Curing Tinnitus ...

[bill 112]

Dr.Nagler what you said in your comments I absolutely agree with you....I remember way back before my T days sitting in a very quiet room waiting for a lift from football training.The room was completely silent and I remember sitting there bored and I started to clench my jaw really tight and I could hear this very very faint hissing whenever I clenched my jaw.So I covered my ears and done it again and yet again this extremely faint hissing sound would appear which was barely audible youd have to really strain to hear it.I remember laughing and going thats weird(little did I know)but it would always go back to pure silence when I stopped.But as far as it being normal im not so sure.I had to clench my jaw really tight for about 5 minutes before the faint hissing would appear and then completely disappear again.I asked a couple of my friends to try this and they clenched their jaw for about 10 minutes and heard absolutely nothing just silence even in the quietest of rooms.When I was last talking to my audiologist at my last visit he was trying to explain T to a relative of mine his exact words were"Tinnitus isnt an ordinary human function its without doubt a disorder of the auditory pathways to some degree we have conducted tests at UCL to prove this is not a physcological problem but a physiological problem which we proved beyond doubt.We had two volunteers one with T and one without and the results were exactly what we were hoping for....a huge difference in key auditory areas of the brain between the T patient and the non T patient.On our scans we could see hyperactivity in these parts of the brain compared to the non T patient which indicated a disorder to some degree.On a few scans it was that clear it was like physically looking at T with your own two eyes thats how conclusive the tests were.These tests were performed on many participants all with similar results none of the particapents had any measureable hearing loss.As for curing it....well thats the next challenge"his words exactly and I honestly do believe this is a curable condition how else do you explain DBS patients T disappearing it proves T can quietened or banished altogether its just whats the safest and most effective way is what I suspect is the real challenge.As for conscious perception I agree also for example imagine putting someone one in a sound proof and telling them you are doing an experiment on how many times they move their legs in 20 minutes.When you return you ask them how many times did you move your legs and they will most likely respond with an accurate answer then ask them did you hear anything in the last twenty minutes which they will most likely say no.Now this time ask them to stay in the same room and take note of every sound they hear and your guarenteed when you return they will have a list as long as your arm because they are consciously looking for sound.HaHa sorry for the essay guys

 

[jazz]

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.

@jchinnis Welcome to TT!

What you observed above is so true....

To me, individual variability is the main factor complicating therapeutic advances. If you look at rTMS studies, for example, some researchers are now citing individual variability as significant. Such observations, of course, are preferable to dismissing therapeutics like rTMS as ineffective for tinnitus. Distinguishing between responders and non responders includes an analysis of what does and does not work and why. Whether the factors affecting individual variability--for example, etiology, duration, gender, limbic involvement, age of onset, etc.--will ever be formulated into treatment protocols remains to be seen. Developing a wide range of therapeutics is the only answer to overcome individual variability. It doesn't matter if these therapeutics are preventative, curative or ameliorative. All are needed.

In the future, tinnitus will be a curable. For those who currently suffer, moreover, I believe new therapeutics will render their tinnitus imperceptible.

 

[erik]

Maybe we don't need a cure....just a way to find the volume knob and turn it down some....

 

[mick1987]

I agree with erik, turning down the volume would be enough for a lot of people, in fact wouldn't it be easier to focus on treatment first, cure later?

 

[Grace]

Yeah i agree if they find a way to turn it up and down that would be great! Ofcorse everyone would be turning it wayyyy downn! Lol

 

[jazz]

I agree with erik, turning down the volume would be enough for a lot of people, in fact wouldn't it be easier to focus on treatment first, cure later?

Most research funds, I believe, are currently allocated to relief. Many funds specifically are being allocated to various psychological treatments, like TRT, that truly do help tinnitus sufferers. Even invasive technologies--like vagus nerve stimulation (e.g., Micro Transponder)--are not designed to cure tinnitus, but rather to reduce its intensity and your awareness of its sound.

So, yeah, turning the volume down is big goal among researchers!

