Curing Tinnitus ...

[Dr. Nagler]

Hi All -

In another thread @Mpt wrote about his mom, a teacher who had tinnitus but was unaware of it until another teacher missed a few days of school because of her own tinnitus. You can read the details here:

https://www.tinnitustalk.com/threads/interesting-conversation-with-my-mom.4135/

Anyway, that got me thinking. Back in 1953 Heller and Bergman did an interesting experiment that has since been duplicated a couple of times. They took eighty healthy adults with normal hearing and no history of tinnitus. They put them one by one in an audiogram booth with the same instructions every one of us is familiar with: when you hear the sound I put into your headphones, push the button. And very shortly 94% of them pushed the button. But nobody ever introduced a sound into their headphones! What these folks heard upon purposely listening hard for sound in a silent environment was their own tinnitus that they never before knew they had. You might think it was their imagination, but when asked to describe the sound they heard through their headphones, the variety of descriptions - hum, ring, buzz, crickets, hiss, roar, etc. - was the same as folks who have severe intrusive tinnitus describe.

So some degree of tinnitus - even tinnitus that is so innocuous that people are totally unaware of it unless straining to hear it in a silent room - is a normal physiological phenomenon. (Makes sense, when you think of it, because the auditory system is one of the most active systems in the body.) Now obviously folks on this board do not have just a little tinnitus; they have a lot of tinnitus. But let's suppose you are a researcher searching for a cure for tinnitus. How do you cure something the mere presence of which is normal? Do you just cure tinnitus of a certain loudness? And if that's the case, how loud is loud? Isn't it sort of a moving target?

I do not have any answers here. Just something to think about.

Stephen Nagler

 

[MattK]

Hi All -

In another thread @Mpt wrote about his mom, a teacher who had tinnitus but was unaware of it until another teacher missed a few days of school because of her own tinnitus. You can read the details here:

https://www.tinnitustalk.com/threads/interesting-conversation-with-my-mom.4135/

Anyway, that got me thinking. Back in 1953 Heller and Bergman did an interesting experiment that has since been duplicated a couple of times. They took eighty healthy adults with normal hearing and no history of tinnitus. They put them one by one in an audiogram booth with the same instructions every one of us is familiar with: when you hear the sound I put into your headphones, push the button. And very shortly 94% of them pushed the button. But nobody ever introduced a sound into their headphones! What these folks heard upon purposely listening hard for sound in a silent environment was their own tinnitus that they never before knew they had. You might think it was their imagination, but when asked to describe the sound they heard through their headphones, the variety of descriptions - hum, ring, buzz, crickets, hiss, roar, etc. - was the same as folks who have severe intrusive tinnitus describe.

So some degree of tinnitus - even tinnitus that is so innocuous that people are totally unaware of it unless straining to hear it in a silent room - is a normal physiological phenomenon. (Makes sense, when you think of it, because the auditory system is one of the most active systems in the body.) Now obviously folks on this board do not have just a little tinnitus; they have a lot of tinnitus. But let's suppose you are a researcher searching for a cure for tinnitus. How do you cure something the mere presence of which is normal? Do you just cure tinnitus of a certain loudness? And if that's the case, how loud is loud? Isn't it sort of a moving target?

I do not have any answers here. Just something to think about.

Stephen Nagler

When my ENT officially diagnosed me with tinnitus, he actually told me that he has it too and that his is really loud. But the thing is, it doesn't bother him at all. He told me it's because he's had it ever since he was a little kid, and he didn't know that wasn't normal to hear it. He thought everyone had it. He said it wasn't until he was in college that he learned that it wasn't a normal thing. So lucky thing for him was that he had it at such a young age that he didn't know what was supposed to be normal. Unfortunately that isn't the case when you develop it as an adult who is old enough to know this isn't "normal".

That's an interesting study you mentioned. But could it be explained by temporary tinnitus? I've heard that the brain doesn't like "silence" and when put in a completely silent situation, most people will develop temporary tinnitus until put back into a normal situation. Could that be what's happening here? In fact, this concept has been talked about briefly in the Youtube video, "Tinnitus the Loud Silence".

 

[citigirl13]

I am not sure there can ever be a "cure" for T - however, surely there will be a treatment that can lower the volume of T. As I mentioned in Mpt's thread, I believe most people have some degree of T, but theirs is quite low. I think if you have a sudden increase in volume it makes it more worrying.

