Should Tinnitus Research Focus on Brain Instead of Ear?

[Tweedly]

I am really curious what people are thinking about the following... To put it in a sentence, I've been thinking that:

The root of tinnitus is always the brain. It doesn't matter what caused your tinnitus. Therefore research should focus on the brain and not the ear.

I believe research like FX-322 etc, is great for hearing loss, but will not fix all tinnitus cases. There are more people with hearing loss without tinnitus than with. Why? Because it's the brain that is producing the tinnitus. Yes, hair cells might be lost, nerves damaged. But it is always the brain that should provide the noise cancelling feature. With tinnitus sufferers it fails to do so. So if you want to fix tinnitus for everyone and not make it a guessing game, then research should go into the brain area for tinnitus sufferers instead of the ear. Because even if you fix the ear, tinnitus might keep on living in the brain due to neuroplasticity, or actual damage.

I read many posts on Tinnitus Talk that talk about "noise induced" tinnitus as if it matters how you got it. First of all nobody can really know beyond any reasonable doubt what caused their tinnitus (people sometimes seem to think their tinnitus is noise induced, even if they got it weeks or more after the event, that to me is a total guess). Furthermore does it really matter?

I believe my tinnitus is caused by migraines. But even then my nerve might be damaged or hair cells in the cochlea lost due to blood circulation issues, so does the approach to it differ from
noise induced tinnitus? Some people, like @Michael Leigh seem to think so, I am curious about their opinions regarding this...

I'll stop my rambling here. It's just something I've been thinking about more and more after reading tons of research and Tinnitus Talk posts.

 

[Tweedly]

Added to this: This view of tinnitus being an ear related issue might actually be damaging to patients. When I started asking questions to my neurologist about my tinnitus and a possible connection to my migraines because I read research about it, she just said she never heard about this and that tinnitus was more something in the field of ENT doctors.

However, ENT doctors don't have any real answers either beyond the simple anatomy of the outer and middle ear induced tinnitus (like wax problems etc.).

So the specialists whose territory it seem not to be up to date about research in their own field when it comes to tinnitus.

 

[Vicki3116]

I definitely think the brain. The brain is the perceptual center of us so whatever else is going on in the body, it's the brain that perceives it. You won't get very far studying phantom limb pain by examining the removed limb, for example. Not everyone has hearing loss/ear damage so by going to the root of the problem, you'd be able to help a much larger proportion of patients, i.e. those with and without hearing loss.

But maybe I'm biased because my hearing is excellent

 

[PeteJ]

I voted, both. Imho, from my own reading and reasoning, there is a link or correlation between the two especially when it comes to tinnitus.

Surely, researchers are well aware of it and take it into consideration. That probably requires a *fusion* of science fields but there's no other choice.

Edit: I think you ought to consider gradual but accumulative damage to the ear, too. E.g. loud noises over time and then one major trigger that causes the tinnitus, an acoustic trauma.

Consider this analogy. Repetitive hurricanes finally break down this cabin. Finally, there are logs that are loose but still upright. Finally, one gust of wind brings it all down. But, it took it a little while to keel over after the wind.

We are being exposed to noise all the time. Everything might not be shown on an audiogram but I would speculate the brain cannot handle or process cumulative hearing loss or sudden hearing loss, in particular.

 

[DRobi]

Tinnitus is a problem of both the ear and the brain. The conventional wisdom is that tinnitus starts with a lesion or disruption in the auditory system, anywhere from the outer ear through the auditory nerve, which then sets up a standing pattern of hyperactivity in the auditory cortex. Why the brain does not recognize this malfunction and reestablish a new homeostasis on its own is a real mystery, and that is likely where a cure will be found.

 

[Tweedly]

But maybe I'm biased because my hearing is excellent

I've been wondering about this. I had two audiograms up to 8000 Hz, both above average. One audiogram up to 18,000 Hz, also above average. And also an OAE (where they send signals into your ear and measure the feedback from specific hair cells), also excellent.

I have the notion that my hearing might even be a bit better after my tinnitus onset than before, I seem to be able to hear higher frequencies than before, but maybe I am just listening more attentively now.

But might these excellent test results just have something to do with our brains increasing the gain of our auditory systems when hearing loss occurs? An evolutionary tool to help us hear after trauma, so we can still outrun predators. That we would then get background noise as well would, from an evolutionary viewpoint, be less important to fix.

 

[Lurius]

I definitely think the brain. The brain is the perceptual center of us so whatever else is going on in the body, it's the brain that perceives it. You won't get very far studying phantom limb pain by examining the removed limb, for example. Not everyone has hearing loss/ear damage so by going to the root of the problem, you'd be able to help a much larger proportion of patients, i.e. those with and without hearing loss.

But maybe I'm biased because my hearing is excellent

I also answered the brain and I agree with this 100%, but my hearing is also quite good so I might also be biased

 

[Vicki3116]

Added to this: This view of tinnitus being an ear related issue might actually be damaging to patients. When I started asking questions to my neurologist about my tinnitus and a possible connection to my migraines because I read research about it, she just said she never heard about this and that tinnitus was more something in the field of ENT doctors.

