Round and Oval Window Reinforcement for the Treatment of Hyperacusis

[Blujay]

Interesting, thanks.

It appears that Gelfoam is a substance used to stop bleeding. Haven't found info on any adhesive effects.

I did see an article on perilymph fistula, where the surgeon used fibrin glue to cover the new tissue and the round & oval windows.

 

[lapidus]

Someone posted today about having the surgery done recently:
http://www.chat-hyperacusis.net/post/hope-new-surgical-treatment-8079046

It's however not that informative. Wish the patient could've described his/her symptoms more and report LDLs etc. But it's something at least.

 

[lymebite]

Wish the patient could've described his/her symptoms more and report LDLs etc.

There is some additional information posted now on LDLs and symptoms.

http://www.chat-hyperacusis.net/post/hope-new-surgical-treatment-8079046

 

[Mithrandir]

Who's the first on TT to try it ? For the moment that's a big hope for the H community !

 

[TeresaD]

I, for one, will be waiting to hear the results in the May update. I'm very excited about this!

 

[lymebite]

A bit more information - here is the abstract for the May 21, 2016 presentation in Chicago by Dr. Silverstein (it is the first abstract in the document, page 2 of the PDF). The link and the uploaded PDF are the same - the PDF is uploaded in since sometimes these links do not work forever.

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

 

[lapidus]

A bit more information - here is the abstract for the May 21, 2016 presentation in Chicago by Dr. Silverstein (it is the first abstract in the document, page 2 of the PDF). The link and the uploaded PDF are the same - the PDF is uploaded in since sometimes these links do not work forever.

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

"Intervention: Using a transcanal approach, the round and oval window were reinforced with temporalis fascia or tragal perichondrium in six patients (9 ears)."

Wasn't there like 20 patients?

 

[lymebite]

Wasn't there like 20 patients?

I am guessing the situation is that the research study was approved for 20 patients, but because hyperacusis is so rare, it has been challenging finding patients to participate. When I spoke with Dr. Silverstein on the telephone earlier this year he mentioned the difficulty in identifying good candidates. I expect that is part of the reason the effort went into conducting those seminars that are on YouTube - to help spread awareness among people with hyperacusis with the goal of interesting people in participating.

On the Hyperacusis Network, the poster from a few days ago said she was patient #16. But her surgery was only 10 days prior, so that would of course be too recent to include in the study results.

 

[lapidus]

I am guessing the situation is that the research study was approved for 20 patients, but because hyperacusis is so rare, it has been challenging finding patients to participate. When I spoke with Dr. Silverstein on the telephone earlier this year he mentioned the difficulty in identifying good candidates. I expect that is part of the reason the effort went into conducting those seminars that are on YouTube - to help spread awareness among people with hyperacusis with the goal of interesting people in participating.

On the Hyperacusis Network, the poster from a few days ago said she was patient #16. But her surgery was only 10 days prior, so that would of course be too recent to include in the study results.

Ah, I see. I'm just remembering what you said a while back:

I did speak with Dr. Silverstein last week. Not much new to report relative to what @Zimichael has already relayed, perhaps a couple minor updates. He said they have now performed the procedure on about 15 patients with several more scheduled.

So I didn't really get the impression that Silverstein had a hard time finding candidates.

 

[lymebite]

Ah, I see. I'm just remembering what you said a while back:

Yes, the numbers are not totally consistent, if my notes and post are correct and it is correct that the poster from last week was patient #16. In any event, sure wish we were talking about 100 or more patients instead of 15, 16, or 20. Hopefully we will learn more after the Chicago presentation.

 

[Blujay]

If the six patients in the presentation include the five in the video, that's one patient more. I think everyone was hoping for more information...

As far as I can tell, the patients in the video, while highly encouraging, don't closely match the profiles of many hyperacusis sufferers who have frequented these forums. Can others who have watched the video comment on this?

 

[Blujay]

In one video, Dr. Silverstein mentions that patients who had LDL's of 60 to 70 decibels before surgery improved to a range of 90 to 100 decibels after surgery.

On the other hand, the presentation package for the Chicago meeting says:
"Preliminary analysis of the data reveals improved postoperative mean LDL test scores of 10.2 dB (SD = 5.4)
in nine ears."

Am I missing something?

 

[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?

Patient #16 who recently posted on the H Network reports there is a new approach on time between ears:

"Dr S is having us recent patients wait 6 months before having the second ear done because most patients see the most significant improvement after the first ear and he wants to make sure that doing the second ear is actually necessary. In other words the LDL's of the ear that was not operated on improved as well."

