New University of Michigan Tinnitus Discovery — Signal Timing

[AfroSnowman]

What was this member's experience? Was it helpful?

If you do a search through this thread, you can find lots of comments both real time and after the fact reflection from @linearb.

 

[SarahMLFlemmer]

Yes, the member is @linearb.

I'm pretty new here, 4 months in. I've looked through @linearb's posts. Does he have a specific post that relays his experience with the clinical trial? Is the clinical trial that he participated in the Michigan device, or something similar?

 

[AnthonyMcDonald]

In my opinion, electrical stimulation of the ear is going to help a lot more people in more meaningful ways, so I wouldn't bet the farm on Dr. Shore's device.

In what ways? I assume you mean the cochlea. The numerous papers I've read from different researchers all point to the DCN in the brainstem (and HCN, TCC, etc) in combination with voltage gated potassium channel (Kv7.2/3) dysfunction to be point of origin of tinnitus generation, not the cochlea.

Why do you think people who severed their 8th cranial nerve still perceive tinnitus?

 

[Nick47]

Does he have a specific post that relays his experience with the clinical trial? Is the clinical trial that he participated in the Michigan device, or something similar?

@SarahMLFlemmer, yes to all.

 

[awake 44]

In what ways? I assume you mean the cochlea. The numerous papers I've read from different researchers all point to the DCN in the brainstem (and HCN, TCC, etc) in combination with voltage gated potassium channel (Kv7.2/3) dysfunction to be point of origin of tinnitus generation, not the cochlea.

Why do you think people who severed their 8th cranial nerve still perceive tinnitus?

As usual, I totally agree with @AnthonyMcDonald. Numerous devices for electrical stimulation of the ear have been already tested. The oldest one I'm aware of was set up in 1972. If that path was the right one, we would all have been cured a long time ago.

However, I think this field should not be abandoned completely. I think bimodal stimulation of the DCN is number #1 priority. Electrical stimulation of the ear in my opinion is something that should be continued in the background, as some usefulness has been reported.

I'm pretty new here, 4 months in. I've looked through @linearb's posts. Does he have a specific post that relays his experience with the clinical trial? Is the clinical trial that he participated in the Michigan device, or something similar?

@linearb reported improvement after testing the device as far as I remember.

 

[Nick47]

As usual, I totally agree with @AnthonyMcDonald. Numerous devices for electrical stimulation of the ear have been already tested. The oldest one I'm aware of was set up in 1972. If that path was the right one, we would all have been cured a long time ago.

However, I think this field should not be abandoned completely. I think bimodal stimulation of the DCN is number #1 priority. Electrical stimulation of the ear in my opinion is something that should be continued in the background, as some usefulness has been reported.

I agree on the DCN, it has research and now a treatment.

What concerned me though was that severing the auditory nerve did resolve tinnitus for some. What do we make of that?

I don't agree that electrical stimulation of the cochlear should be abandoned, far from it. Look at the reduction people get with cochlear implants + the early results from extra cochlear electrical stimulation. Is the electrical stimulation changing activity in the DCN?

Megan Beers Wood found that in pain hyperacusis the Type 2 nerve fibers in the cochlea send the pain signals.

I see tinnitus basically as starting with cochlear damage that changes input into the auditory nerve. That changed input causes misfiring in the DCN. From here it fucks us over, gets processed as noise in the auditory cortex, spreads to attention and emotional networks etc.

So I see both approaches targeting the root cause and they could work in tandem.

 

[AnthonyMcDonald]

What concerned me though was that severing the auditory nerve did resolve tinnitus for some

These statistics are based on a shoddy study from ~30 years ago with no trace of it existing anywhere else, no references, and no information about the people who partook in it. I wouldn't bank on its results.

 

[Stacken77]

The numerous papers I've read from different researchers all point to the DCN in the brainstem (and HCN, TCC, etc) in combination with voltage gated potassium channel (Kv7.2/3) dysfunction to be point of origin of tinnitus generation, not the cochlea.

I agree, it sure looks like the DCN is at fault here. However, according to the paper The effect of dorsal cochlear nucleus ablation on tinnitus in rats, removal of the DCN did not significantly affect tinnitus:

Contrary to prediction, bilateral dorsal DCN ablation did not significantly (n=11, p=0.707) affect the psychophysical evidence of tinnitus, and ipsilateral dorsal DCN ablation appeared to increase the evidence of tinnitus (n=9, p=0.018) compared to pre-ablation performance. It was concluded that the DCN does not act as a simple feed-forward source of chronic tinnitus.

Maybe rats just don't translate well to humans, but interesting either way. Any thoughts?

 

[linearb]

I'm pretty new here, 4 months in. I've looked through @linearb's posts. Does he have a specific post that relays his experience with the clinical trial? Is the clinical trial that he participated in the Michigan device, or something similar?

I'm just going to speak to this directly since my old posts are buried under years of cruft. The trial was in early 2016.