However, ENT doctors don't have any real answers either beyond the simple anatomy of the outer and middle ear induced tinnitus (like wax problems etc.).

So the specialists whose territory it seem not to be up to date about research in their own field when it comes to tinnitus.

That's really interesting because I saw my neurologist today and he's convinced that my tinnitus is linked to migraines, even though I've only ever had one. Just goes to show that even amongst experts, an opinion is only an opinion

 

[Tweedly]

We are being exposed to noise all the time. Everything might not be shown on an audiogram but I would speculate the brain cannot handle or process cumulative hearing loss or sudden hearing loss, in particular.

This would seem highly logical to me too.

Question remains then, why most (actually virtually everyone, since everyone will experience hearing loss when they age) still not get tinnitus, even after sudden hearing loss.

 

[Peter Q]

I definitely think the brain. The brain is the perceptual center of us so whatever else is going on in the body, it's the brain that perceives it. You won't get very far studying phantom limb pain by examining the removed limb, for example. Not everyone has hearing loss/ear damage so by going to the root of the problem, you'd be able to help a much larger proportion of patients, i.e. those with and without hearing loss.

But maybe I'm biased because my hearing is excellent

I too think that sound perception is mediated via the brain. In a lot of tinnitus there is hyper-arousal and hyper-awareness. The brain/cognitive functions can become so finely tuned that every sound can become distorted or magnified. Hypochondria is a good example of this, when the brain becomes obsessively alert to bodily functioning. There are surely cases where tinnitus and hypochondria are mutually reinforcing.

 

[AliasM]

I think the focus and subsequent cure lies in studying and treating cells in the DCN.

 

[Brain Tumor Dave]

My initial tinnitus and some hearing loss starting 50 years ago was from inner ear damage from bleeding ear infections. Then the first symptoms from a brain tumor in 2008 REALLY increased my tinnitus! I'm deaf in one ear now - receiving nothing from external stimuli. But the tinnitus, of course, isn't from an external stimulus. It's still in my deaf ear. Nerve damage on that side. The mechanics of my ear still function; an operational ear drum, etc., but my brain receives signals from that damaged nerve and processes it as garbage noise.

So the study of both would be necessary to clear mine up.

 

[Tweedly]

My initial tinnitus and some hearing loss starting 50 years ago was from inner ear damage from bleeding ear infections. Then the first symptoms from a brain tumor in 2008 REALLY increased my tinnitus! I'm deaf in one ear now - receiving nothing from external stimuli. But the tinnitus, of course, isn't from an external stimulus. It's still in my deaf ear. Nerve damage on that side. The mechanics of my ear still function; an operational ear drum, etc., but my brain receives signals from that damaged nerve and processes it as garbage noise.

So the study of both would be necessary to clear mine up.

That's some story you carry with you Dave. And it shows the difficulty of this whole tinnitus thing, though I assume it's not the only thing that is on your mind if you have a brain tumor. Also, in a deaf ear, sound enrichment or masking would be nearly impossible I assume?

I hope it is somewhat benign or at least slow in it's growth, considering you've had it for so long?

I wish you all the best with the difficult situation you're in!

 

[Diesel]

I voted ear. Both options are vague, though. Tinnitus is a broad, vague, often misrepresented diagnosis of a SYMPTOM of a number of underlying causes. I believe that research at this point is a lot closer to solving tinnitus for the ear; and if drugs like those in the research section are able to take tinnitus as a result of hearing loss off the table, it will be much more effective to then focus on other underlying causes that are non-hearing related; or where hearing loss is not part of a multi-factoral cause.

 

[Brain Tumor Dave]

That's some story you carry with you Dave. And it shows the difficulty of this whole tinnitus thing, though I assume it's not the only thing that is on your mind if you have a brain tumor. Also, in a deaf ear, sound enrichment or masking would be nearly impossible I assume?

I hope it is somewhat benign or at least slow in it's growth, considering you've had it for so long?

I wish you all the best with the difficult situation you're in!

Tweedly, thanks for the support! Yes, there's many other complications, some deadly, concerning my slow-growing tumor (37mm at most recent MRI) that presses against the other nerves in that same bundle. Tinnitus is just one of the many symptoms. My tumor will eventually have to be cut out as both radiation and chemo' are impossible in my case. Mine has been growing at half the speed of most in this category; about a mm every two years.

As enrichment goes, yes, difficulty there, too. Masking doesn't touch it on that side. And I've had to explain to people who say, "Hey, just get a hearing aid!"
I tell them it's nerve damage; my brain can't process the signals correctly. If without a hearing aid I could barely hear, "Meh, muh, blah bluh, meh." A hearing aid would change that into a very easily heard, "MEH, MUH, BLAH BLUH, MEH!"