Repeated Modified Nerve Blocks and Auditory and Non-Auditory Nerve Stimulation

[Gb3]

UPDATE:

Dr. Heon Man Sirh wrote back to me. He gave me the name of one of the US patients undergoing treatment that is willing to speak to me.

I have written to that person - let's see if they respond.

Fingers crossed.

Please ask them how long they had tinnitus and what caused it. Thanks.

 

[Uklawyer]

Please ask them how long they had tinnitus and what caused it. Thanks.

Have done.

 

[David S]

UPDATE:

Dr. Heon Man Sirh wrote back to me. He gave me the name of one of the US patients undergoing treatment that is willing to speak to me.

I have written to that person - let's see if they respond.

Fingers crossed.

Great news! Well done!

 

[Padraigh Griffin]

UPDATE:

Dr. Heon Man Sirh wrote back to me. He gave me the name of one of the US patients undergoing treatment that is willing to speak to me.

I have written to that person - let's see if they respond.

Fingers crossed.

Awesome work. Well done. Looking forward to hearing the report!

 

[Chinmoku]

UPDATE:

Dr. Heon Man Sirh wrote back to me. He gave me the name of one of the US patients undergoing treatment that is willing to speak to me.

I have written to that person - let's see if they respond.

Fingers crossed.

Well done @Uklawyer, this is great news. We desperately need this kind of feedback.

Even with this sample of one, it is worth checking the following if you have the chance.

1. On the scale 0-10, where was this person tinnitus before starting?
2. After the treatment so far (how many sessions?), where is s/he in the scale?
3. Cause of the tinnitus onset?
4. Hearing loss? Hyperacusis? Other ear conditions?
5. Had this person tried other treatments?
6. Is the treatment very painful, high discomfort?
7. Does s/he manage to communicate satisfactorily in English with the clinic?
8. Has s/he been able to collect other testimonials from the clinic or other foreign clients (s/he doesn't have to tell us any names or identifying info but only if other people benefited significantly that s/he has witnessed directly)?
9. Is s/he getting the placenta injected too (growth factors extracted from placenta I imagine)?
10. Is s/he coordinating with a western doctor or has s/he gone there entirely on their own?

Maybe too many questions, but maybe our friend will be willing to tell.

 

[Uklawyer]

Hi @Chinmoku. Thanks. I have asked a number of these questions. I will look at these additional points if/once I receive a response. I hope it will be forthcoming and helpful.

What's the placenta bit about? I thought it was the basic nerve block that was given.

 

[Chinmoku]

Hi @Chinmoku. Thanks. I have asked a number of these questions. I will look at these additional points if/once I receive a response. I hope it will be forthcoming and helpful.

What's the placenta bit about? I thought it was the basic nerve block that was given.

It was mentioned earlier in the thread that in the past they used to inject "placenta" on top of Lidocaine, but stopped due to (non-severe) allergic reactions. I wondered what this "placenta" could be. Stem cells? Exosomes? My Korean contact said it's probably growth factors from placenta. I don't know if injecting those can help regeneration and inflammation but apparently it's an option one might add to the Lidocaine.

Edit: From your own correspondence with Heon Man Sirh above:

2. Can you use a different nerve block (not Lidocaine) for the treatment?

I think you might be wondering if we can use other injectables for the nerve block. We sometimes use placenta derivatives mix with Lidocaine. It's more effective rather than just Lidocaine only by my experience. But some patients have allergic reaction with that. Not severe just itching, rash, redness.

 

[Uklawyer]

@Chinmoku - well picked up. Okay. I will definitely enquire further once I have received a response.

Thanks.

 

[BrysonKingMe]

Hello,

I am trying to stay off Tinnitus Talk as it drives my focus to my tinnitus.

I have purchased 2 refundable tickets to Seoul for April 19th, with a consultation and first treatment set up for the 21st.

I have thought about this for quite a while and have decided it's worth a shot. Worst case, it doesn't work and I get to see Seoul with my girlfriend, while still keeping my job and working remotely.

Best case, I get to see Seoul with my girlfriend, keep my job, and have little to no tinnitus afterwards.

I plan on keeping a video log of the process as much as I can and post it here to help you all out. This may change if I hear back from some of the US patients' responses, and they are unsatisfactory, but all I have to do now is book my Airbnb and go through a lengthy process to avoid the 7-day quarantine for unvaccinated persons.

