Hidden Hearing Loss, Tinnitus and Trouble Hearing Conversations in Noise

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Yup it's keyhole surgery,they do this routinely when it comes to acoustic neuromas.
 
View attachment 11850 Yup it's keyhole surgery,they do this routinely when it comes to acoustic neuromas.

There is an overview of treatments for acoustic neuroma here, but statistics are not great in terms of hearing preservation after surgery:

http://www.hopkinsmedicine.org/otolaryngology/specialty_areas/otology/conditions/treatment.html

Radiosurgery is one of the options: "Thousands of patients have received radiation treatment for acoustic neuromas, several hundred at Johns Hopkins. Radiosurgery is a non-invasive treatment that uses precisely focused, narrow beams of radiation to both treat the acoustic neuroma and to reduce the dose of radiation delivered to the surrounding tissues including the hearing, balance and facial nerves."

"The preservation of hearing following surgery has traditionally presented a greater challenge than facial nerve presentation. The precise reason for this difference is unclear. That is, the surgical removal of acoustic neuromas treats the facial and hearing nerves gently and with equal surgical care. However, whereas facial nerve preservation of facial function ranges in the high 90% range, hearing preservation ranges from 30 to 50% following the retrosigmoid approach"

As for hyperacusis, some clinics offer laser therapy (as I understand it, this is not radiation like acoustic neuroma surgery), but at big public hospitals they do not have this technology, and most doctors say the hospital does not buy that because it does not work.
 
Not sure if they would have to open us. From what I understood they have to make to sure that the cells lands on the damaged area. For us it's in the cochlea so maybe that's why Rivolta is making his study for a gel that can deliver stem cells in the cochlea through the round window.
Sure that would be more effective to open us and make them land precisely on the damages connections but I'm not sure they can safely do that...
 
There is an overview of treatments for acoustic neuroma here, but statistics are not great in terms of hearing preservation after surgery:

http://www.hopkinsmedicine.org/otolaryngology/specialty_areas/otology/conditions/treatment.html

Radiosurgery is one of the options: "Thousands of patients have received radiation treatment for acoustic neuromas, several hundred at Johns Hopkins. Radiosurgery is a non-invasive treatment that uses precisely focused, narrow beams of radiation to both treat the acoustic neuroma and to reduce the dose of radiation delivered to the surrounding tissues including the hearing, balance and facial nerves."

"The preservation of hearing following surgery has traditionally presented a greater challenge than facial nerve presentation. The precise reason for this difference is unclear. That is, the surgical removal of acoustic neuromas treats the facial and hearing nerves gently and with equal surgical care. However, whereas facial nerve preservation of facial function ranges in the high 90% range, hearing preservation ranges from 30 to 50% following the retrosigmoid approach"

As for hyperacusis, some clinics offer laser therapy (as I understand it, this is not radiation like acoustic neuroma surgery), but at big public hospitals they do not have this technology, and most doctors say the hospital does not buy that because it does not work.
To me hearing being damaged from an acoustic neuroma is a given,I would imagine a tumour growing and putting pressure on the nerve would most certainly do damage not to mention if the tumour is growing on the nerve itself.

I would also imagine removing the tumour would do damage to the nerve and that's why hearing is greatly affected as a result,I wouldn't blame the surgery but more so the cause of that surgery having to take place i.e the tumour.
 
To me hearing being damaged from an acoustic neuroma is a given,I would imagine a tumour growing and putting pressure on the nerve would most certainly do damage not to mention if the tumour is growing on the nerve itself.

I would also imagine removing the tumour would do damage to the nerve and that's why hearing is greatly affected as a result,I wouldn't blame the surgery but more so the cause of that surgery having to take place i.e the tumour.

Yeah, what I meant is that for H and T there should be other options in the future (or I hope so..) Sometimes the problem (H or T) starts suddenly but for some people it starts in a subtle way, or disguised by other health problem that is more common. It is surprinsing that then H or T can progress to become almost unbearable in some cases. Maybe in the future there will be some early solution for this, some early treatment to at least avoid the condition gets worse.
 
Yes, along with my T it became harder for me to understand conversation in noisy environments. And yes, my hearing test put me inside the norm... As far as the doctor can see I have perfect hearing...
 
I have a hard time hearing what people are saying when there is noise around. And i have testet my hearing and it was fine. If someone is talking about me while im watching TV i cant hear what they are talking about in TV i can hear them talking loud but i cant hear what they are saying.
 
