- Sep 21, 2016
- 1,051
- Tinnitus Since
- 2011 - T, 2016- H, relapsed 2019
- Cause of Tinnitus
- noise-induced
To be honest, I'm still getting my head around all this so I really appreciate your detailed and thorough response. Yeah, I think there's a possibility that cochlear damage could then trigger middle ear hyperactivity as a consequence, as per the Liberman paper. I think if that's the case then there's reason to be hopeful that FX-322 could help. I posted an article a while ago on 'Neuroplasticity and Pain' and here's another written by the same author (who has written extensively on this topic) on 'Persistent Pain as a Disease Entity.'Great point, you're right, I agree on that. FX-322 could in theory fix the tinnitus regardless of how it started (pre existing or acoustic shock). Although subsequent setbacks originating in the mid ear causing fresh TGN inflammation could generate that tinnitus again or other problems in the cochlea requiring further FX-322. Let's say FX-322 works though then that would be amazing in itself because in theory you'd know you could fix the cochlea over and over (as long as you had the support cells to do it), and then if the problem of setbacks and delayed facial pain etc. remained, subsequently causing the tinnitus etc. to return each time, then that could help to highlight the real cause of the problems in the mid ear and put research for it on the right track.
I agree that it's so unlikely for there to be zero hearing loss or tinnitus, whether it was present already or as a result of the acoustic shock. My hypothesis a few posts back was at one end of the spectrum putting all the emphasis on the mid ear being damaged but not the inner ear, but there could be any number of variations in between. The chance that you've had an acoustic shock strong enough to cause some hearing loss and tinnitus, yet not strong enough to sensitize the TGN or cause any significant mid ear damage I'd say is more than possible and could explain your particular symptoms and make FX-322 perfect for you. I still think the above reply to Diesel applies though if you are now susceptible to acoustic shocks or setbacks. Does your tinnitus fluctuate or is it constant? If it fluctuates does it do so in parallel with any other symptoms? Because if it does and you can pin the other symptoms down to a possible inflammatory response it could tell you if your tinnitus is being modulated from outside the cochlea.
This hypothesis is assuming the mid ear is the trigger for setbacks and pain and even cochlea damage, that's the whole point of it, propose something and then try and smash the theory. The 'what triggers what' theory is a different hypothesis I'm trying to get my head around, it depends on so many things. But for this current theory, if an acoustic shock does damage the mid ear and the cochlea together but FX-322 fixes only the cochlea, yet the setbacks repeatedly damage the cochlea again and again requiring more and more FX-322 then the mid ear surely needs to be fixed as well. The big problem and the reason I'm digging so much into this though, and I'm sure I speak for a lot of acoustic shock noxacusis sufferers, is that the part of this I really want to fix is the constant setbacks and months of crippling facial pain over and above anything else. And I believe this requires a mid ear related fix.
@tommyd87, thanks, yes that's all it is, just a theory to run with. I don't particularly believe it's true or untrue. I'm just questioning it with everything I can throw at it until it crumbles lol.
I think I get what you're asking but it could be 2 different questions. Your first quote could point to the possibility that the cochlea is being damaged first and sending some kind of response to the mid ear that is then also damaging itself due to acoustic shock, is that right? If that's the question then I'd say that whether FX-322 could fix both depends on if there is now a heightened state of alert somewhere in the nervous system that has been turned on like a switch that the the mid ear will continue to respond to even if the cochlea gets fixed. Unless the cochlea can be fixed and then the mid ear 're-learnt' it's normal response over time. I'm trying to work on some other concepts to do with what is triggering what.
But if this is your question, 'So the middle-ear and vestibule can also be 'stimulated' by intense noise. Could it be possible that sub-noxious then, if it's not affecting the inner ear, could still stimulate the middle ear?' I'd say definitely yes because that acoustic shock paper goes into so much detail about how the tensor tympani can severely damage itself causing all the TGN sensitization etc. upon hearing damaging (noxious) noise. And I think to answer your question, the important thing I pick up on here is that the tensor tympani is responding to what it feels is noxious noise (whether unreasonably so or not) and therefore causing the devastating mid ear symptoms cluster regardless of how noxious the noise actually is. This is why I think sometimes we get lowered tolerance. The noise that the mid ear thinks is so noxious and is responding so dramatically to due to some kind of heightened response (causing all kinds of inflammatory responses that ARE causing pain) actually in fact possess zero risk of damaging the cochlea at all.
@xyz, thanks, I'll read that, that looks like it going to take a while to understand.
https://journals.lww.com/anesthesia...ain_as_a_Disease_Entity__Implications.37.aspx
Under the sub-heading, 'Pain as a Secondary Disease', he states:
"In describing all these changes, it has been suggested that the induction of these changes leads to a state in which the perception of pain is maintained independently of inputs to the nervous system. While it is tempting to speculate that this is indeed the case in people who have persistent pain despite no evidence of pathology, there is little evidence to support this proposition. A hip replacement will usually lead to a substantial reduction, if not elimination, of pain arising from an osteoarthritic hip, no matter how long the pain has been present. Secondary pathological changes, such as central sensitization, mood changes, and disability, may occur as a result of persistent nociceptive inputs. However, they will generally all resolve after a procedure that results in resolution or removal of the underlying primary pathology."
I'm approaching this with no scientific or medical background but this seems encouraging to me and perhaps indicates that if you get rid of the underlying pathology (damaged cochlea with FX-322) then it could have a positive effect and the middle ear symptoms could 'normalise' over time. So, it seems to suggest that it's unlikely that the pain would end up becoming a self-perpetuating mechanism if you were to fix the underlying primary pathology (assuming the culprit is a damaged inner ear).
I think your second part about whether the middle-ear is directly affected though is intriguing and is a very real possibility though. One thing I wonder - is it possible to determine if your middle-ear or TTM is damaged? Can that be observed by a clinician? One thing that I experience personally that is strange is that my facial pain was primarily isolated on the left side of my face yet my right ear is the one that will 'spasm' slightly if I trigger it by shutting one eye.
If the problem resides in the middle ear my question is how do we fix it? Can the tensor tympani be repaired? If there's inner ear damage we know that restoring the hair cells and synapses will solve it, but the middle ear seems so complex.