 

[mick1987]

Most research funds, I believe, are currently allocated to relief. Many funds specifically are being allocated to various psychological treatments, like TRT, that truly do help tinnitus sufferers. Even invasive technologies--like vagus nerve stimulation (e.g., Micro Transponder)--are not designed to cure tinnitus, but rather to reduce its intensity and your awareness of its sound.

So, yeah, turning the volume down is big goal among researchers!

Oh...OK..lol..I'm not one for keeping updated on research.

Hey I noticed you and I got tinnitus the same time august 2012, horrible month and year! Luckily doing a lot better now 19 months later, how about you?

 

[MikeA]

<snip>

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.

<snip>

Stephen Nagler

This, I feel is one of the keys to habituation; the knowledge the some perceived sound, in the absence of external source is, as Dr. Nagler says, a normal physiological phenomenon.

 

[jchinnis]

@jchinnis Welcome to TT!

What you observed above is so true....

To me, individual variability is the main factor complicating therapeutic advances. If you look at rTMS studies, for example, some researchers are now citing individual variability as significant. Such observations, of course, are preferable to dismissing therapeutics like rTMS as ineffective for tinnitus. Distinguishing between responders and non responders includes an analysis of what does and does not work and why. Whether the factors affecting individual variability--for example, etiology, duration, gender, limbic involvement, age of onset, etc.--will ever be formulated into treatment protocols remains to be seen. Developing a wide range of therapeutics is the only answer to overcome individual variability. It doesn't matter if these therapeutics are preventative, curative or ameliorative. All are needed.

In the future, tinnitus will be a curable. For those who currently suffer, moreover, I believe new therapeutics will render their tinnitus imperceptible.

Jazz, thanks for the welcome. I agree with you in part. There are unquestionably a number of different routes to intrusive tinnitus. And I'm sure that some of them will eventually have different cures or effective treatments than others have. But it does seem that an awful lot of tinnitus probably starts with cochlear damage, even if the damage is rather slight. And I suspect that a most tinnitus will be found to involve the same causal processes and pathways, differing at the finer level, but--hopefully--treatable by the same approach.

Of course, if there are a lot of different types of tinnitus that behave differently when treatments are tested, then the randomized trials will have to be large. Either that, or the inclusion criteria will have to be very stringent in order to reduce the variability of responses.

Some tinnitus trials have, in fact, been very large for that reason and others have deliberately looked for possible subgroups in the response patterns. There was a British study of ginkgo that is an example of the former type of trial, and Dr. Billy Martin (then at Oregon Health Sciences University) certainly tried his best to find a subgroup that would benefit from acamprosate. Both found no effects of the treatments, unfortunately.

Jim

 

[Dr. Nagler]

Most research funds, I believe, are currently allocated to relief. Many funds specifically are being allocated to various psychological treatments, like TRT, that truly do help tinnitus sufferers. Even invasive technologies--like vagus nerve stimulation (e.g., Micro Transponder)--are not designed to cure tinnitus, but rather to reduce its intensity and your awareness of its sound.

So, yeah, turning the volume down is big goal among researchers!

First of all, TRT is not a psychological treatment. At least the TRT community doesn't see it that way.

That aside, most ATA and NIH research funds are devoted to the ultimate development of a cure. I cannot speak to corporate investments. As far as TRT research goes, ATA hasn't funded a TRT study since 1996!!!

Stephen Nagler

 

[Champ]

First of all, TRT is not a psychological treatment. At least the TRT community doesn't see it that way.

That aside, most ATA and NIH research funds are devoted to the ultimate development of a cure. I cannot speak to corporate investments. As far as TRT research goes, ATA hasn't funded a TRT study since 1996!!!

Stephen Nagler

Interesting, did not know that. Thank you for that information... I always thought TRT studies were funded a lot by the ATA

 

[Penelope33]

Ive read that tinnitus is the sound of the normal brain activity that we all have , but for tinnitus to become continual and heard all the time that something has triggered the sounds into our concoious, the hearing nerves are more sensitive.... How on earth this can be rectified I wonder, I hope....
I also wonder the difference of those with noise induced t, whose hair cells are damadged, to those who have not had it brought on by loud noise, are the inner ears still damadged in the same way? How could they whoever they are, know? Or how to fix it.

