New University of Michigan Tinnitus Discovery — Signal Timing

[Watasha]

This seems so obvious... like saying rain is wet. But I seem to recall reading somewhere in the tinnitus literature that the volume of tinnitus is not a good measure of distress... that some people with a loud volume tinnitus will say that it's not that bothersome (have they somehow habituated?) and others who have a low volume tinnitus are driven round the bend by it.

The volume of tinnitus that a patient hears (subjectively of course) would be one of the easy things to measure. Simply play the approximated tone in the audiogram at various degrees of volume and ask "Is that louder or softer than your tinnitus?" And you could also find the volume that masks it completely, and come up with some approximation of how loud it is.

That is also consistent with what I have read, though I would guess a deeper dive into the data would suggest the correlation gets higher as volume increases.

It's also worth noting that most cases of tinnitus volume is actually relatively low. This was a response from Dr. Nagler:

Actually more than half of individuals with severe intrusive tinnitus match at 6dB SL or less. I do not ever recall seeing anybody with a loudness match of greater than 20dB SL. But please note two things. First, we are talking about dB SL and not db. dB SL is the number of dB over the threshold of hearing at the frequency being tested. And second, many audiologists do not know how to do proper tinnitus pitch and loudness matching. So all bets are off if the audiologist doing the testing is not both knowledgeable and experienced in that regard.

 

[GregCA]

The volume of tinnitus that a patient hears (subjectively of course) would be one of the easy things to measure. Simply play the approximated tone in the audiogram at various degrees of volume and ask "Is that louder or softer than your tinnitus?" And you could also find the volume that masks it completely, and come up with some approximation of how loud it is.

This method is routinely used to measure tinnitus loudness (as well as MML - i.e. Minimum Masking Levels) with patients.

There is an analogous process to estimate the pitch/frequency (for those with tonal tinnitus).

 

[Chriscom]

But I seem to recall reading somewhere in the tinnitus literature that the volume of tinnitus is not a good measure of distress... that some people with a loud volume tinnitus will say that it's not that bothersome (have they somehow habituated?) and others who have a low volume tinnitus are driven round the bend by it.

My tinnitus usually is a steady-state high tone. I can think of a couple other more erratic manifestations I've had that blessedly so far are quite temporary. I'd rather have at least a slightly louder steady high tone than some of the other soft erratic ones for sure.

 

[JimmyStrong]

I can't wait for the day Dr. Shore's device comes out. I need some reduction in tinnitus.

 

[dj_newark]

I can't wait for the day Dr. Shore's device comes out. I need some reduction in tinnitus.

Don't we all? I can't wait either. But for now all I'm looking forward to is Dr. Shore answering the Q&A. Whenever that'll be!!!

 

[DeanD]

This method is routinely used to measure tinnitus loudness (as well as MML - i.e. Minimum Masking Levels) with patients.

There is an analogous process to estimate the pitch/frequency (for those with tonal tinnitus).

Although if tinnitus can't be masked in a shower, or if it is sound reactive, how could it be measured?

 

[El BUZZ]

My tinnitus is always fluctuating from a fainting hiss to an unbearably loud angle grinder sound. It is always audible no matter the surrounding sounds but when it is just a weak hiss, my psychoemotional response is much better than when it is that maddening alarm. It changes after sleeping so basically I wake up every morning to a different kind of tinnitus.

I wonder how the device can be customized for someone like me.

 

[GregCA]

Although if tinnitus can't be masked in a shower, or if it is sound reactive, how could it be measured?

There are certainly challenging scenarios.

For example, in my case, my tinnitus can't be masked in a shower, but I still went through the MML measurement with the audiologist. What happened is that the audiologist ramped up the masking sound volume until I would acknowledge that my tinnitus was masked, but that never happened. At some point, the audiologist said she didn't want to crank the masking sound any higher because it would be too dangerous a volume level, so the process ended and I was not able to measure my masking level.

Similarly, I imagine that fluctuating volume, whether due to reactivity or not, creates a moving target that can't be measured.

 

[Ben Winders]

Is there any data in the research paper that shows what kinds of tinnitus cases Dr. Shore's device has been tried on?

Was there at least 1 patient in there that had low frequency humming instead of the more typical high pitched eeee/hissing?

I've said this before but I can't wait for all of us to throw our cacophony of sounds onto this device to see if it holds up 'in the wild'...

 

[AfroSnowman]

There are certainly challenging scenarios.