We haven't published our biggest findings yet, but I am sitting on a manuscript that describes improved perception of speech in noise for older, hearing aid users through training in an immersive "action audio game" that we programmed. These kinds of therapies are used routinely to treat central visual impairments like amblyopia but the auditory field has been slow to pick up on this. I don't have anything definitive to share with this community on tinnitus at this time, but we are actively working on this and have had some encouraging early results for speech in noise processing and tinnitus relief.
Hopeful eyes for near-term tinnitus relief should be focused on brain-based therapies, not cellular repair of chronically damaged ears. Sadly, there really isn't a thread for research on brain-based therapies, because a definitive paper has yet to be published. That means there is lots for us to do in 2017. We'll be working hard to develop objective biomarkers of tinnitus and then start clinical trials for brain-based interventions.

Professor Hebbian,
I hope your research is going well. I just wanted to inquire if your paper has been published? Good luck in all your work!
 
@HomeoHebbian sorry I forgot to tag you in my question. Also when you are predicting attenuation via DNS and gaming do you think that will be lasting treatment effects after months of use or a daily routine treatment
 
Does anyone know what the protocol for the so called binaural hearing test that's supposed to detect hidden hearing loss?

A new article but no "news" unfortunately.
Yeah, I saw that one. It is almost hurtful to see the expression on Matt's face. :(

I forgot to tag you in my question.
No need to tag. When you quote someone they will get an alert. So you have to either tag or quote to get their attention.
 
"The really hard part is then to section the tissue and to label all the cells we put in. This provides proof that the injected cells reconnect the sensory 'hearing' cells to the brain."

Does anyone know what type of cells they are injecting which then land on the glial scars and create a connection?

More importantly are the connected nerves "repaired nerves", "regrow nerves", a damage nerve that extends, or a mix of both?
 
I answered my own question. It is stem cells they place over the glial cells.

Its theorised that these neurons disconnecting are what causes T and H,we can still hear the sound as the haircell is still intact but the underlying neuron that brings that impulse to the brain is now damaged and makes us sensitive to noise thus causing pain from what wouldn't normally be a painful sound.

So the glial stem cell approach would only regenerate damage hair cells? Would it have any effect on damaged nerve fibers. If so how long would the window for that treatment be?
 
@Jim51042 I am not convinced. You are quoting another member on this forum. Quote an article rather.

As for what cells they are using, it says in the Sheffield university article, "using cell lines developed by Sheffield researchers". So the cells they use are likely stem cells. But that doesn't mean that they just inject a bunch of stem cells. They have to label them too in order to show that the treatment works. Also, they would have to differentiate the cells.

There are stem cells and dormant progenitor cells in the ear already, but you don't see them differentiating naturally following a damage (something Frequency Therapeutics, among others, are trying to change with their therapy). If they are injecting cells, then they have already differentiated them in a dish. Meaning they are no longer stem cells when they inject them.

Where do you get the idea that "glial stem cell approach would only regenerate damage hair cells"? They would not regenerate damaged hair cells at all. They are glial cells.

The glial cells surround neurons and provide support for and insulation between them. Glial cells are the most abundant cell types in the central nervous system. Types of glial cells include oligodendrocytes, astrocytes, ependymal cells, Schwann cells, microglia, and satellite cells.

http://www.medicinenet.com/script/main/art.asp?articlekey=11382

Nerves are regenerated naturally in the PNS. Have a look at how this works. The mechanism would be similar in cochlear nerve regeneration. The cochlear nerve belongs to the PNS, but it's a cranial nerve, so it doesn't regenerate naturally. The only cranial nerve that regenerates naturally is the olfactory nerve and its receptor cells. If you want to regenerate the cochlear nerve, you will want to mimic the mechanism found in olfactory nerve or one of the nerves branching off from the spinal cord.
 
Sorry for my misstatements. So this approach I was trying to understand applies cell line to the ear which then if land on glial scar enter and repair the neuron on which it resides.
 
Sorry for my misstatements. So this approach I was trying to understand applies cell line to the ear which then if land on glial scar enter and repair the neuron on which it resides.
I'm not sure where you picked up "glial stem cell approach" or why you are quoting Bill. I don't mean to be rude or anything, but you seem to have conceptual misunderstanding. I am not a professor myself, but let me tell you what I know. Glial scar has nothing to do with hair cells. Alright?

I will quote Bill here just for reference.