Wish me luck. I feel crazy for doing this, but I am in a place where I can do this with little downside besides the $ it will cost to get me there.

To add to this, some background of my tinnitus:

• Gunshots caused severe tinnitus, 10/10, in 2016.
• Reduced to a loud hiss fairly quickly after Prednisone.
• Concussion 2 months after onset led to some crazy noises, electrical-like, that happened intermittently.
• Habituated to mild/moderate tinnitus, didn't care about it at all.
• 2018, involved in a serious car accident where I got a TBI. Caused a tinnitus spike, but returned to baseline.
• 2020, involved in a bicycle accident where I got yet another concussion, but returned to baseline a month after.
• 2022, acoustic trauma from an aftermarket car alarm that went off 3 feet away from my ear. Ever since then, I have had a few "mild" days, mixed with moderate and severe days. Seems to be no pattern to my tinnitus besides being reset by sleep. But I have not had more than 1 mild/moderate day in a row. Next day it always comes back with a vengeance.
• Currently in TRT therapy, will continue it through this treatment.
• I would say currently my VAS score according to this study's chart is about a 7/8 overall. Hard to say with mild days mixed in here and there. Severe day that follows a mild/moderate day is soul-crushing.
• I also have very reactive tinnitus on the bad days, but not the good days...?

That's all -- like I mentioned I am really trying to stay off here, so please don't expect replies to this until I have something to offer.

 

[Uklawyer]

Hi @BrysonKingMe, well done for doing this. It is a brave thing to do but this does look very promising so could end up being a great thing to do.

I have not heard back from the US person that agreed to speak with me. I will chase soon as I am eager to get info on this. I will let you know as soon as I hear back.

Best.

 

[Padraigh Griffin]

Hello,

I am trying to stay off Tinnitus Talk as it drives my focus to my tinnitus.

I have purchased 2 refundable tickets to Seoul for April 19th, with a consultation and first treatment set up for the 21st.

I have thought about this for quite a while and have decided it's worth a shot. Worst case, it doesn't work and I get to see Seoul with my girlfriend, while still keeping my job and working remotely.

Best case, I get to see Seoul with my girlfriend, keep my job, and have little to no tinnitus afterwards.

I plan on keeping a video log of the process as much as I can and post it here to help you all out. This may change if I hear back from some of the US patients' responses, and they are unsatisfactory, but all I have to do now is book my Airbnb and go through a lengthy process to avoid the 7-day quarantine for unvaccinated persons.

Wish me luck. I feel crazy for doing this, but I am in a place where I can do this with little downside besides the $ it will cost to get me there.

To add to this, some background of my tinnitus:

• Gunshots caused severe tinnitus, 10/10, in 2016.
• Reduced to a loud hiss fairly quickly after Prednisone.
• Concussion 2 months after onset led to some crazy noises, electrical-like, that happened intermittently.
• Habituated to mild/moderate tinnitus, didn't care about it at all.
• 2018, involved in a serious car accident where I got a TBI. Caused a tinnitus spike, but returned to baseline.
• 2020, involved in a bicycle accident where I got yet another concussion, but returned to baseline a month after.
• 2022, acoustic trauma from an aftermarket car alarm that went off 3 feet away from my ear. Ever since then, I have had a few "mild" days, mixed with moderate and severe days. Seems to be no pattern to my tinnitus besides being reset by sleep. But I have not had more than 1 mild/moderate day in a row. Next day it always comes back with a vengeance.
• Currently in TRT therapy, will continue it through this treatment.
• I would say currently my VAS score according to this study's chart is about a 7/8 overall. Hard to say with mild days mixed in here and there. Severe day that follows a mild/moderate day is soul-crushing.
• I also have very reactive tinnitus on the bad days, but not the good days...?

That's all -- like I mentioned I am really trying to stay off here, so please don't expect replies to this until I have something to offer.

Best of luck with your tinnitus. I can empathise with your type of tinnitus. I get a few mild days and then bang, soul crushing stuff. And sleep always resets mine too. Well done for being brave and taking the plunge. I feel like you will be rewarded for it. Wishing you well

 

[Chriscom]

I am trying to stay off Tinnitus Talk as it drives my focus to my tinnitus.