For example, in my case, my tinnitus can't be masked in a shower, but I still went through the MML measurement with the audiologist. What happened is that the audiologist ramped up the masking sound volume until I would acknowledge that my tinnitus was masked, but that never happened. At some point, the audiologist said she didn't want to crank the masking sound any higher because it would be too dangerous a volume level, so the process ended and I was not able to measure my masking level.

Similarly, I imagine that fluctuating volume, whether due to reactivity or not, creates a moving target that can't be measured.

Me too, at a certain point the masking sound was so loud that it was painful so I just made her stop.

 

[Utdmad89]

Is there any data in the research paper that shows what kinds of tinnitus cases Dr. Shore's device has been tried on?

Was there at least 1 patient in there that had low frequency humming instead of the more typical high pitched eeee/hissing?

I've said this before but I can't wait for all of us to throw our cacophony of sounds onto this device to see if it holds up 'in the wild'...

No one knows this. Maybe someone has asked that question in the upcoming Q&A.

 

[kingsfan]

This seems so obvious... like saying rain is wet. But I seem to recall reading somewhere in the tinnitus literature that the volume of tinnitus is not a good measure of distress... that some people with a loud volume tinnitus will say that it's not that bothersome (have they somehow habituated?) and others who have a low volume tinnitus are driven round the bend by it.

Some people never change the batteries in their smoke alarms and don't even notice the incessant beeping going off every 30 seconds while others would be driven mad.

Me too, at a certain point the masking sound was so loud that it was painful so I just made her stop.

The volume matching seems like a dangerous test for sure. I had it done a few years ago and wonder if it contributed to my worsening around that time.

 

[DeanD]

There are certainly challenging scenarios.

For example, in my case, my tinnitus can't be masked in a shower, but I still went through the MML measurement with the audiologist. What happened is that the audiologist ramped up the masking sound volume until I would acknowledge that my tinnitus was masked, but that never happened. At some point, the audiologist said she didn't want to crank the masking sound any higher because it would be too dangerous a volume level, so the process ended and I was not able to measure my masking level.

Similarly, I imagine that fluctuating volume, whether due to reactivity or not, creates a moving target that can't be measured.

Do you know how loud in dB she went to before ending the test?

 

[Joe Cuber]

My tinnitus is always fluctuating from a fainting hiss to an unbearably loud angle grinder sound. It is always audible no matter the surrounding sounds but when it is just a weak hiss, my psychoemotional response is much better than when it is that maddening alarm. It changes after sleeping so basically I wake up every morning to a different kind of tinnitus.

I wonder how the device can be customized for someone like me.

I wondered the same thing, since my tinnitus behaves the same way as you describe @El BUZZ (changes in sleep, waking up to a different experience each day). I read through the paper just now, and it doesn't mention whether any of the participants in the study has intermittent/varying/fluctuating tinnitus (unless I missed it). There's no specific mention of intermittent/varying/fluctuating tinnitus being an exclusion criterion, so perhaps some of the participants have it but the paper doesn't mention it. I wonder how they would accommodate the treatment and measurements for folks like us.

 

[El BUZZ]

I wonder how they would accommodate the treatment and measurements for folks like us.

Trying to be optimistic as well as pragmatic; I take for granted some of the clinical trial participants have had fluctuating tinnitus as it is a very common version of this condition. Who hasn't gone through a spike? Anyone serious about tinnitus knows it, so I think Dr. Shore has it in the pocket.

 

[BadNeighbors]

Some people never change the batteries in their smoke alarms and don't even notice the incessant beeping going off every 30 seconds while others would be driven mad.

I tested this with a friend the other day. Her tinnitus doesn't bother her all that much. We played music louder and louder until our eeeeee was masked. She needed to play the music much louder than me. Mine bothers me quite a bit and hers barely seems to matter. I don't get it.

Maybe it doesn't bother her because she got it in her teens/early 20s? Maybe because she just associates it with a normal part of aging? No clue why hers is louder than mine but less annoying.

 

[DeanD]

I tested this with a friend the other day. Her tinnitus doesn't bother her all that much. We played music louder and louder until our eeeeee was masked. She needed to play the music much louder than me. Mine bothers me quite a bit and hers barely seems to matter. I don't get it.

Maybe it doesn't bother her because she got it in her teens/early 20s? Maybe because she just associates it with a normal part of aging? No clue why hers is louder than mine but less annoying.

Maybe pitch too (?)

I can manage louder hissing better than I can quieter tonal.

 

[GregCA]

Do you know how loud in dB she went to before ending the test?