Noise damages the synapses that underly its corresponding haircell,just because these synapses are damaged doesn't necessarily mean the haircell will die as a result.Its theorised that these neurons disconnecting are what causes T and H,we can still hear the sound as the haircell is still intact but the underlying neuron that brings that impulse to the brain is now damaged and makes us sensitive to noise thus causing pain from what wouldn't normally be a painful sound.There are also noiceptors connected to these neurons and noiceptors only fire when they detect incoming damaging stimuli,they don't fire for any other reason.If someone's voice causes you pain that's the noiceptors telling you that your nerves can't handle this and that this sound is potentially harmful stimuli.The brain will try and protect itself by triggering the middle ear muscle to contract(TTTS)which it does via the facial nerve,also remember the auditory nerve is directly connected to the facial nerve.

There is a lot of content here. It's a lot to take in, and I won't go over all of this. So let me jump back to glial scar right away.

Glial scar refers to scar formation in the nervous system. Not in sensory cells! Hair cells are the sensory receptor cells of the cochlea, the organ of hearing. They are not nerve cells. Therefore, glial scar has nothing to do with them, or at least not directly.

Most commonly, glial scar refers to scar formation in the central nervous system, not in peripheral nervous system. Scar formation in the CNS is thought to be a major obstacle to recovering from neurodegenerative diseases like Parkinson's. It's a way for the brain to protect itself, so that the degeneration may not spread to other areas of the brain. That's why it forms these glial scars.

Glial scars are formed by glial cells. Glial cells are not neuronal cells. Instead, they provide support and protect neuronal cells in both CNS and PNS. Which explains why they form these scars - to protect the surrounding nerve cells!

Overcoming the glial scars is kind of a central idea in treating diseases like Parkinson's. The promise of treating Parkinson's, Alzheimer's and Huntington's is in large held back by glial scars. As far as I know, cell transplants are the only way to treat these diseases. But so far, scientists have been trying to get past these scar formations and physically guide the transplanted cells into the right place. So this is where the idea of placing the cells on top of the glial scars comes from, which has been shown to be more effective, if not completely necessary. We have been doing it wrong the whole time.

Now we come to glial scars of the auditory nerve. Now that you know the historical context, you understand why and how this would work. Scientists would place the stem cells on top of glial scars to help restore synapses with the hair cells.

Have a look at the image below and take note of how the cells are injected. To the right you see the traditional approach where the needle enters the glial scar before the cells are release into the scar. To the left you see the new approach where the cells are released next to or on top of the glial scar.

Fig.1-Tsekiya.png

You will find the article here:
https://atlasofscience.org/transplanted-cells-reveal-potential-for-functional-neural-regeneration-2/

With "surface transplantation", donor cells autonomously enter gliotic auditory nerve. Subsequently, they form synapses with hair cells and cochlear nucleus cells (oblique red arrows). In stark contrast, glial scar is seriously damaged with traditional intra-neural transplantation, leading to the failure of restoration of auditory nerve function (...)

It's also likely that the ultimate goal of restoring natural hearing will require that both hair cells and auditory nerve cells are regenerated, so this therapy could be of more use further down the line.
 
After spinal-cord injury, cells called astrocytes form a scar that is thought to block neuronal regeneration. The finding that the scar promotes regrowth of long nerve projections called axons challenges this long-held dogma.

http://www.nature.com/nature/journa...re17318.html?lang=en&WT.ec_id=NATURE-20160414

The "long-held dogma"! This leads me to believe that some doctors, and even some researchers are just plain idiots. They are too afraid to try new ideas! They like to keep to the old teachings, like it's a God given truth. They keep to their comfort zone. What do they care, they have their paycheck at the end of the month whatever they do. Thank God for people that stick their neck out and put their career and reputation on the line every few decades or so. If it were not for them we would be completely lost.

I know that bit is about spinal cord injury. But any new knowledge is welcome, because it often means that it can be applied to other areas as well. Like this whole discovery of "surface transplantation" in attempts to repair nerve damage in the auditory system.

https://www.ncbi.nlm.nih.gov/pubmed/26080415
 
Thank you that was very informative. This process is at the the university level. Any thoughts on if it will make it into development? If so when?
 
Overcoming the glial scars is kind of a central idea in treating diseases like Parkinson's.

To you have a reference for this? That's not my understanding of Parkinson's at all, and a pubmed search of glial scar and Parkinson's turns up little. Similarly, I don't believe glial scars have anything to do with Alzheimer's.