I have purchased 2 refundable tickets to Seoul for April 19th, with a consultation and first treatment set up for the 21st...-- like I mentioned I am really trying to stay off here, so please don't expect replies to this until I have something to offer.

You've had a tough road, best of luck to you and thanks for communicating what you can, when you can.

 

[Toby1972]

• 2022, acoustic trauma from an aftermarket car alarm that went off 3 feet away from my ear. Ever since then, I have had a few "mild" days, mixed with moderate and severe days. Seems to be no pattern to my tinnitus besides being reset by sleep. But I have not had more than 1 mild/moderate day in a row. Next day it always comes back with a vengeance.
• I would say currently my VAS score according to this study's chart is about a 7/8 overall. Hard to say with mild days mixed in here and there. Severe day that follows a mild/moderate day is soul-crushing.

That's all -- like I mentioned I am really trying to stay off here, so please don't expect replies to this until I have something to offer.

Me the same. My bad days are discouraging. It only helps that every now and then I have a better day. This is my new rest.

I wish you luck.

 

[LGuapo]

Seems to be no pattern to my tinnitus besides being reset by sleep.

This would describe mine, as well. It seems to be common. I would really like to understand the mechanism of action w.r.t. sleep. I can imagine a few models, I suppose. Some sort of signaling or inhibitory chemical build up? Or the reverse? I suppose there is so much that is not understood about both sleep and tinnitus that I'll never know. Also, I can't rule out that the tinnitus is actually gradually changing, but I only notice the overnight changes because from my conscious perspective they are instant. It certainly doesn't feel like that's the answer, though.

 

[Ela Stefan]

I have a question. It is well known that when tinnitus becomes chronic, there are chemical and cellular changes along the neural pathways to the central auditory cortex, along with neural changes to the efferent auditory nerves back to the cochlea.

Meaning there is central gain, sensitization, that for the time being, would work on its own, as a loop, without the peripheral damage being a factor anymore.

So how blocking the nerve ending or ganglion nerve would produce changes in the central auditory cortex or the other endings of the auditory nerve along its way to the center, or changes in the neurons themselves of the auditory nerve?

Because all of these are affected when you have tinnitus. There are chemical, biological changes of the auditory nerve on the afferent and efferent pathways that actually maintain wrong signaling, i.e. tinnitus.

 

[Uklawyer]

@Ela Stefan - again, seems to be neuroplasticity: the brain is adapting to something. The signal is amplified and pathways reinforced, I imagine (in neuroplastic terms).

If such changes can occur in response to stress or medication or injury to the inner or middle ear then, arguably, those changes can be reversed. Blocking the signal and restimulating appears to induce those "reverse" changes, acting as a form of reset (as does signal timing bimodal stimulation).

 

[Rayk]

This would describe mine, as well. It seems to be common. I would really like to understand the mechanism of action w.r.t. sleep. I can imagine a few models, I suppose. Some sort of signaling or inhibitory chemical build up? Or the reverse? I suppose there is so much that is not understood about both sleep and tinnitus that I'll never know. Also, I can't rule out that the tinnitus is actually gradually changing, but I only notice the overnight changes because from my conscious perspective they are instant. It certainly doesn't feel like that's the answer, though.

And mine also - always reset by sleep. Mine follows a distinct pattern. 1 to 2 days of tinnitus at a manageable level followed by 2 to 3 days of severe tinnitus and the drop or increase always takes place when I am sleeping or trying to sleep as I wake 3 to 4 times a night.

 

[Chinmoku]

I have a question. It is well known that when tinnitus becomes chronic, there are chemical and cellular changes along the neural pathways to the central auditory cortex, along with neural changes to the efferent auditory nerves back to the cochlea.

Meaning there is central gain, sensitization, that for the time being, would work on its own, as a loop, without the peripheral damage being a factor anymore.

So how blocking the nerve ending or ganglion nerve would produce changes in the central auditory cortex or the other endings of the auditory nerve along its way to the center, or changes in the neurons themselves of the auditory nerve?

Because all of these are affected when you have tinnitus. There are chemical, biological changes of the auditory nerve on the afferent and efferent pathways that actually maintain wrong signaling, i.e. tinnitus.

Nobody knows, I'm afraid, we can only speculate.

