Visited a Neurologist Yesterday...

[Vinnitus]

Hello all,

So I visited a neurologist yesterday, it wasn't specifically for Tinnitus but for the equilibrium disturbances I sometimes experience since the acoustic event and the onset of the Tinnitus. I couldn't hold myself back though and asked him if he thinks the brain might play a role in the generation or perpetuation of Tinnitus. His answer was a straight-out solid "NO, that is not possible. It is an ear problem.". My jaw dropped and that's how I pretty much left the office.

It seems the neglect for recent developments isn't solely limited to the field of ENT. I will see him again next week to discuss the results of my tests, so I will prepare a nice story for him. I will inform him about the research of Dr. Rauschecker and see what he says...

Just wanted to put this out there.

 

[JurgenG]

That's just sad..

 

[Jason C]

It sure is an ear problem but the thing is the ears do so much more than just hearing,

My balance is still way off after acoustic trauma that damaged my hearing and therefore balance.

Throw in depression, self hate and anxiety and you have serious mental health issue too deal with too.

 

[stophiss]

Hi Vinny,
Next time you see him, be sure to ask the $64K question...which disproves his thesis...
Why a subset with hearing loss...some with profound hearing loss...why don't they have tinnitus if tinnitus is ear and not brain based?

ENT's are like car mechanics or ditch diggers. Some are better than others.

I suggest you consider seeking another medical professional.

Hope you feel better.

 

[Newloud]

Don't underestimate the stubbornness of highly educated professionals. It might be a bigger threat to progress than underfunding.

 

[stophiss]

It sure is an ear problem but the thing is the ears do so much more than just hearing,

My balance is still way off after acoustic trauma that damaged my hearing and therefore balance.

Throw in depression, self hate and anxiety and you have serious mental health issue too deal with too.

Well...it is agreed generally tinnitus starts at the ear and even in some instances difficult to prove with hidden hearing loss. But...the ear changes the brain and morphs neuroplasticity in many cases causing tinnitus. Tinnitus is brain aka devoid of electrical stimulus from the ear...the brain generates a phantom sound.

Will share a further comment which is universal advice based upon all the similar comments on this forum about mental health. Unless you address your mental health which is generally achieved by medication...in my opinion, you have little chance of co-existing with T or H with quality of life.
Good luck

 

[JurgenG]

Well...it is agreed generally tinnitus starts at the ear and even in some instances difficult to prove with hidden hearing loss. But...the ear changes the brain and morphs neuroplasticity in many cases causing tinnitus. Tinnitus is brain aka devoid of electrical stimulus from the ear...the brain generates a phantom sound.

Will share a further comment which is universal advice based upon all the similar comments on this forum about mental health. Unless you address your mental health which is generally achieved by medication...in my opinion, you have little chance of co-existing with T or H with quality of life.
Good luck

I wonder, because if it really starts in the ear and only after a while becomes a neurological condition.
Is there an advantage drown your T out, so you don't hear it anymore, and the brain is not getting any stimulus from it? Or is that just a silly theory.

And is there a way to know if it's "still in the ear" or moved?

 

[stophiss]

I wonder, because if it really starts in the ear and only after a while becomes a neurological condition.
Is there an advantage drown your T out, so you don't hear it anymore, and the brain is not getting any stimulus from it? Or is that just a silly theory.

And is there a way to know if it's "still in the ear" or moved?

Conventional wisdom, drowning out T is not effective to habituation. Rather...having sound enrichment...versus masking....just below the sound threshold of tinnitus so the brain recognizes the tinnitus sound is said to be most effective.

Truthfully, tinnitus never exists 'in the ear' therefore it never moves. Sound is a construct of the brain. Sound does not exist in the universe or in the ear. The ear is an instrument to convert air pressure to electrical stimulus. Electrical stimulus is converted by the brain into the construct of sound. So the notion of tinnitus being in the ear is bogus. Tinnitus is speculated to be caused by the 'change in the ear' which changes the brain. The inner ear changes and so changes how the ear converts air wave pressure to electrical stimulus. One concept of tinnitus is...tinnitus occurs because the brain no longer hears certain frequencies because there is degradation to the inner ear and therefore the brain searches for those frequencies.

Hope that makes sense.

 

[JurgenG]

Conventional wisdom, drowning out T is not effective to habituation. Rather...having sound enrichment...versus masking....just below the sound threshold of tinnitus so the brain recognizes the tinnitus sound is said to be most effective.

Truthfully, its never in the ear per se. Sound is a construct of the brain. Sound does not exist in the universe or in the ear. The ear is an instrument to convert air pressure to electrical stimulus. Electrical stimulus is converted by the brain into the construct of sound. So the notion of tinnitus being in the ear is bogus. Tinnitus is speculated to be caused by the 'change in the ear'...how the ear converts air wave pressure to electrical stimulus. One concept of tinnitus is...tinnitus occurs because the brain no longer hears certain frequencies because there is degradation to the inner ear and therefore the brain searches for those frequencies.