 

[Beth]

Wow! So many questions and answers....it's such a complicated subject. A couple of years before I got tinnius I had an ear infection and had my ear packed with gauze with antibiotic on it. No problem, and the infection went but I remember being on holiday in Scotland, we'd rented a cabin for the week and I have never been anywhere as quiet. It was wonderful and I remember lying in bed on my good ear so that I would hear absolutely nothing and that lasted for the week we were on holiday. I heard pure silence. I had a friend who thought silence was 'noisy' and I didn't understand her but maybe she had tinnius and didn't know it. I often think about that wonderful silence and mourn its loss. Why can't people who've had that get back to it? It does make me wonder if it' something physical but then I haven't any noise damage and good hearing for my age so what's going on with us all?!!

 

[Valentin]

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

Stephen Nagler

i had nothing to listen to while being in these rooms, i was(unfortunately unable nowadays) sleeping using earplugs for more than 10 years and never heard anything in my ears, no matter how tired or drunk i was, but that was the past....

 

[Ray Seddon]

Hi Bill 112 - I am a 30-year sufferer (long-term noise induced - tractors and rifles) and was interested to read your experience with your jaw - I regularly visit a chiropractor for readjustment of a neck problem - he is good and has helped me with that immensely. Couple of visits ago I mentioned my T and he did some adjustments to my jaw (apparently mine is a bit lop-sided - well that explains why I don't do selfies!!) - the jaw adjustment didn't seem to do anything but he told me to exercise it by pushing on one side and applying opposite pressure with my jaw to counter the push. This caused an incredible increase in volume (same sound) of my T, so much so that I am scared to continue with this, as the volume is just bearable now and I don't want to do anything to exacerbate it. But it is interesting - T seems to be affected by this movement (or perhaps misalignment) of my jaw. I can't go anywhere with this as I said I'm not game to pursue the exercises, but it is of interest that you have similar experience with clenching your jaw.
Cheers - I will keep masking - countless thanks to Stephen's sounds on this site!!
Ray

 

[Tenna]

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".

You're making an interesting point. Yes he has had time to adjust yes he has super loud tinnitus, however the thought of its' normality was clearly decisive, not the actual wrong and not the loudness of the wrong.
As some extent of buzzing and ringing is considered perfectly normal to which no cure is needed, would a cure work for him when his non-normal ringing (t) is his normality? And can something even be defined as a cure, when he considers the his super loud t, as normal health.

 

[Dr. Nagler]

i had nothing to listen to while being in these rooms, i was(unfortunately unable nowadays) sleeping using earplugs for more than 10 years and never heard anything in my ears, no matter how tired or drunk i was, but that was the past....

I understand. What I am saying is that unless you were purposely listening for a sound under those conditions, you would not have been duplicating the conditions of the Heller & Bergman study.

Regardless, I am so pleased that that was in the past!

Stephen Nagler

 

[Steve]

If tinnitus is in our head and the listener refuses to hear it does that tinnitus cease to exist? (thinking of trees and forests here)

None of us are in that much control of our minds unfortunately, but it seems logical that we should be able to de-classify the threat and lose the intensity of the noise back to virtual zero. We have plenty of people who have lowered their perception of it by using psychological (or Neurophysiological) methods, but the majority don't perceive it as any sort of cure. Most search for an instant holy grail instead, total eradication.

When I think back to the statement of ignorance from my ENT 11 years ago, it probably had a much deeper philosophical point (that he certainly didn't mean to convey). The best cure that we have at the moment is possibly found in 'learning to live with it', however that applies to us and whichever current therapy works best to achieve that.

For me perception is the massive wall we have to climb, getting to tinnitus being a non-entity because it has no function or purpose to us.

 

[Dr. Nagler]

If tinnitus is in our head and the listener refuses to hear it does that tinnitus cease to exist? (thinking of trees and forests here)

As I see it, @Steve, you cannot refuse to listen to your tinnitus, but you can become more and more unaware of it over time.

