Hi and welcome!
Hearing damage scenarios:
Hearing loss can happen at different points in the auditory system. It is likely that damage happens on several layers. It is however known that synapses are more fragile than hair cells.
You can have damaged stereocilia on the hair cells and perhaps you can also have dysfunctional hair cells that are still present. Lastly, you can simply have dead hair cells that are entirely removed from the epithelium after some time.
You have multiple synapse ribbons per hair cell. It is possible to have a functional hair cell with only one synapse ribbon instead of three for example (not sure about the maximum per hair cell).
It's also possible that the nerve endings to the hair cells are retracted, but I'm not sure if the hair cells remain alive when that happens.
It is obviously also possible that something is wrong upstream in the brainstem or beyond that, but my knowledge is limited in that regard.
Maybe someone can complement on all the possible scenarios.
How to test your hearing to have an idea what is damaged:
Hair cell functionality is tested with a pure tone audiometry, and it's obviously best to have an extended audiogram. It's a very basic test and my main problem with it is that they only test intervals instead of all frequencies. You could have gaps between the intervals and the test would not reveal that at all (even if they say it's not necessary I'm still in doubt).
To my knowledge, and this is common in my country, you can test hair cells also by doing a DPOAE test, which is objective and not subjective as is the case with an audiogram. Both tests should give you a rough idea to what extent you have hair cell damage. I believe the DPOAE test is more solid than an audiogram, but my research shows it is perhaps only for outer hair cells. This point is not entirely clear to me. My audiologist did not mention anything about that, but Wikipedia refers to OHCs and not IHCs as well.
To test if you may have cochlear synaptopathy, you should do a word recognition test, as well as a word in noise test. This is also a subjective test, but it gives you a rough idea if you have synapse degradation. The reasoning behind it, is that you need to have multiple synapses working per hair cell (at a certain frequency) to have a higher (better or more clear) understanding of what is being said. This is something that an audiogram will never be able to tell.
I do not know to what extent you can detect nerve damage or partial neuropathy. Perhaps you can test this to a certain degree with a FMRI done by a neurotologist. I have not done so.
I believe there is something called an Auditory Brain Response (ABR) test which could tell you if you have an issue in your brainstem. I did not take this test as I believe they briefly blast your ears with high volume sound. No thanks.
The more tests you do, the better you will know what type of damage you may have and what solution may work the best in the future to restore your hearing.
Again, it's logical to assume you have various levels of damage.
Lastly, these are all hearing regeneration solutions we are talking about and it remains a hypothesis if this will actually alleviate the tinnitus or not. We hope so, but until we get there, we don't really know for sure. At least that's my opinion. Most people seem to think it will help to reduce tinnitus.
If anyone wants to elaborate on that, please do.
Many thanks for your reply. Did you get this out of some book or what? I'm amazed at how research has come forward and how I have been left behind. I knew about the inner and outer hair cells since the 1990's. But synaptopathy? Above my head. I ain't no rocket surgeon.
But to my point. In appreciation of your kind information let me tell you how I handle "the night".
The coping mechanism that I kind of developed or stumbled onto is a follows: From way back in my teens I learned the yoga techniques of concentrating on your breath. Also concentrating on your heart beat and finally your pulse.
Years later when I got my tinnitus I had a try at Autogenic training -- it's a kind of "fast yoga" if I could borrow a term from the fast-food industry. This takes daily practice for about a two or three months until you get it to be part of your nature.
Now here is the thing: I found that in the early morning, when I would awake and my tinnitus would be most intrusive I somehow was subconsciously using the pulse on the left side of my face... i.e. my left cheek to drown out the sound of my tinnitus and could get back to my forty-winks. I think the success of this might have had something to do with the pillow I had then.
And here the story gets semi tragic. The pillow I was using -- I believe it had your regular polyester filling-- but somehow much harder than the regular polyester. I think it had a cotton cover to it, but that might have been polyester too. Well long story short, it served the purpose very well in somehow amplifying or echoing the sound of my pulse. And then someone nicked it.
You don't know what you've got till it's gone.
I have another pillow now after trying many of them. It's OK but not as good as the original -- or maybe it's that my tinnitus has got much louder and more intrusive with the passing years.
These days I get about four hours sleep and then, waking in the early morning I try to use mindfulness/autogenic training to home in on my pulse just like I explained. It's hard work -- but often it works and I manage to get for more sleep. I also use a sound machine. and finally if I don't get back to sleep the radio with a timer helps too.
Maybe I have got this entry in the wrong section, it's more about coping than research, but if you can regain the night and get a good sleep, it helps divert from your tinnitus during the day.
Easier said than done I know.
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