Round and Oval Window Reinforcement for the Treatment of Hyperacusis

[lymebite]

The Silverstein Institute is offering another hyperacusis seminar in Florida next week:

https://www.eventbrite.com/e/hypera...eshare&utm-source=strongmail&utm-term=listing

 

[Mithrandir]

@Zimichael Hello Mister,
This surgery is very interesting, I read some people tried it with success, Did you make the experience ? Do you know if in USA, several doctors do that or only silverstein ?

Thanks !

 

[Craig in Cali]

 

[generalfuzz]

Talk by Dr. Silverstein in 2016

 

[PaulBe]

Meanwhile, Mainstream research is beetling away trying to find a magic pill to claim copyright over.

 

[Mithrandir]

I ask to my ENT, he told me, the risk is being deaf...

 

[AnxiousJon]

I ask to my ENT, he told me, the risk is being deaf...

That's always a risk of surgery of the middle ear.

 

[noisebox]

Yeah and if you ask an optician about laser corrective surgery for eye site they will tell us all the bad points. Audiologists don't want a cure for T or H.

 

[japongus]

Talk by Dr. Silverstein in 2016

The problem though is he's only curing dehiscence disorder and believes that everything that isn't low LDL is misophonia, which when you look close into is poorly thought out nonsense as it could be middle ear myoclonus instead. But great vid.

 

[lapidus]

Dr. Silverstein will present the latest results of the study at COSM May 21 in Chicago.
http://cosm.md/

 

[lymebite]

Here is the agenda for the part of COSM that includes the segment on "Round and Oval Window Reinforcement for the Treatment of Severe Hyperacusis" - Dr. Silverstein presents on Saturday May 21, 2016 at 2:25 pm.

http://www.americanneurotologysociety.com/images/forms/16ansprelim.pdf

 

[lymebite]

A short post mentioning a discussion about potential research of the mechanism behind Round and Oval Window Reinforcement Surgery for hyperacusis on the Hyperacusis Research Facebook page:

https://www.facebook.com/hyperacusisresearch

"At the 2016 ARO conference, Bryan Pollard, President of Hyperacusis Research, met with experts from Columbia University.

Dr. Anil Lalwani, one of the nation's leading ear surgeons, chairs the Hearing Health Foundation's Council of Scientific Advisors. His meeting with Bryan afforded an opportunity to understand the real-life difficulties of patients living with hyperacusis and noise-induced pain.

Hirobumi Watanabe, Ph.D., a research scientist at Columbia, has performed modeling work of the round window response to sound. Bryan discussed with them the round/oval window reinforcement surgery performed by Dr. Herbert Silverstein on a limited number of hyperacusis patients. The patients have seen improvement with this surgery, but there is a small degree of hearing loss. Bryan proposed that Hirobumi consider modeling this reinforcement procedure to learn more about the possible patient impacts."

 

[lapidus]

A short post mentioning a discussion about potential research of the mechanism behind Round and Oval Window Reinforcement Surgery for hyperacusis on the Hyperacusis Research Facebook page:

https://www.facebook.com/hyperacusisresearch

"At the 2016 ARO conference, Bryan Pollard, President of Hyperacusis Research, met with experts from Columbia University.

Dr. Anil Lalwani, one of the nation's leading ear surgeons, chairs the Hearing Health Foundation's Council of Scientific Advisors. His meeting with Bryan afforded an opportunity to understand the real-life difficulties of patients living with hyperacusis and noise-induced pain.

Hirobumi Watanabe, Ph.D., a research scientist at Columbia, has performed modeling work of the round window response to sound. Bryan discussed with them the round/oval window reinforcement surgery performed by Dr. Herbert Silverstein on a limited number of hyperacusis patients. The patients have seen improvement with this surgery, but there is a small degree of hearing loss. Bryan proposed that Hirobumi consider modeling this reinforcement procedure to learn more about the possible patient impacts."

I was actually thinking about asking Bryan at Hyperacusis Research about why they haven't mentioned anything about Silverstein's procedure on their facebook page yet but there you go. I'm not sure I know what "modeling work" is though.

 

[Mithrandir]

@japongus you think that only functions for SCDS and not for "normal" H ?

 

[japongus]

@japongus you think that only functions for SCDS and not for "normal" H ?

I'm not sure right now, but my impression was that his round and oval window reinforcement was supposed to be designed for dehiscence.

 

[lymebite]

The round and oval window reinforcement surgery has been used most commonly to treat perilymph fistula, and more recently SCDS. But Dr. Silverstein noticed that when treating patients for those other conditions, their hyperacusis improved. To investigate further, he is conducting a research study in which the surgery is performed on patients with only severe hyperacusis as their primary symptom.

The results of the study will be presented on May 21, 2016 in Chicago:

http://www.americanneurotologysociety.com/images/forms/16ansprelim.pdf

I am hoping to hear good results, that lots of severe H patients experienced good improvement!

 

[PaulBe]

Gee, if it proves successful then we may get it in Australia in ten years if all the ENTs who are invested in Audiology chains can be removed from the picture.

 

[Blujay]

Since Dr. Silverstein does just one ear at a time, does anyone know how much time is required to pass between each ear surgery?

 

[lymebite]

Since Dr. Silverstein does just one ear at a time, does anyone know how much time is required to pass between each ear surgery?

I think it is around a couple months. Whether or not the second ear is done is up to the patient - if they feel they got good improvement from the first one.

 

[Blujay]

I've been looking at videos of similar procedures to see how this is done. Are they cutting into the side of the ear canal 'before' the ear drum, and then pushing the drum aside to access the round window?

Also, it appears in the Silverstein video that only the round window is being reinforced. If so, why would it be called "Round and Oval Window Reinforcement"?