So let me rephrase your question. Since you are the only person who hears your tinnitus, do you even have tinnitus during the times that you happen not to be unaware of it?

Your trees falling in a forest analogy is a good one.

The philosopher would say that if nobody hears the tree falling, then there is no sound; there is only a sound wave.
The physicist would say that the sound wave is the sound.

In tinnitus, regardless of whether or not you are aware of your tinnitus, you still have all of your tinnitus-related subcortical neural activity. Researchers tend to claim that it is the neural activity that makes tinnitus what it is. On the other hand many clinicians claim that if the subcortical neural activity does not achieve cortical expression (i.e., when you are not aware of tinnitus), then you do not have tinnitus - all you have is tinnitus-related subcortical neural activity.

Hope this helps more than confuses.

Stephen Nagler

 

[MattK]

Isn't it sort of weird how tinnitus is a malfunction in the brain, and we in a sense "are" our brain and every thought we have stems from our brain, but yet, our brain cannot tell our own brain that it is malfunctioning? To put it another way: since our thinking stems from our brain, so in one sense, our brain knows its malfunctioning if you know that your tinnitus is from your brain. But yet, since we cannot consciously make our brain stop, it's like saying our brain knows it's malfunctioning, but yet, our brain cannot tell itself that it is.

 

[Dr. Nagler]

Isn't it sort of weird how tinnitus is a malfunction in the brain, ...

I don't see tinnitus as a brain malfunction. Seems to me that in tinnitus the brain is doing just what it's supposed to do - only perhaps too well.

I realize that the above may not be a particularly popular notion, but it is how I have come to view things.

And that's another potential stumbling block in the search for a cure! What exactly are you supposed to fix?

Stephen

 

[jchinnis]

I have very different views on this, Stephen. I don't think we are really at the point of designing clinical trials to test tinnitus cures--where your concerns make a lot of sense. I think we are still doing research to sort out what is going on in those with tinnitus. There are still competing hypotheses about what tinnitus is.

Premature precise definitions of the disorder and the cure aren't going to really move us forward.

 

[Steve]

I have very different views on this, Stephen. I don't think we are really at the point of designing clinical trials to test tinnitus cures--where your concerns make a lot of sense. I think we are still doing research to sort out what is going on in those with tinnitus. There are still competing hypotheses about what tinnitus is.

Premature precise definitions of the disorder and the cure aren't going to really move us forward.

It does feel like we are somewhat fumbling in the dark at the moment. Where do you sit on the timeframe of that hypothesis that will lead to the development of a cure?

And does everybody think it will be a universal cure (withstanding pulsatile tinnitus)?

 

[tom68]

I don't see tinnitus as a brain malfunction. Seems to me that in tinnitus the brain is doing just what it's supposed to do - only perhaps too well.

I realize that the above may not be a particularly popular notion, but it is how I have come to view things.

And that's another potential stumbling block in the search for a cure! What exactly are you supposed to fix?

Stephen

I think you are mixing up "too well" with " too much". Assuming the implied cause of tinnitus is correct of course. I don't see it as at all problematic to define what a fix would be - eliminate the sound tinnitus sufferers hear or reduce it to a level which no longer causes them stress or negatively impacts on their life.

The search for a cure is difficult, who knows perhaps impossible, but defining what would constitute a cure seems very simple, let's not create obstacles where none exist.

 

[Dr. Nagler]

I have very different views on this, Stephen. I don't think we are really at the point of designing clinical trials to test tinnitus cures--where your concerns make a lot of sense. I think we are still doing research to sort out what is going on in those with tinnitus. There are still competing hypotheses about what tinnitus is.

Premature precise definitions of the disorder and the cure aren't going to really move us forward.

We disagree. I think that it you are going to try to cure something, it would be helpful to agree on what the hell it is that you are trying to cure. And in all these years the research community has yet to do that!

Jim, you know where I stand. I do not believe there will ever be a cure for tinnitus. But I would love to be wrong about that and have donated thousands over the years to tinnitus research in the hopes that I am!