That being said, some people have T and yet have never been to a doctor about it. For some people it is not a big deal and they can habituate to it quickly. I think controlling anxiety is key. However, I appreciate there are some people with very loud T which can increase their anixety levels. When it is loud and disrupts your hearing/sleeping patterns etc, it can be very stressful.

 

[Mpt]

Dr Nagler,

The story of my mom actually brought up another question in my mind about people having tinnitus "switch ears". When I first got tinnitus I had an infection, was on azithromycin, and had just gotten done having my ear syringed. I first heard the ringing in my left ear only (if it was in my right ear it was very faint)-- after a few days I was put on a course of prednisone and the ringing in my left ear died down considerably, then when I was tapering off I noticed a ringing in my right ear when I put my head on the pillow one night for the first time-- and to this day my left ear is nearly silent- if I plug it with a finger I can very rarely hear a ring-- sometimes I hear nothing--its basically very quiet- if this was my T I would consider myself healed, while my right ear rings 24/7 now-- it has been very puzzling to me that the ear that initially rang is silent and the other side is the ear that I hear T out of now- I wonder that in the first few weeks when I was hyper vigilant if the volume got turned up on a pre-existing noise that I always had

 

[Beth]

Hi, that's an interesting topic. I posted in an earlier thread that I thought it is useless looking for a drug to 'cure' tinnitus as we are juast listening to the perfectly normal sounds (albeit amplified) of ourselves. If for most people, it is the normal sounds in the auditory system, blood flow through the ears, somatic sounds etc then how could that be cured unless those actions were stopped? Brain death may do it but I think the side effects of that may prove unpopular.

Surely the best 'cure' is to find a way to reduce our negative reaction so that we become like the folks who have been aware of it all their lives but couldn't care less. With my limited knowledge of tinnitus (so I'm always happy to be corrected as I want to learn as much as pos) I think that the biggest problem for a lot of tinnitus sufferers is that they will settle for nothing less than a cure. If we hear it and it bothers us as much as grass is green bothers us then that for me is bliss.....

There will be people I suppose who have a physical reason for the sound (?) which may or may not be able to be cured but I don't see any way forward for most other than changing reaction and attitude and when I can do both I probably won't be here any more!!

 

[Dr. Nagler]

That's an interesting study you mentioned. But could it be explained by temporary tinnitus? I've heard that the brain doesn't like "silence" and when put in a completely silent situation, most people will develop temporary tinnitus until put back into a normal situation. Could that be what's happening here?

I don't think so, @MattK, because audiology booths aren't really soundproof. They are not actually silent; they are just very quiet. So if what you propose is true - that for the folks in the experiment their brains somehow "turned on" their tinnitus in silence, that wouldn't explain the detection of tinnitus in relatively quiet (but not totally silent) environments. I think it's much more probable that everybody has some degree of tinnitus all the time, and as you listen for it purposely it becomes more and more apparent the quieter the environment.

But who knows?

I was merely pointing out one of the difficulties that researchers face when trying to find a cure.

Stephen Nagler

 

[Dr. Nagler]

Surely the best 'cure' is to find a way to reduce our negative reaction so that we become like the folks who have been aware of it all their lives but couldn't care less.

Well, that's not actually a cure, @Beth, but in 2014 it seems to me to be the most practical approach. And in my opinion that will continue to be the case until, if ever, an actual cure is developed.

Too bad so many tinnitus sufferers reject the types of approaches you refer to as unacceptable - because they are not true cures.

Stephen Nagler

 

[tom68]

I don't see why the fact some noise may or not be normal is a problem in itself - if a cure is possible then why not cure it for anyone that finds it impacts negatively on their life?

Beth - I don't see why we shouldn't try and cure it - if a high pitched tone is a normal physiological sound how come I went 45 years without being able to hear it? That's not to say we shouldn't use strategies to make the best of it, to cope, to tune out the sound, but not give up trying to eliminate it. Put it this way - for years I lived near a main road - I thought the noise didn't bother me - I wasn't consciously aware of it all that much - but when I went to the countryside and listened to real silence I realised what I missed out on most of the time.

 

[Mpt]

Beth...