 

[lymebite]

I've been looking at videos of similar procedures to see how this is done. Are they cutting into the side of the ear canal 'before' the ear drum, and then pushing the drum aside to access the round window?

Also, it appears in the Silverstein video that only the round window is being reinforced. If so, why would it be called "Round and Oval Window Reinforcement"?

They gain access to the middle ear using a transcanal tympanomeatal flap approach. What that means is a little above my pay grade, but I think that means they are cutting around the edge of the eardrum enough so they can move it aside as if it were a door on hinges.

They put one circle of new tissue over the round window, and a smaller circle of new tissue over the stapes footplate. This is also getting above my pay grade, but from looking at pictures I believe the oval window is positioned over the stapes footplate. So, there are two new circles of tissue, one installed over the round window and one installed over the stapes footplate / oval window.

 

[Blujay]

Thank you for the good explanation.

Are you still considering?

 

[lymebite]

Are you still considering?

I am still considering it. For now, I am going to wait for the release of the study results on May 21. That may help me make a decision.

How about you?

 

[bill 112]

I was actually thinking about asking Bryan at Hyperacusis Research about why they haven't mentioned anything about Silverstein's procedure on their facebook page yet but there you go. I'm not sure I know what "modeling work" is though.

I was talking to Bryan via email the other day,he suggested and admitted that although there was no real proof that it worked,but to try LLLT or rTms?Never mentioned Silverstein once.

 

[Blujay]

Thanks, Lymebite. It will be very interesting to see the completed study on this, and it's a good idea to wait for those results.

The latest posted video of Dr. Silverstein and his patients makes the procedure look like a life-changer, especially his comment that people walk in before surgery with 60 to 70 decibel discomfort levels, and walk out with 90 to 100.

Also, logic suggests that a permanently protected inner ear would make one generally immune to the setbacks that can so easily devastate the progress of those who do TRT with bare ears.

It was encouraging to see the patient in the video who had the surgery done four years ago, whose condition continues to get even better as time passes. It's possible that the procedure protects against continued irritation from sounds that can make sensitivity hang on for so long.

Dr. Silverstein mentions that the procedure hasn't helped anyone with tinnitus. But maybe he hasn't done enough patients yet. I think many on this forum would think that tinnitus which simply does not 'worsen' due to sound exposure would be a fantastic improvement.

Also, I'm thinking this procedure could mimic the effect obtained by some people who had the patience to wear earplugs religiously for somewhat louder sounds, and saw their tinnitus drop in volume over time. I often wonder what percentage of tinnitus is permanent, and what percentage is due to repeated irritation.

And although reactive tinnitus was only briefly mentioned by Dr. Silverstein in an earlier video, it seems that the procedure could have a positive effect on that, too. What if, for some people, reactive tinnitus just happened to be caused by excessive vibration in the inner ear, which this procedure treats?

The brave pioneers in the video seem confident and happy that they took the leap. It is encouraging.

 

[lapidus]

I was talking to Bryan via email the other day,he suggested and admitted that although there was no real proof that it worked,but to try LLLT or rTms?Never mentioned Silverstein once.

Yeah, I'm not that surprised that he didn't mentioned it since it's not really an option for you or almost anyone yet. There's only one place in the whole world who is doing the procedure at the momen, the Silverstein Institute. And it's still in a study phase. I'm also guessing the reason Bryan haven't posted much about it on their facebook page etc is because there aren't any official results yet. I too would be careful if I were in his position.

@Blujay
Very interesting thoughts from you again. However, I wouldn't hold my breath for this to be a treatment for T at all but you have a good point with "I think many on this forum would think that tinnitus which simply does not 'worsen' due to sound exposure would be a fantastic improvement."

 

[japongus]

Hain from dizziness and balance dot com is skeptical of this, it might be worth reading into what his thought processes are

http://www.dizziness-and-balance.com/disorders/unilat/scd.htm

''New conditions can sometimes elicit entrepreneural activity in surgeons. There currently is an oversupply of otologic surgeons in the United States. In the past, a somewhat similar condition to SCD (perilymph fistula), was associated with an immense surge in operations, many later determined to be inappropriate.''

 

[JonL]

Hain from dizziness and balance dot com is skeptical of this, it might be worth reading into what his thought processes are

http://www.dizziness-and-balance.com/disorders/unilat/scd.htm

''New conditions can sometimes elicit entrepreneural activity in surgeons. There currently is an oversupply of otologic surgeons in the United States. In the past, a somewhat similar condition to SCD (perilymph fistula), was associated with an immense surge in operations, many later determined to be inappropriate.''

Hi. The article that you linked to does not discuss the procedure that folks are discussing in this thread. The article that you linked to is discussing a specific disorder (SCD) and a different procedure (round window plugging). On the other hand, this thread and the related video are about the treatment of hyperacusis (specifically in patients without SCD) and the procedure of round and oval window reinforcement. This procedure is different from round window plugging. (In one of their articles on SCD, Silverstein [the ENT who we are talking about] and colleagues explicitly describe how round and oval window reinforcement is more beneficial than round window plugging for the treatment of SCD: https://www.ncbi.nlm.nih.gov/pubmed/24667055). What the findings suggest so far is that round and oval window reinforcement (not plugging) appears to be helping folks with hyperacusis.

 

[Blujay]

They put one circle of new tissue over the round window, and a smaller circle of new tissue over the stapes footplate.

Do you know what keeps these pieces of tissue in place? Why wouldn't they just fall off into the middle ear?

 

[lymebite]

Do you know what keeps these pieces of tissue in place? Why wouldn't they just fall off into the middle ear?

Gelfoam is used to hold the new tissue in place. I don't know much about Gelfoam, so not sure if that holds the tissue in place permanently, or just temporarily, and the new tissue eventually adheres on its own like with a skin graft. But Gelfoam is what is used.