What could be happening here is that alternating stimuli with blocks may send opposing signals through the nerves and the innervated tissue and this kind of activity decorrelates or calms the joint maladaptive firing of neurons. This is so speculative, however, to be worthless. Without precise measurements and imaging, we cannot say anything.

 

[GeorgeLG]

It is thought that there is more than one mechanism. If this was purely about hair cells, nerve pathways to the brain and central gain, then you would not read all these posts of mechanical maneuvers in other areas eliminating or changing tinnitus.

There is quite a bit written about TMJ and ear problems and more written about cervical spine problems and TMJ. There can be so many mechanisms at work and there are so many speculations.

Some theories involve the vagus or trigeminal nerves which originate away from the inner ear altogether. I have no idea about cause and effect but TMJ arrives at the same time as noxacusis for me.

George

 

[FlatDarkEarth]

I have a question. It is well known that when tinnitus becomes chronic, there are chemical and cellular changes along the neural pathways to the central auditory cortex, along with neural changes to the efferent auditory nerves back to the cochlea.

Meaning there is central gain, sensitization, that for the time being, would work on its own, as a loop, without the peripheral damage being a factor anymore.

Can you speak to that being 'well known'? I see the idea, that tinnitus 'sets into the brain' tossed around occasionally, but I never see any research attesting to that. I've never seen the specifics you mention in research.

With how misunderstood tinnitus is and how people struggle to even treat it, I wonder how that much is understood about the specifics of tinnitus setting into the brain.

 

[Uklawyer]

Update: I have managed to get some feedback from the US patient.

How long have you had tinnitus (and your age if comfortable disclosing)?
7 months. I'm 44.

Do you know the cause of it?
No, it just started one day. I never exposed myself to loud sounds though.

How bad is it (volume and intrusiveness)?
It's only in my left ear but it's chronic and pretty bad at times. Usually sounds like an irregular hiss/sizzle/electrical short circuit mixed with high pitched ringing. (I have since spoken with them and they rated their (pre-treatment) tinnitus at a 7 out of 10).

What treatments have you previously tried to help with tinnitus (and did anything help at all)?
I have tried physiotherapy (McKenzie method), acupuncture, pink noise therapy, lipoflavonoids, Ginkgo biloba. Unfortunately nothing seems to have helped.

How many treatments have you had with Dr. Heon Man Sirh?
7 so far (I think it's now 8, at c. 3 sessions per week.)

How would you rate your tinnitus now following treatment (and did you notice improvement after each treatment)?
I'd rather wait until I complete the treatment to answer this.

Could you briefly describe the treatment process and any side effects?
It is quite simple. 3 needles inserted around the ear where they sit for 40 minutes. Then injection of Lidocaine or placental derivatives. There is very little discomfort and I've had no side effects.

Any idea how many treatments you will have?
I will continue to have treatments until I or the clinic feel they're no longer providing benefit.

Do you have any hearing loss, hyperacusis or any other ear condition? Do you get ear fullness?
In real world testing I don't notice any hearing loss at all, although my audiogram showed some mild high frequency left sided hearing loss (the side with the tinnitus). Here's my audiogram: (I won't post this as it has the individual's name, but hearing loss is c. 20 dB up to 2 kHz then descends uniformly to 35 dB at 8 kHz).

I don't think I have hyperacusis in that few sounds cause me actual pain, but my ear does flutter from certain sounds and it can be very irritating. Sometimes even my own voice causes it. From what I've read I believe it is tonic tensor tympani syndrome.

Have you met anyone else at the clinic or heard about any other results?
I know there is currently one other Westerner at the clinic receiving treatment but I have not spoken to him.

Are you able to easily communicate with the doctor and any others at the clinic? What are they like?
Most people at the clinic do not speak English, but Dr. Soo Ji Sirh speaks English and I can communicate with her very well. Everyone at the clinic is exceptionally thoughtful and kind, and I believe they are earnest, sincere, and truly committed to helping people with tinnitus

Are you coordinating with any doctors in the US or are you effectively there on your own?
I had seen three ENTs in New York City, an audiologist, and I received an MRI of my internal auditory canals (no vestibular schwannoma). I decided to come here on my own with no coordination with other doctors.