As far as I know, cell transplants are the only way to treat these diseases.

Cell transplants have not been approved for any of these diseases.


That isn't the 'article' i.e. the actual paper. You will find the paper here: http://www.pnas.org/content/112/26/E3431.full
 
http://www.nature.com/nature/journa...re17318.html?lang=en&WT.ec_id=NATURE-20160414

The "long-held dogma"! This leads me to believe that some doctors, and even some researchers are just plain idiots. They are too afraid to try new ideas! They like to keep to the old teachings, like it's a God given truth. They keep to their comfort zone. What do they care, they have their paycheck at the end of the month whatever they do. Thank God for people that stick their neck out and put their career and reputation on the line every few decades or so. If it were not for them we would be completely lost.

I know that bit is about spinal cord injury. But any new knowledge is welcome, because it often means that it can be applied to other areas as well. Like this whole discovery of "surface transplantation" in attempts to repair nerve damage in the auditory system.

https://www.ncbi.nlm.nih.gov/pubmed/26080415

Here is the full article of you last link.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4491783/

The researcher successfully resotred auditory function by repairing the auditory nerve using the glial scar that was created by the injury.

Another article associated with this : https://www.sheffield.ac.uk/research/impact/stories/novel-sensory-neuroscience-cells-1.573958
 
Are you saying that cell transplants aren't approved or that in these lab studies there is another method used
Stem cells have not been approved for Parkinson's, Alzheimer's and Huntington's.

Regarding your questions:
This process is at the the university level. Any thoughts on if it will make it into development? If so when?

This process is at the level of a single paper using rodents. It's been cited 7 times and (as far as I can tell) not by anyone building on it so while this paper is loved around here, it doesn't appear that it has caught on the same way among other scientists. I will be more excited about this when there is follow-on work by the group that published the paper or by others using the technique for other applications.
 
To you have a reference for this?

"Reactive glial cells are like police vehicles, ambulances, and fire trucks immediately rushing in to help -- but these rescue vehicles can cause problems if too many of them get stuck at the scene. The problem with reactive glial cells is that they often stay at the injury site, forming a glial scar and preventing neurons from growing back into the injured areas"

~ Professor Gong Chen, Penn State University, 2013
http://science.psu.edu/news-and-events/2013-news/Chen12-2013

Here is the actual paper:
http://www.cell.com/cell-stem-cell/fulltext/S1934-5909(13)00550-X

Cell transplants have not been approved for any of these diseases.
That's true! Not in humans, no. They have only been done on animal models. But we may not need to do cell transplants. There is a new approach of using microsurgery and gene therapy to convert the glial cells into neural cells for localized injuries. This is the work of Gong Chen and his team.

There is also a drug therapy under development that could be used in more spread out injuries, or in degenerative diseases like Alzheimer's. The goal is the same, converting glial cells into neural cells. This is also the work of Gong Chen and his team. They showed that up to 90% of the glial cells were successfully converted into neurons.

That isn't the 'article' i.e. the actual paper.
Yeah, I may have used the wrong word there. I mainly posted the link to reference the image source. I think the that image is very informative, and it's not to be found in the original "article article". But it is provided by the team from Kyoto University.
 
Are you saying that cell transplants aren't approved or that in these lab studies there is another method used
They are not approved in human subjects. In animals... well, I don't want to rise the ethical debate, but who would stop you? Besides, you will probably not find Alzheimer's in an animal.

The problem of cell transplants is that many of the cells will die in the process. Most of them will be rejected by the immune system. Their survival is limited. The surviving cells' ability to integrate with the host cells and form neural circuits is also limited. Also, brain tumors can develop. For these reasons, scientists have started to look for other options. One of these is based on reprogramming glial cells into neurons.

As you can see there are many different approaches to degenerative diseases, nerve regeneration, etc. It's too much to cover in this forum perhaps. The discovery that cell transplants work better if you transplant them on the surface of the glial scar, rather then into the scar, is an important clue. If we ever need to do cell transplants, that's how we would do it. But science has progressed further than that. We are now talking about reprogramming glial cells into neurons. This mostly relates to diseases of the CNS. But the article you linked to above relates to the PNS and it's on the same track as these new approaches for treating CNS diseases. They talk about switching, i.e. reprogramming glial cells of the PNS (Schwann cells) into "repair mode".
 

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