I've talked to several people who received AM-101 after noise trauma, who had loud T, and they claimed that within a month of treatment they heard basically no sound unless they were in a totally quiet environment and concentrating on listening to it--- not saying that this is a "cure", just pointing out how slippery "testing" a drug on something as subjective as T can be--- but it seems like its unlikely that it was habituation for these individuals either-- maybe it was a placebo effect that made them think they were better and the volume turned down, maybe the drug turned down the volume on the nerve and they were left with some small residual cochlear or "brain" t, which is the faint sound they now describe now, I don't know-- I know the volume in my left ear has gone down to probably the level they describe without any treatment, while volume in my right ear is louder

 

[Grace]

Yeah seems everyone has it to a degree and i agree how there prob isnt ever gonna be a full cure cause its our body making the sounds naturally but for T people like us that cant hear silence at at i think they can find something in the future to settle it down to where we hear silence like others. But any decrease would be amazing tooo!

 

[MattK]

Too bad so many tinnitus sufferers reject the types of approaches you refer to as unacceptable - because they are not true cures.

Yeah, I think that is a part of the depression/anxiety that comes with tinnitus, especially at first. Having mine a relatively short time, I can really frustrate myself by just thinking about an event before Feb 13 2014, and thinking, "I didn't have tinnitus at that time... and that wasn't even long ago." It wasn't until I came to a point of "acceptance" that I really considered approaches to help me habituate. I guess in a sense, conceding to go through with these habituation approaches is sort of like conceding that there is any chance of getting back to "normal".

I understand that tinnitus is very difficult for doctors to treat, and I can understand why, except in a few circumstances. But, if we can develop treatments to help people who have mental disorders like hearing voices, or help people who have brain malfunctions like seizures, then why not be able to eventually help actually reduce the sound of tinnitus? I'm not talking that it's just as loud but you just don't pay attention to it. But it does seem like there should be a possibility of legitimately turning down the volume.

There are times in my personal case, where my tinnitus is more silent than other times. And this is not due to me not noticing it, or because of ambient sounds. How do I know this? Because when I wake up in the mornings, sometimes my tinnitus is very faint. Almost to the point where I wonder if it is there. I have even sat in quiet rooms in the morning to intentionally try to hear my tinnitus, but I have to REALLY listen. But as the day goes on, it gets louder. Sometimes I might not be thinking of my tinnitus and will be in a situation where there is a lot of ambient noise and suddenly I'll notice my tinnitus. Or sometimes I'll come back home from work and step into a quiet room at home, and my tinnitus is considerably loud... I don't even have to "try" to listen for it.

So, if my tinnitus can have very silent moments, then theoretically, there should be a way to make that the norm. We mignt not know how to do that at present time, but in theory, my tinnitus should be able to stay "silent". If it was how it is on some morning 24/7, then I would consider myself cured from tinnitus.

 

[DebS]

I agree with you MattK. I can hear my tinnitus almost all the time, but when it's relatively low, I can pretty much ignore it and feel good about the day. But when I get a screeching loud day, it's almost like a physical pain or migraine; I get a headache like a piercing feeling in my skull, tight neck, and even my eyes ache. If only there was a pill to make the volume go down.

 

[James]

I'd agree, Tinnitus is a normal body function. But how did mine get so LOUD? It won't quiet down.
I agree with @Beth, it will stop when I'm dead.

I think the basic definition is off, even those TRT guys say it's a "perceived sound".
It's not a sound at all. Sounds are what we hear externally. It's in the nervous system, (my layman's opinion, (Btw, I know very little about it all).

Researches and Doctors get paid for dealing with difficult issues, that's their job.
I don't think it's a moving target, even if it is so what. The understanding is there, right? The next step is what's needed. I'd enjoy a cure or a better medicine, nothing wrong with having challenges in science and medicine. Maybe someone with a big needle can inject something.

 

[Valentin]

As i said in another post, i used to stay in soundproof musician room and actually heard nothing exept me turning the pages of the magazine i was reading.

what those people might have heard is something so faint that even in a soundproof room they had to purposely listen to it, it might very well be the bloodflow or the sound of them inhaling air but nothing like what we 'hear'.

 

[dan]

As i said in another post, i used to stay in soundproof musician room and actually heard nothing exept me turning the pages of the magazine i was reading.

what those people might have heard is something so faint that even in a soundproof room they had to purposely listen to it, it might very well be the bloodflow or the sound of them inhaling air but nothing like what we 'hear'.

