Episode 25: Tinnitus and Pain, One and the Same? — Prof. Peter McNaughton

[Tinnitus Talk]

Prof. Peter McNaughton from King's College London is not only a very nice guy (for example, we had to re-attempt our recording three times due to technical difficulties and he was extremely accommodating), but also a very interesting researcher – a unicorn if you will.

He has been researching chronic pain for decades and from there developed an interest in tinnitus, because he believes the two share some important commonalities in terms of the underlying mechanisms. For reference, it's almost unheard of for a researcher from another field to develop an interest in tinnitus.

He also happens to believe that tinnitus, like pain, is a peripheral rather than a central phenomenon. A controversial idea within the tinnitus field, but Peter likes to shake things up a bit, and we hope the tinnitus research community welcomes healthy debate on the topic.

In fact, check out our Tinnitus Week 2025 thread for some responses from tinnitus researchers about Peter's theories.

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We welcome any discussion, but please keep the following in mind when commenting:

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This episode was produced by @Markku and @Hazel, with the transcript created by @Hazel as well. Do you want to take part in creating the podcast? Let us know.

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[UKBloke]

Thank you @Markku, @Hazel and the rest of the team for another fascinating podcast. It was a great listen.

I find Prof. McNaughton's ideas intriguing, and would echo what he said insofar as it's always good when someone
new comes along and shakes up the field.

Tinnitus as a peripheral phenomenon does make sense. The kind of things I can't reconcile, however, are examples
of people who sustain a knock to the head then go on to experience chronic tinnitus, or Ménière's as a trigger,
and various other complaints. I'm not convinced these are the kind of peripheral damage Prof. McNaughton talks of. Or if they are, we're looking at quite a wide range of peripheral damage, and perhaps even some reinterpretation.

I think it's good that Prof. McNaughton acknowledges there very well may be some other thing going on upstream
that completes the tinnitus loop. His animal models have evidently returned some interesting results, but it still leaves
that nagging question unanswered; why don't all people with hearing damage end up with chronic tinnitus?

 

[Nick47]

why don't all people with hearing damage end up with chronic tinnitus?

Does the type of hearing damage (hair cells, auditory nerve cells, etc.) matter?

Many people experience temporary tinnitus after hearing damage, suggesting some level of recovery. Is this explained by Thanos Tzounopoulos' work?

If the answer to any of the above is "yes," it clears the muddy water some.

 

[UKBloke]

Does the type of hearing damage (hair cells, auditory nerve cells, etc.) matter?

To be honest, I've largely skirted the "type of damage" debate because of the major problem I see with quantifying it. But I do think this is where Peter McNaughton's work can be interesting with, "temporary tinnitus after hearing damage", being a good example.

We could have a case of noise-induced damage to stereocilia that showed up on an audiogram together with acute tinnitus. In that instance, I don't see any reason not to suggest that inflammation as a result of the noise onslaught may trickle down and put pressure on or around the auditory nerve, thus causing the tinnitus that would eventually subside once the inflammation resolved.

The example fits the dysfunctional neural-gating model of tinnitus:

• Squeeze the auditory nerve -> overdrive the upstream dysfunctional neural gate = tinnitus
  
  
• Relieve the auditory nerve (inflammation resolved) -> upstream dysfunctional neural gate returns to function (just about) = no tinnitus

There are obviously some caveats here, but I believe the general principle is sound enough.

Is this explained by Thanos Tzounopoulos' work?

Doesn't he put tinnitus in the brain?

 

[Nick47]

Doesn't he put tinnitus in the brain?

Good point. Yes, the brainstem indeed.

 

[HighleyTall]

An acoustic neuroma can compress or inflame the auditory nerves, potentially causing tinnitus, even in individuals with normal or perfect hearing according to their audiogram.

In some cases, patients continue to experience tinnitus after the acoustic neuroma is surgically removed, with outcomes varying depending on the removal technique used.

For other patients, tinnitus may resolve following the removal of the acoustic neuroma (perhaps due to the inflammation resolving).

 

[sunnier days]

When you get damage from chemotherapy in the peripheral nerves you can get loss of sensation, pain, or paresthesia. Perhaps the nerves in the ears work the same way and you can get hearing loss, hyperacusis, or tinnitus.