 

[Bertman]

@Blujay I share your idea on how it would be great against setbacks due to noises that aren't really damaging levels, such as a big room full of people. That would really help with mostly everyones social lives here.

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.

Couple thoughts though. Forgive me as I have not read the whole thread, but do you know if this really protects the inner ear, or just kind of mask the symptoms of hyperacusis. Because that would be very unfortunate if we were to think a certain level of noise if fine since it wouldn't bother us, and then still get an increase in tinnitus. Second, at the beginning of the thread it states that the only downside was mild loss in higher frequencies. Wouldn't this make most peoples tinnitus seem louder as many of us have a higher pitched sound, so losing that, even mild amount, of external noise would have an adverse affect on our perception of T.

 

[Blujay]

@Blujay I share your idea on how it would be great against setbacks due to noises that aren't really damaging levels, such as a big room full of people. That would really help with mostly everyones social lives here.

Couple thoughts though. Forgive me as I have not read the whole thread, but do you know if this really protects the inner ear, or just kind of mask the symptoms of hyperacusis. Because that would be very unfortunate if we were to think a certain level of noise if fine since it wouldn't bother us, and then still get an increase in tinnitus. Second, at the beginning of the thread it states that the only downside was mild loss in higher frequencies. Wouldn't this make most peoples tinnitus seem louder as many of us have a higher pitched sound, so losing that, even mild amount, of external noise would have an adverse affect on our perception of T.

Before you read on, please keep in mind that nothing is for sure, so please be careful.

In my estimation, it appears that this procedure could help prevent inner-ear damage. The reason is that it dampens excessive vibrations that could otherwise harm the inner ear.

If your second question is, "Could high-frequency hearing loss from the procedure hinder environmental sounds from masking my high-frequency tinnitus?," I think that's possible.

However, if you are an optimist, you could consider that the damage causing your high-frequency tinnitus, now protected from excessive vibration, might have the chance to heal and improve.

The patients in Dr. Silverstein's video don't mention greater perception of tinnitus. That's all we have to go on for now.

 

[TeresaD]

@Zimichael

hi! Just wondering if you ever got the surgery? Just wanted an update from you, if possible.

Thanks!

 

[japongus]

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.

Isn't that the kind of twisted logic we have over at hyperacusis.net? I mean, surely if the surgery works then ''hyperacusis'' all along was merely just otalgia of the middle ear, and that central gain (or cochlear microphonics) was a hyperinflated old wives tale.

 

[Mithrandir]

Someone understood if the surgery help Hyperacusis, but for H wit pain, or just ear pain ? What do you think about that ? :-P

 

[japongus]

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.

Well, no thanks to chat-hyperacusis.net and hyperacusis.net, that ban-happy edit-nutso echo chamber ignored those who cured themselves with tenotomies a decade ago and went on to theorise about all the obsessive compulsive brain limbic disorders we had. The middle ear muscles issue were theorised by Marsha Johnson over a decade ago there too, but that ridiculous forum convinced her to change the definition of soft sound sensitivity to selective soft sound sensitivity because it didn't chime with Jastreboff's ivory tower sensibilities and conjecture about hair cells and central gain... soft sound sensitivity had already been established and defined the instant JoeM who had a tenotomy and cured said this:

''6) You mentioned you were at a party and were good. This is a strange phenomenom I tried to explain to my docs about when there is a lot of white noise like being at a party or such, the ear doesn't act up. My thoughts on this is that because the ear can't focus on one sound, it doesn't act up, OR, it is less noticeable because the ear is working on "listening" to so many other sounds...my theories though.''



right now Rob on this operation being discussed in the chat-hyperacusis forum is busy claiming that ''it is possible if patients feel more comfortable around sound after the procedure, they will be willing to expose themselves to more sound and to more ambitious environments. In turn, this could potentially improve their sound tolerance.'' Quite the wishful thinking desperate rescue of TRT. Clutching at straws, radical Jastreboffism never spotted how true misophonia didn't have a physical feeling in the ear in most cases if not all, and it clearly never had much, if any, knowledge of the middle ear, never took any consideration of otalgia, not to mention microvascular compression and other somatosensorial tinnituses...

http://www.chat-hyperacusis.net/post/hyperacusis-surgery-7084386

Is this the same operation as the recent shift from SCDD to general ''hyperacusis''? Cuz Carol i think her name is says ''The operation is called round window closure and stapedial tendon transection''

If its like that, then all the ranting I've been in a limbo in for the last 6-9 months will have been validated. But the problem as usual is who are going to be the black sheep and unfortunate souls that repeat the bad experience Astrid and others might have had with similar procedures...