------------------------------------

I know we want to know about results, but as the patient is still in treatment, they want to wait until completion of treatment before commenting on efficacy (which sort of makes sense).

I hope the above info is useful.

 

[BrysonKingMe]

Update: I have managed to get some feedback from the US patient.

How long have you had tinnitus (and your age if comfortable disclosing)?
7 months. I'm 44.

Do you know the cause of it?
No, it just started one day. I never exposed myself to loud sounds though.

How bad is it (volume and intrusiveness)?
It's only in my left ear but it's chronic and pretty bad at times. Usually sounds like an irregular hiss/sizzle/electrical short circuit mixed with high pitched ringing. (I have since spoken with them and they rated their (pre-treatment) tinnitus at a 7 out of 10).

What treatments have you previously tried to help with tinnitus (and did anything help at all)?
I have tried physiotherapy (McKenzie method), acupuncture, pink noise therapy, lipoflavonoids, Ginkgo biloba. Unfortunately nothing seems to have helped.

How many treatments have you had with Dr. Heon Man Sirh?
7 so far (I think it's now 8, at c. 3 sessions per week.)

How would you rate your tinnitus now following treatment (and did you notice improvement after each treatment)?
I'd rather wait until I complete the treatment to answer this.

Could you briefly describe the treatment process and any side effects?
It is quite simple. 3 needles inserted around the ear where they sit for 40 minutes. Then injection of Lidocaine or placental derivatives. There is very little discomfort and I've had no side effects.

Any idea how many treatments you will have?
I will continue to have treatments until I or the clinic feel they're no longer providing benefit.

Do you have any hearing loss, hyperacusis or any other ear condition? Do you get ear fullness?
In real world testing I don't notice any hearing loss at all, although my audiogram showed some mild high frequency left sided hearing loss (the side with the tinnitus). Here's my audiogram: (I won't post this as it has the individual's name, but hearing loss is c. 20 dB up to 2 kHz then descends uniformly to 35 dB at 8 kHz).

I don't think I have hyperacusis in that few sounds cause me actual pain, but my ear does flutter from certain sounds and it can be very irritating. Sometimes even my own voice causes it. From what I've read I believe it is tonic tensor tympani syndrome.

Have you met anyone else at the clinic or heard about any other results?
I know there is currently one other Westerner at the clinic receiving treatment but I have not spoken to him.

Are you able to easily communicate with the doctor and any others at the clinic? What are they like?
Most people at the clinic do not speak English, but Dr. Soo Ji Sirh speaks English and I can communicate with her very well. Everyone at the clinic is exceptionally thoughtful and kind, and I believe they are earnest, sincere, and truly committed to helping people with tinnitus

Are you coordinating with any doctors in the US or are you effectively there on your own?
I had seen three ENTs in New York City, an audiologist, and I received an MRI of my internal auditory canals (no vestibular schwannoma). I decided to come here on my own with no coordination with other doctors.

------------------------------------

I know we want to know about results, but as the patient is still in treatment, they want to wait until completion of treatment before commenting on efficacy (which sort of makes sense).

I hope the above info is useful.

@Uklawyer, fantastic, although I really wish he had answered the one question we're all curious about.

He did say "until they're no longer providing benefit", implying that they have provided benefit this far...

Please follow up with him to provide an update when he has finished with treatment.

 

[Padraigh Griffin]

Great, thanks @Uklawyer. We will have to wait for final results for the patient. Hope it works for them.

 

[Ela Stefan]

Can you speak to that being 'well known'? I see the idea, that tinnitus 'sets into the brain' tossed around occasionally, but I never see any research attesting to that. I've never seen the specifics you mention in research.

With how misunderstood tinnitus is and how people struggle to even treat it, I wonder how that much is understood about the specifics of tinnitus setting into the brain.

One of the many many articles about it:

The Role of Central Nervous System Plasticity in Tinnitus

 

[FlatDarkEarth]

One of the many many articles about it:

The Role of Central Nervous System Plasticity in Tinnitus

Thanks for finding that. I'm having a tough spike right now that is very unlikely due to any additional changes in the ear/hearing so what you said was of particular interest. Lots to digest there.

 

[Uklawyer]

@Uklawyer, fantastic, although I really wish he had answered the one question we're all curious about.