Hope that makes sense.

Yeah, it does, I just wonder. Since there are people with a delayed onset, is it first the haircells that take the damage, and after this "overload" the nerve? Or is the nerve-theory also bogus? And is it nothing more than you say "haircells dissapear = brain fills in".

 

[stophiss]

Yeah, it does, I just wonder. Since there are people with a delayed onset, is it first the haircells that take the damage, and after this "overload" the nerve? Or is the nerve-theory also bogus? And is it nothing more than you say "haircells dissapear = brain fills in".

Jurgen,
I believe onset is much more complicated. For example, some with dramatic hair loss in the cochlea don't experience tinnitus. So...it is all how the brain reacts to degradation to the cochlea. This can be exacerbated by stress and the hormone cortisol. If there is a common link to tinnitus on this forum, its that many have either a pre-disposition to anxiety or depression and in particular were going through life altering events when contracting tinnitus. Many but not all. I will further speculate that onset doesn't have to be precipitous. It can be years in the making based upon underlying genetics. A perfect storm in waiting if you will based upon genetics interacting with environment.

 

[JurgenG]

Jurgen,
I believe onset is much more complicated. For example, some with dramatic hair loss in the cochlea don't experience tinnitus. So...it is all how the brain reacts to degradation to the cochlea. This can be exacerbated by stress and the hormone cortisol. If there is a common link to tinnitus on this forum, its that many have either a pre-disposition to anxiety or depression and in particular were going through life altering events when contracting tinnitus. Many but not all. I will further speculate that onset doesn't have to be precipitous. It can be years in the making based upon underlying genetics. A perfect storm in waiting if you will based upon genetics interacting with environment.

This is indeed the weirdest. I know what you mean.
My ear with some damage is the one with almost no T. In the other my audiometry is perfect, and the T is much more audible.

 

[Vinnitus]

Yeah, it does, I just wonder. Since there are people with a delayed onset, is it first the haircells that take the damage, and after this "overload" the nerve? Or is the nerve-theory also bogus? And is it nothing more than you say "haircells dissapear = brain fills in".

From what I understand and shortly summarized; the latest theories (by Liberman) seem to imply that it are the actual connections between the hair-cells and the auditory nerve which disappear or get damaged first (the synapses) upon a noise insult. The actual hair cells might be left intact or slightly damaged. This could potentially offer an explanation why some deaf people do not experience Tinnitus, as they lost hair cells but not the connection between those hair cells and the auditory nerve. The "synaptic" hearing loss seems a different type of hearing loss than the classical "hair cell" hearing loss with different symptoms. "Synaptic" hearing loss seems responsible for reduced speech-in-noise comprehension (which often comes first), while "hair cell" hearing loss seems responsible for increase in auditory tresholds like shown in the audiogram.

The loss of synaptic connections causes a loss of input to the brain, which initiates a compensatory mechanism where input from other nerves (i.e. somatosensory nerves) could become hyperactivated in order to keep the input on the same level, potentially causing the often experienced "somatic tinnitus". This is research Susan Shore is involved in.

The loss of input to the brain can also cause maladaptive neuroplasticity under certain circumstances, which is potentially responsible for the perpetuation of Tinnitus as so-called "ringing in the brain". A lot of factors might be involved in this one (brain chemistry and the influences of stress etc.), like @stophiss mentioned above. If you are interested in this subtype of Tinnitus, you should read up on the research by Josef Rauschecker for example.

This all implies that the actual Tinnitus is not generated in the ear, but is a consequence of the damage to the inner ear and the circumstances in the brain regarding brain chemistry.

The brain plays a viable role in the generation and perpetuation of almost all kinds of Tinnitus according to the latest ideas. Hence I was baffled to hear this neurologist denying the matter.

 

[Vinnitus]

Yeah, it does, I just wonder. Since there are people with a delayed onset, is it first the haircells that take the damage, and after this "overload" the nerve? Or is the nerve-theory also bogus? And is it nothing more than you say "haircells dissapear = brain fills in".

The delay you refer to is thought to be due to oxidative stress caused by the (noise) overexposure. The overexposure causes stress and cell apoptosis (cell death) of sensory cells in the hearing system. Upon cell death these dying cells release glutamate, considered a neurotoxin if present in high amounts, which causes even further cell death or damage to nearby sensory cells. It is like a chain-reaction. It is hence thought that damage after noise overexposure can continue up to a few days after the actual exposure. This is the basis for prednisone and it's short window of opportunity for administration as it is thought to potentially work on minimizing this oxidative damage. Results have been varied however, and I believe prednisone has never been officially proven to be useful for such cases. A lot of doctors hence do not readily offer prednisone treatment to patients in case of noise trauma.

If enough damage to the hearing structures has been done, it might ultimately result in Tinnitus. This could explain the Tinnitus onset a few days or even a week after the actual event has passed.