 

[japongus]

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.

Ok, then, I see... round window reinforcement... instead of plugging. I'll still like to know why stapedial resection was carried out because I read so much about ''myoclonus'' resections from a decade ago I'm wondering if Silverstein is closing the missing link between ''hyperacusis'' and ''myoclonus'' with this recent wave of operations he'll supposedly be detailing on may 21.

 

[Bobby B]

So much for the theory that exposing your ear to loud sounds is going to improve your H...
This looks like a permanent ear plugging or drum limitation

 

[PaulBe]

Yeah, I know Jiri..I mean, Japongus. I watch and find myself consistently disappointed. Chat-H really is the Sound Therapy network. Dogma births easy and dies hard.

 

[japongus]

So much for the theory that exposing your ear to loud sounds is going to improve your H...
This looks like a permanent ear plugging or drum limitation

Middle ear tenotomies have also been associated with curing Meniere's, so I wouldn't be surprised if it turns out that all along laser therapy was only curing certain types of etiology in the middle ear, not the cochlea, not the central gain either. So Wilden and Jastreboff might have enacted quite an embarassing foolish battle.

It escapes me why the at least two academic papers I found, one from 2003 the other from 2012, talking of middle ear muscles and menieres haven't become mainstream (search middle muscles meniere on libgen dot io/scimag). Maybe something went wrong or maybe knowledge just gets worse. Some of the treatments for menieres include hearing aids, medications, so there may be a profit incentive... or maybe the world is just becoming less knowledgeable... the paper from 2003 says ''
Our results are consistent with the experiences of many authors in the late 19th and early 20th centuries who found
tenotomy to be a promising approach for treating MD'' lol....

 

[japongus]

I dunno @Mithrandir but maybe if the effect on the ear is reduced nearby nerves won't be activated, I guess we would have to ask Silverstein.

BTW, is anyone from tinnitustalk going to his May 21st conference? to take notes and ask questions, could be good, no?

 

[Bobby B]

My take on this - and @japongus feel free to correct me as you seem to know a lot more than most of us - that H can be related to nerve damage in some ways.

Kind of reminds me of shingles - I had it once and just rubbing a shirt against my torso would be incredibly painful.

We know that light (LLLT or diodes, polarized light no only lasers ) does help with nerve healing - there are lots of serious studies on that and even a few human ones.

So that's my take here - LLLT helps nerve healing and in cases where the H issue is related to nerves, then it may help.

As for the surgery, I don't see how this is different from wearing ear protection if the goal is to limit ear drum movement.

More convenient than having to wear protection sure but still you do loose low db hearing in the process.

 

[Lura]

Yes, I would like to know the same, regarding whether Zmichael had the procedure. Sounds like we have similar symptoms !

 

[japongus]

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!

So is anyone near Chicago to go see him on May 21? This could potentially be very interesting. Just like the european tinnet conference it really should be front page on tinnitustalk.

I phoned their center last week for info and was told by a nurse they'd get back to me on who is elegible for the surgery. But I want to know specifics like why the f does Carol mention a stapedial transection over at chat-h and get Silverstein to talk about whether this possible transection makes people with H more or less sensitive to noise, or whether round window reinforcement reduces the theoretical stapedial contractions (which wouldn't explain why Carol mentions a stapedial transection without any of the articles or videos doing so).

 

[Mithrandir]

If anybody has news from the COSM

 

[japongus]

If anybody has news from the COSM

I misread the whole thing and was told by Silverstein's team that it was just a presentation they did to the american neurotology society, seven minutes long, and that all the info was out already in the seminars. Also that they're up to 15 patients, which seems odd given that 5 months have passed since they said they had 13 or maybe even 15 patients to someone else in the this forum. I guess if business is as usual they still might be getting the positive results.

 

[japongus]

As for me, I'm now really stuck on whether I have true hyperacusis or true myoclonus and which operation to think about first. I wonder if the excessively vibrating oval window could cause the same theoretical stapedial pull my soft sound sensitivity would be causing, or whether both transection and reinforcement might have collateral effects as I am a pretty extreme case.