Stephen

 

[Dr. Nagler]

The search for a cure is difficult, who knows perhaps impossible, but defining what would constitute a cure seems very simple ...

The research community has yet to do that. You can do it. I can do it. Jim can do it. But the guys actually charged with finding it can't seem to agree on what it is they are trying to find.

Stephen

 

[MattK]

I think you are mixing up "too well" with " too much". Assuming the implied cause of tinnitus is correct of course. I don't see it as at all problematic to define what a fix would be - eliminate the sound tinnitus sufferers hear or reduce it to a level which no longer causes them stress or negatively impacts on their life.

The search for a cure is difficult, who knows perhaps impossible, but defining what would constitute a cure seems very simple, let's not create obstacles where none exist.

Sorry Dr. Nagler, but I have to agree with tom68 in that I also think you're confusing "too well" with "too much". The way I see it, if the cause for tinnitus is that the brain is being "hyperactive" in the auditory cortex (I'm obviously assuming this is the cause) then what we're supposed to fix is the hyperactivity so that the "phantom sound" will, hopefully, disappear.

But to say it is work too well, is sort of like saying a muscle twitch/spasm is the muscle working "too well". I realize from an emotional point of view, it is "better" to think of your brain as working too well, rather than too much. But either way, it is a malfunction from how it normally does, right?

 

[jchinnis]

It does feel like we are somewhat fumbling in the dark at the moment. Where do you sit on the timeframe of that hypothesis that will lead to the development of a cure?

And does everybody think it will be a universal cure (withstanding pulsatile tinnitus)?

I don't think we are fumbling in the dark. There are a lot of interesting hypotheses in research proposals, some drawing on general concepts and some involving novel mechanisms. And the technology for studying these ideas has become quite powerful and more affordable. Money is what is in short supply.

I don't think one can talk about a timeframe until the research has produced a clear path to a cure. For instance, I think there will be cures for many viral diseases within 5-10 years due to research discoveries about how newly understood types of RNA function in cells. It looks like there is now a path leading to specific cures. There's even a new research target in Alzheimer's that was unknown until very recently. I wouldn't quite say that it provides a clear path to a cure yet, but it's a big step. Tinnitus needs more scientific research before we will have a path to a cure.

 

[Dr. Nagler]

Sorry Dr. Nagler, but I have to agree with tom68 in that I also think you're confusing "too well" with "too much". The way I see it, if the cause for tinnitus is that the brain is being "hyperactive" in the auditory cortex (I'm obviously assuming this is the cause) then what we're supposed to fix is the hyperactivity so that the "phantom sound" will, hopefully, disappear.

But to say it is work too well, is sort of like saying a muscle twitch/spasm is the muscle working "too well". I realize from an emotional point of view, it is "better" to think of your brain as working too well, rather than too much. But either way, it is a malfunction from how it normally does, right?

@MattK, I do not see tinnitus as a brain malfunction. I said that my position would be unpopular here, but it is what it is.

Most importantly, and please keep this in mind. What I happen to think about tinnitus has absolutely no bearing whatsoever on if or when it will ever be cured.

And for what it's worth, I hold @jchinnis in very high regard. I have known him personally for some 18 years now and absolutely love his posts in this thread.

Stephen Nagler

 

[Ray Seddon]

The research community has yet to do that. You can do it. I can do it. Jim can do it. But the guys actually charged with finding it can't seem to agree on what it is they are trying to find.

Stephen

Dr Nagler, I recently heard a radio interview with a neurologist or surgeon who is conducting treatment of stroke victims with something I think (I was driving at the time) was called deep brain-cell stimulation, where a micro probe was inserted into the brain. This probe is so small and it is rounded at the end so it just pushes its way between the cells without damage. Then it is used to monitor brain activity and then to stimulate different areas. The treatment is done with the patient awake and apparently has resulted in instant movement of hands and limbs previously paralysed by stroke. I was thinking if something like this could target the fright-flight section of the bran, and switch off the response to tinnitus? I should have got more detail on this research and treatment but it was reported to be going on in several countries, Germany was one.