimulate ear hair growth via gene therapy, stem cells, small molecules or something similar; or, alternatively, emulating the lost cells via a direct implant that was an order of magnitude smaller and more precise than hearing loss implants. The point is, both of these are plausible solutions, and are under the reach of current technology. The later is even more of a cellular-scale engineering problem than a medical problem. Yet, other than FX-322, there seems to be nothing being done in their directions. We're not making progress!
Now, I realize some of the things I said are probably naive, while others may be obvious to most of you. Regardless, these things are not obvious to me; it seems like most of these points make sense, yet are, for some reason, overseen by everyone here. If that's the case, I'd love to hear what is wrong with my line of thought. And, if not, I wonder why we're doing it so wrong, and what could be done to push the field to the right direction.