This is what I remember, from the 4-week non-placebo trial (which I correctly guessed was not placebo on about day 15):

• Days 1-7: zero change at all, distress and volume ratings around 7/10.
• Days 7-14: my subjective daily ratings of both volume and distress decrease slightly.
• Days 15-30: subjective ratings continue to fall, bottoming out around a 4-5 for volume and a 2-3 for distress. For me this gets into "super liveable, barely notice this". Note that I had lived with minor tinnitus for a decade or more prior to my 2010 trauma.
• Days 31-40: Device use discontinued, tinnitus slowly reasserts itself back to baseline.

I agree, it sure looks like the DCN is at fault here. However, according to the paper The effect of dorsal cochlear nucleus ablation on tinnitus in rats, removal of the DCN did not significantly affect tinnitus:

Maybe rats just don't translate well to humans, but interesting either way. Any thoughts?

Eh. Apples and oranges. Just because the DCN has become hyperactive doesn't mean that surgically removing or degrading it will solve the problem, it may just push the aberrant neuroplastic attempts at regaining homeostasis into other structures or make them permanent.

I don't think research to do with retraining the DCN (UMich, etc) has a ton to do with research on ablating it, any more than research on things which improve cardiac health have a ton to do with research on removing parts of the heart muscle and replacing with a pacemaker. Very, very different modalities targeting the same physiological region.

Of course, I can hardly be considered an unbiased source, because I used the UMich thing and strongly believe it works for me. Just my .02.

 

[Nick47]

Maybe rats just don't translate well to humans, but interesting either way. Any thoughts?

Rants don't translate well to humans. Guinea pigs do.

My thoughts are different in my conclusions. Just as cutting the auditory nerve doesn't attenuate tinnitus, why should removing the DCN? It's actually logical to me it wouldn't attenuate the tinnitus as the upstream parts will now be even more affected, just like cutting the auditory nerve. Dr. Shore's device modulates the DCN so that the upstream effects are also affected.

I'm surprised at the author's conclusions. It's like saying, to cure pain in the arm, we should be able to cut the arm off. What happens? Phantom limb pain.

 

[GtwoK]

Out of curiosity, is the understanding that Dr. Shore's device would not function in cases where the user had habituated to tinnitus, and would only function on relatively "new" cases (< 6 months)?

 

[JimmyStrong]

Rants don't translate well to humans. Guinea pigs do.

So why aren't more tests done on guinea pigs instead of rats?

 

[ErikaS]

I'm just going to speak to this directly since my old posts are buried under years of cruft. The trial was in early 2016.

This is what I remember, from the 4-week non-placebo trial (which I correctly guessed was not placebo on about day 15):

• Days 1-7: zero change at all, distress and volume ratings around 7/10.
• Days 7-14: my subjective daily ratings of both volume and distress decrease slightly.
• Days 15-30: subjective ratings continue to fall, bottoming out around a 4-5 for volume and a 2-3 for distress. For me this gets into "super liveable, barely notice this". Note that I had lived with minor tinnitus for a decade or more prior to my 2010 trauma.
• Days 31-40: Device use discontinued, tinnitus slowly reasserts itself back to baseline.

Eh. Apples and oranges. Just because the DCN has become hyperactive doesn't mean that surgically removing or degrading it will solve the problem, it may just push the aberrant neuroplastic attempts at regaining homeostasis into other structures or make them permanent.

I don't think research to do with retraining the DCN (UMich, etc) has a ton to do with research on ablating it, any more than research on things which improve cardiac health have a ton to do with research on removing parts of the heart muscle and replacing with a pacemaker. Very, very different modalities targeting the same physiological region.

Of course, I can hardly be considered an unbiased source, because I used the UMich thing and strongly believe it works for me. Just my .02.

Thank you for sharing this feedback. When you received this intervention, what was the profile of your tinnitus? Single tone, multi-tone, reactive, nonreactive?

 

[Nick47]

Out of curiosity, is the understanding that Dr. Shore's device would not function in cases where the user had habituated to tinnitus, and would only function on relatively "new" cases (< 6 months)?

You had to have tinnitus for longer than 6 months to take part in the trials.

 

[Watasha]

I'm betting the farm. I've got the whole damn plantation on the line for this.

Don't. I'm a big fan of Dr. Shore and the device, but I think electrical stimulation is not far off and will be even more effective.

Thing is, there will always be something better around the corner.

The Michigan device is the only tangible treatment on the way though.

For sure, but electrical stimulation is right around the corner and looks to be VERY effective.

 

[Nick47]

For sure, but electrical stimulation is right around the corner and looks to be VERY effective.

The extra cochlear stuff seems 5-6 years away at least. Or am I missing something?

 

[linearb]

Thank you for sharing this feedback. When you received this intervention, what was the profile of your tinnitus? Single tone, multi-tone, reactive, nonreactive?

Multi tone, most annoying is oscillatory stuff that's predominately left but also centralized and in the 12 kHz range.

For me reactivity is a function of being stuck in a panic feedback loop for an extended period (weeks to months) causing all my sensory neurons to amp up; I think by the time I was enrolled in the trial I was mostly past the panic and more depressed than anything else, but, I don't really remember.

 

[AnthonyMcDonald]

Rants don't translate well to humans. Guinea pigs do.