If I recall correctly, it was 55 dB above hearing level, which, coincidentally, is also 55 dB, so probably a masking stimulus around 110 dB?

 

[dd314]

If I recall correctly, it was 55 dB above hearing level, which, coincidentally, is also 55 dB, so probably a masking stimulus around 110 dB?

I hope they would know better than that. I know some people on here can handle loud noise just fine but others would be leaving that test with aural fullness and 24 hours later hyperacusis and screaming tinnitus. 110 dB is fucking LOUD.

 

[Watasha]

I hope they would know better than that. I know some people on here can handle loud noise just fine but others would be leaving that test with aural fullness and 24 hours later hyperacusis and screaming tinnitus. 110 dB is fucking LOUD.

These values seem way out of bounds to me.

A few quotes from the link involving minimum masking levels...

Typically, tinnitus will be measured closer to the intensity of a whisper than to a shout, between 4 and 7 dB above the threshold of hearing. This finding presents somewhat of a puzzle, because often clients describe their tinnitus as being perceptually "very loud," when in fact the measurable loudness is in the very low range of 4 to 7 dB.

In most cases the MML is 8 dB SL or less. It is rare for the MML to go above 22 dB SL.

(Source)

 

[JimmyStrong]

I am honestly at peace and looking forward to getting hearing aids within the next 1-4 years. I don't even feel like dwelling on what could have been if my ears were healthy. I just want to do my best in life now.

But I do have a question and that is: will Dr. Shore's device remove the brain fog and tiredness since it is reducing the hyperactivity in the brain/DCN? And will hearing aids also bring a reduction in the brain fog/tiredness as well?

 

[Markku]

 

[DeanD]

View attachment 55513

Amazing work guys!

Interesting to read Dr Shore believes everyone has the modulating tinnitus mechanism but depends how strong it is as to whether it can be modulated to a noticeable effect. Mine is multi-tone, very loud and reactive and I have never been able to modulate it by doing anything.

Surprised, and a little disheartened, to read that no one part of the study had sound reactive tinnitus or even hyperacusis by the looks of things - (is it really THAT rare!?) so it's still an unknown as to how the audio from the device would react for those sufferers. For that it looks like we'll need to wait for the real world tests.

 

[Hazel]

@Markku worked so hard on this for many hours. Curating the questions, proof reading the answers, and creating a beautiful web page. Awesome work!!!

We aim to share this more widely through social media and our newsletter, but of course you guys here get it first. We will add some general background information about bimodal stimulation and the device as well, to make it accessible to lay audiences who may not be as knowledgeable as you folks

Definitely a milestone to get this done. I must admit, I have not yet read through the answers myself. I can imagine though that it will still leave you pondering about some things. I hope at least that we've been able to satisfy your curiosity a bit and that it helps to see all the questions and answers in one place

 

[kingsfan]

I am too busy answering questions.

I cackled

Thanks @Markku for putting together all these questions and answers as well as a nice looking interface to boot.

 

[Nick47]

Nice formatting @Markku.

 

[Hardwell]

I really appreciate you guys putting this together, I can only imagine how much hard work it was going through all those questions and choosing which ones to put through to Dr. Shore.

And I really appreciate her giving us her time to answer the questions. Although as expected, she didn't really tell us anything more than she already has.

 

[Utdmad89]

Amazing work guys!

Interesting to read Dr Shore believes everyone has the modulating tinnitus mechanism but depends how strong it is as to whether it can be modulated to a noticeable effect. Mine is multi-tone, very loud and reactive and I have never been able to modulate it by doing anything.

Surprised, and a little disheartened, to read that no one part of the study had sound reactive tinnitus or even hyperacusis by the looks of things - (is it really THAT rare!?) so it's still an unknown as to how the audio from the device would react for those sufferers. For that it looks like we'll need to wait for the real world tests.

I wouldn't say hyperacusis is rare. I would say they were just very particular on who they let in the study to make sure their results were iron tight and leave little room for doubt.

 

[UKBloke]

Nice one @Markku and @Hazel

Over to you, Auricle Inc.

 

[Ryan Scott]

This question and answer gives me hope. I often contemplate how the duration of having tinnitus affect the efficacy of treatments. Also, I just realized that she studied at Louisiana State University, Geaux Tigas!

Does time since tinnitus onset matter? Will the treatment be equally effective for someone who has had tinnitus for weeks/months versus someone who has had tinnitus for decades?

Our studies have shown no influence of tinnitus duration on treatment efficacy.

Thanks @Markku for the hard work. I really enjoyed and learned from reading through the questions.