An experiment was also done where they instructed normal people with no tinnitus to constantly wear earplugs for a week or more. At the end of experiment, some people developed tinnitus in the plugged
ear(s), which went away after cessation of experiment.

Therefore it is safe to conclude that tinnitus results from plastic changes in the brain in response to loss of peripheral auditory input, which in this case was reversible. In our case it is a lot more permanent.

 

[jchinnis]

I think tinnitus has two components. Usually there is some sort of impairment of the auditory system that increases the normal amount and type of noise. And usually there is a changed level of monitoring and increased detectability of the noise.

A cure would mean reducing the noise to a normal (non-tinnitus) level, and perhaps also doing some sound-based or cognitive therapy to return the monitoring to a normal level. After the cure, one would still hear tinnitus if tested a la Heller and Bergman, but one wouldn't notice it ordinarily.

Many physiological and psychological signs and symptoms are like tinnitus in having a normal level and an abnormal level. Body temperature or blood glucose are examples. We don't say that the disease hasn't been cured if there is still a temperature or blood glucose that can be measured...

 

[jchinnis]

[Techy alert!] There's actually a good model for this sort of thing from psychophysics and decision theory known as the theory of signal detectability. If you designed a computer system to determine when a certain type of sound was present, you would be faced with the need to specify the tradeoff between different types of errors. Detecting the sound when it was not there might not be as bad as not detecting it when it was.

If you shift the costs of those errors (how much you care about them), then the computer will change how often it reports the sound as present. There's no doubt in my mind that we do the same thing internally, as the theory is quite general

(Another parameter in the mathematical theory is known as d-prime, which is a measure of how different the target sound and the other sounds are. I think that probably usually shifts as a result of certain changes to the auditory system.)

Jim

 

[dan]

"A cure would mean reducing the noise to a normal (non-tinnitus) level, and perhaps also doing some sound-based or cognitive therapy to return the monitoring to a normal level. After the cure, one would still hear tinnitus if tested a la Heller and Bergman, but they wouldn't notice it ordinarily." Jim Chinnis

OP, this will finally answer your question as to what a cure for tinnitus would mean. I am going to copy it, so every time you (or another) will ask it, I would paste it. Please remember it.

 

[Beth]

I too would love a cure and have prayed many nights for there to be one but I see a difficulty finding a cure for what is a natural noise for most, however irritating. When I first got T I felt that only an absolute cure would do, I wasn't even interested in any therapy that took time; I wanted something immediately and a permanent cure would be the only thing I'd settle for. Years down the road I now know that that is not likely and although I wish it for everyone who suffers with T, I think we have to make the most of all the excellent therapies out there and do what we can to help ourselves and get on with the life we put on hold while waiting for that cure.

I remember talking to a lady who had tinnitus which was very loud but she'd habituated (in my looking for a cure days) and she said it didn't bother her at all. I found that hard to believe and said, 'if the opportunity came along for something to make it go away for ever, surely you'd take it?' She thought for quite some time and said, 'Do you know, I don't know if I could be bothered. I get a headache three or four times a year and have to take a pain killer but I wouldn't make any efort to stop them because it's not a problem and I feel the same way about my tinnitus. It's there but so what.' I have always rememberd that conversation because at the time I did not believe her, but now I do.

 

[dan]

@Beth
"I remember talking to a lady who had tinnitus which was very loud but she'd habituated (in my looking for a cure days) and she said it didn't bother her at all. I found that hard to believe and said, 'if the opportunity came along for something to make it go away for ever, surely you'd take it?' She thought for quite some time and said, 'Do you know, I don't know if I could be bothered."

Did you ask her to qualitatively describe her tinnitus? Does she hear it while driving with the windows down playing music?
Keep in mind that for one person LOUD tinnitus can mean any tinnitus-depending on one's reaction to it.

 

[Dr. Nagler]

I don't see why the fact some noise may or not be normal is a problem in itself - if a cure is possible then why not cure it for anyone that finds it impacts negatively on their life?

@tom68, the issue isn't who should be cured once a cure is found. That one's pretty obvious.

The issue has to do with the ability of researchers to find that cure in the first place. If, as the experiment suggests, the presence of some degree of tinnitus is a normal physiological phenomenon, then how does one go about finding a cure for something that everybody has? I don't necessarily see this problem as a deal-breaker for researchers, but it sure makes things more challenging for them.