My thoughts are different in my conclusions. Just as cutting the auditory nerve doesn't attenuate tinnitus, why should removing the DCN? It's actually logical to me it wouldn't attenuate the tinnitus as the upstream parts will now be even more affected, just like cutting the auditory nerve. Dr. Shore's device modulates the DCN so that the upstream effects are also affected.

I'm surprised at the author's conclusions. It's like saying, to cure pain in the arm, we should be able to cut the arm off. What happens? Phantom limb pain.

Like @Stacken77 has said, removing the DCN did not eliminate behavioral signs of tinnitus. This is because, from what I've read in some papers, the DCN isn't solely responsible for the persistence of tinnitus. Sure, it may originate there, but the hyperactivity spreads throughout the auditory pathway, the HCN, TCC, etc.

I assume the Shore device, by stimulating the DCN & other somatic co-factors, causes a ripple effect up the auditory pathway. Just ripping out the DCN won't solve anything.

 

[ErikaS]

Multi tone, most annoying is oscillatory stuff that's predominately left but also centralized and in the 12 kHz range.

For me reactivity is a function of being stuck in a panic feedback loop for an extended period (weeks to months) causing all my sensory neurons to amp up; I think by the time I was enrolled in the trial I was mostly past the panic and more depressed than anything else, but, I don't really remember.

Thank you for sharing! Wow, encouraging to know that even though you had multiple tones that oscillated, you still saw/heard notable decrease and improvement. That's amazing.

 

[TashaJane]

Do we think Dr. Shore will do a 3rd trial?

 

[ajc]

Do we think Dr. Shore will do a 3rd trial?

The device will launch first but there might be other real world studies later:

It is not clear if there will be a Phase III study, but there will be other 'real world' studies once the device is in the market to assess efficacy.

https://www.tinnitustalk.com/posts/671379/

 

[TashaJane]

The device will launch first but there might be other real world studies later:

It is not clear if there will be a Phase III study, but there will be other 'real world' studies once the device is in the market to assess efficacy.

https://www.tinnitustalk.com/posts/671379/

Thank you.

 

[Joshua Macleod]

This is what I remember, from the 4-week non-placebo trial (which I correctly guessed was not placebo on about day 15):

• Days 1-7: zero change at all, distress and volume ratings around 7/10.
• Days 7-14: my subjective daily ratings of both volume and distress decrease slightly.
• Days 15-30: subjective ratings continue to fall, bottoming out around a 4-5 for volume and a 2-3 for distress. For me this gets into "super liveable, barely notice this". Note that I had lived with minor tinnitus for a decade or more prior to my 2010 trauma.
• Days 31-40: Device use discontinued, tinnitus slowly reasserts itself back to baseline.

Thank you for dropping in and letting us know how it went for you.

How did you find the transition back to baseline after a subjectively perceived drop in volume?

 

[awake 44]

Do we think Dr. Shore will do a 3rd trial?

We don't want a 3rd trial! Let us have the device available ASAP. Then we will test it on ourselves.

 

[ajc]

We don't want a 3rd trial! Let us have the device available ASAP. Then we will test it on ourselves.

Once again you lack insight. 3rd trial is definitely something Dr. Shore will do, because she's a great researcher. But she will do it as post-market study. The device will launch first, then the post-market study commences.

She's able to continue tinker with the tech and science when she gets more and more participants in future studies. This can translate into a more effective V2 device.

 

[Watasha]

The extra cochlear stuff seems 5-6 years away at least. Or am I missing something?

Are you referring to the implantable devices like Dr. Djalilian's and Mayo Clinic? If so, I'd say that's a reasonable timeframe. The preliminaries showed such high effectiveness, it's very encouraging.

 

[dj_newark]

Don't. I'm a big fan of Dr. Shore and the device, but I think electrical stimulation is not far off and will be even more effective.

For sure, but electrical stimulation is right around the corner and looks to be VERY effective.

No, Dr. Shore's device is right around the corner. Dr. Djalilian's is farther off. I'm hoping that by the time that's out I won't need further treatment. But who knows? I certainly may.

Also when the Auricle device is out, the Shore team will continue working on it to improve its efficacy and the number of people it'll work for after it's been released. So I am still betting the farm on that!

If you want to wait for a better treatment, wait for what Dr. Lim has in store as the next version of Lenire. That is going to top everything! The future for treatment of tinnitus is exciting indeed!

 

[Nick47]

If you want to wait for a better treatment, wait for what Dr. Lim has in store as the next version of Lenire. That is going to top everything! The future for treatment of tinnitus is exciting indeed!

@dj_newark, surely sarcasm?

 

[UHPTS]

If you want to wait for a better treatment, wait for what Dr. Lim has in store as the next version of Lenire. That is going to top everything! The future for treatment of tinnitus is exciting indeed!

Not sure what you mean. Is this a joke?

 

[dj_newark]

@dj_newark, surely sarcasm?

No, are you not familiar with Dr. Lim's work at the University of Minnesota? The current Lenire is a joke. The next version based on his work will be game changing.