@BrysonKingMe - I wished for the same. We are all so eager to see instant results that we forget that it's more of a process. I will keep you updated and provide any other information that may be useful. If you have any questions, feel free to ask and I will pass them on.

 

[Jerad]

The patient mentioned he's done 7 treatments so far, so perhaps that's a good sign. Probably wouldn't keep paying all that money if it wasn't providing any benefits. My main concern with this treatment (for me personally) is that I had a spike from Lidocaine not too long ago. So I don't know if I can do it.

 

[BrysonKingMe]

The patient mentioned he's done 7 treatments so far, so perhaps that's a good sign. Probably wouldn't keep paying all that money if it wasn't providing any benefits. My main concern with this treatment (for me personally) is that I had a spike from Lidocaine not too long ago. So I don't know if I can do it.

We were also told by the doctor that they have had "excellent results" after 4 treatments.

I would be hesitant to say my tinnitus was improving until I was done, as well.

 

[Joey72]

Question is why couldn't the person say one way or the other if he/she had any improvement...

 

[chinup]

Update: I have managed to get some feedback from the US patient.

How long have you had tinnitus (and your age if comfortable disclosing)?
7 months. I'm 44.

Do you know the cause of it?
No, it just started one day. I never exposed myself to loud sounds though.

How bad is it (volume and intrusiveness)?
It's only in my left ear but it's chronic and pretty bad at times. Usually sounds like an irregular hiss/sizzle/electrical short circuit mixed with high pitched ringing. (I have since spoken with them and they rated their (pre-treatment) tinnitus at a 7 out of 10).

What treatments have you previously tried to help with tinnitus (and did anything help at all)?
I have tried physiotherapy (McKenzie method), acupuncture, pink noise therapy, lipoflavonoids, Ginkgo biloba. Unfortunately nothing seems to have helped.

How many treatments have you had with Dr. Heon Man Sirh?
7 so far (I think it's now 8, at c. 3 sessions per week.)

How would you rate your tinnitus now following treatment (and did you notice improvement after each treatment)?
I'd rather wait until I complete the treatment to answer this.

Could you briefly describe the treatment process and any side effects?
It is quite simple. 3 needles inserted around the ear where they sit for 40 minutes. Then injection of Lidocaine or placental derivatives. There is very little discomfort and I've had no side effects.

Any idea how many treatments you will have?
I will continue to have treatments until I or the clinic feel they're no longer providing benefit.

Do you have any hearing loss, hyperacusis or any other ear condition? Do you get ear fullness?
In real world testing I don't notice any hearing loss at all, although my audiogram showed some mild high frequency left sided hearing loss (the side with the tinnitus). Here's my audiogram: (I won't post this as it has the individual's name, but hearing loss is c. 20 dB up to 2 kHz then descends uniformly to 35 dB at 8 kHz).

I don't think I have hyperacusis in that few sounds cause me actual pain, but my ear does flutter from certain sounds and it can be very irritating. Sometimes even my own voice causes it. From what I've read I believe it is tonic tensor tympani syndrome.

Have you met anyone else at the clinic or heard about any other results?
I know there is currently one other Westerner at the clinic receiving treatment but I have not spoken to him.

Are you able to easily communicate with the doctor and any others at the clinic? What are they like?
Most people at the clinic do not speak English, but Dr. Soo Ji Sirh speaks English and I can communicate with her very well. Everyone at the clinic is exceptionally thoughtful and kind, and I believe they are earnest, sincere, and truly committed to helping people with tinnitus

Are you coordinating with any doctors in the US or are you effectively there on your own?
I had seen three ENTs in New York City, an audiologist, and I received an MRI of my internal auditory canals (no vestibular schwannoma). I decided to come here on my own with no coordination with other doctors.

------------------------------------

I know we want to know about results, but as the patient is still in treatment, they want to wait until completion of treatment before commenting on efficacy (which sort of makes sense).

I hope the above info is useful.

Interesting that he seems to have randomly gotten tinnitus without a clear incident. I wonder if he had a COVID-19 vaccine dose right around the time of getting tinnitus. My first dose of Pfizer basically destroyed my ears and turned manageable tinnitus into something truly horrific. Thankfully it has improved a good deal over time but it's nowhere near as minor as it was before.

I'm hoping we get good news, thanks so much for all the legwork you've done Uklawyer.