Stephen Nagler

 

[cullenbohannon]

Personally even if my t was very faint and i was habituated I would still want mine gone if I had the chance. I understand that habitation means you don't react either way. But you would gain silence if it was gone which is something I think we would all appreciate if we had it again. I do think there will be effective treatments some in trial phases already proving to be somewhat effective. Research to t is new so I'm optimistic

 

[Dr. Nagler]

I think the basic definition is off, even those TRT guys say it's a "perceived sound".

As I see it, @James, the problem isn't that the definition is off. From my perspective the problem is that the research community has yet to agree on a uniform definition in the first place. Everybody seems to look at it a little differently.

Stephen Nagler

 

[Dr. Nagler]

As i said in another post, i used to stay in soundproof musician room and actually heard nothing exept me turning the pages of the magazine i was reading.

Right. But were you purposely listening for anything you could possibly hear like those in the experiment were doing?

Stephen Nagler

 

[Dr. Nagler]

A cure would mean reducing the noise to a normal (non-tinnitus) level, and perhaps also doing some sound-based or cognitive therapy to return the monitoring to a normal level. After the cure, one would still hear tinnitus if tested a la Heller and Bergman, but one wouldn't notice it ordinarily..

Agreed. I myself have always defined a cure as the lasting inability to detect tinnitus upon hard listening in the range of one's normal auditory environments. So we define it similarly - since an audiology booth (a la Heller and Bergman) is hardly within the range of normal auditory environments.

Of course, similar to the fact that in all these years the research community has yet to come up with a uniform definition of "tinnitus" (see Post #23) lies the fact that they have not yet come up with a uniform definition of "cure" as related to tinnitus. Again, not a deal-breaker - but it sure makes things more difficult!

As I see it anyway.

Stephen Nagler

 

[Dr. Nagler]

"A cure would mean reducing the noise to a normal (non-tinnitus) level, and perhaps also doing some sound-based or cognitive therapy to return the monitoring to a normal level. After the cure, one would still hear tinnitus if tested a la Heller and Bergman, but they wouldn't notice it ordinarily." Jim Chinnis

OP, this will finally answer your question as to what a cure for tinnitus would mean. I am going to copy it, so every time you (or another) will ask it, I would paste it. Please remember it.

@dan, Jim and I agree on how to define cure as related to tinnitus (see my post #25). That's not the problem. The problem has to do with getting the research community to agree on a definition of cure as related to tinnitus. Hell, they cannot even agree on a definition of what it is they are trying to cure in the first place!

Stephen Nagler

 

[jchinnis]

I don't think tinnitus is all that special in that regard. Experts don't agree on what normal blood pressure is either. They can't agree on when a drug makes it normal again. The experts don't agree on what it is they are trying to cure there, either.

But there are still effective drugs for hypertension.

 

[Dr. Nagler]

I don't think tinnitus is all that special in that regard. Experts don't agree on what normal blood pressure is either. They can't agree on when a drug makes it normal again. The experts don't agree on what it is they are trying to cure there, either.

But there are still effective drugs for hypertension.

Right.

As I was careful to point out in Post #25, in my opinion the failure of the research community to come up with a definition for tinnitus and a definition for cure is not a deal-breaker. It just makes things more difficult.

And by the way, researchers have not come up with a cure for hypertension either. All they have found is drugs and other approaches to help manage it.

Stephen Nagler

 

[tom68]

Well, that's not actually a cure, @Beth, but in 2014 it seems to me to be the most practical approach. And in my opinion that will continue to be the case until, if ever, an actual cure is developed.

Too bad so many tinnitus sufferers reject the types of approaches you refer to as unacceptable - because they are not true cures.

Stephen Nagler

Do so many sufferers reject them, or do they just reject them as being as good an outcome as a cure?

 

[Dr. Nagler]

Do so many sufferers reject them, or do they just reject them as being as good an outcome as a cure?

You make a good point, @tom68.

I've been involved with the on-line tinnitus support community for some 18 years now, and I would say it is as much the former as the latter. But that's just my take on it.

Certainly that's the attitude of much of the ENT community, when they tell tinnitus sufferers that nothing can be done for them.

Stephen Nagler