Below I have linked a study discussing this. In this study the combination of vitamins A, C, E + Magnesium taken shortly before and/or up until a few days after the event seem to be able to limit damage due to oxidative stress after a noise event.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1950331/

 

[Vinnitus]

Hi Vinny,
Next time you see him, be sure to ask the $64K question...which disproves his thesis...
Why a subset with hearing loss...some with profound hearing loss...why don't they have tinnitus if tinnitus is ear and not brain based?

ENT's are like car mechanics or ditch diggers. Some are better than others.

I suggest you consider seeking another medical professional.

Hope you feel better.

I am certainly planning to do so. One has to wait a good amount of time before one is able to see a neurologist here, so I should make my visit worthwhile. I am planning to compose a cohesive story based on some studies showing the brain is indeed involved in tinnitus generation and/or perpetuation and see what he has to say. I plan to do it in such a way that he won't feel I'm challenging his knowledge in the field. A lot of people working in the medical field seem sensitive to this in my experience. I want to play the patient, albeit an informed one. I hope it will result in an interesting conversation.

 

[erik]

Many physicians are so busy with their practice they fail to keep up to date on new standards of care and evidence based care. There is supposed be processes in place to assist with continuing education but they are ineffective. Most of it is passive learning (reading material). There are other tools available to doctors, but is is time intensive to stay up to date and physicians just don't have the time or they get comfortable in their practices and the care they are already providing.

This is why we, the patient, must be as informed about our medical history and conditions as possible to better understand what questions to ask. Knowledge will also help us to know when a doctor's responses and advice are bogus such as in Vinnitus's instance.

 

[fhs]

This video sums it up very well. There are physical changes in activity that happen in the brain seen in an MRI.

 

[SilverSpiral]

I think you guys may be taking what the ENT is saying a bit too literally or something. Obviously the brain plays a roll, as it is what processes sensory input, but what he's saying is that in terms of acoustic trauma, it's nothing "wrong" with the brain, it's the brain reacting to something wrong/sudden change in the ear.

 

[Vinnitus]

I think you guys may be taking what the ENT is saying a bit too literally or something. Obviously the brain plays a roll, as it is what processes sensory input, but what he's saying is that in terms of acoustic trauma, it's nothing "wrong" with the brain, it's the brain reacting to something wrong/sudden change in the ear.

Yeah, well, this wasn't exactly my point. My point was the exact question if the brain played a role in the generation and/or perpetuation of Tinnitus. The latest research seems to confirm it indeed does play a role. There is nothing "wrong" with the brain, like you said, as it always adapts and changes according to circumstances, but it behaves or changes in a particular way as a consequence of some sensory event which is thought to play a role in Tinnitus. So the answer should be "yes, possibly", not the outright denial as given by the neurologist.

 

[lolkas]

Interresting indeed. My two cents:

Human body is very intelegent. It adopts/reacts to everything. We get symptoms as a result of difficiency/damage or disease to alert with underlying issue. Problem is - we are not good yet on 100% with causes because diagnosis techniques are not good enough. Tinnitus is indeed an organ that will generate phantom noise, not ear.

This is i think why: when we are born - our body has it own, individual "state" of optimal health, even if something is not quite right. Now lets say pearson was born deaf - he in most cases wont have Tinnitus since his auditory system was missing out in first place, therfore brain does not have to create phantom noise.

Person that lets say suffered acoustic trauma - looses nerve fibers/hair cells in cochlea (most cases) and brain is unable to get feedback from them on specific frequency. This is why we have different hissing/tone in general.

People that have whoosong - blood flow and need to clean their "tubes"

People with crickets - caused by muscle spasm.

TMJ - inflamation of joint and surrounding areas that might affect auditory nerve. Tonal/hissing sound in most if not all cases.

Otoxic stuff - damage to cochlea/auditory nerve. Hissing/tonal sound.

 

[Dmitriy]

A friend of my, who is neurologist, says that they do not deal with T unless patient complains of Vertigo. Even then, they try to focus on Vertigo, not T itself. She does not claim T is caused or not caused by brain, but there is nobody that can do anything about it, so it makes sense to focus on other symptoms that may be addressable.

 

[Melike]

Why a subset with hearing loss...some with profound hearing loss...why don't they have tinnitus if tinnitus is ear and not brain based?

ENT's are like car mechanics or ditch diggers. Some are better than others.

I had one ENT in my early days that said young people shouldn't have T, it is normal for older people. If you have T at a young age, it should certainly be a brain tumor. ugh.

 

[Carlyi]

I had one ENT in my early days that said young people shouldn't have T, it is normal for older people. If you have T at a young age, it should certainly be a brain tumor. ugh.

ENT's, i can't take any of them seriously. Atleast the onces i have been to.
The first one i went to checked my ears and said, well they are perfect.
I kept asking him what could cause my T. and didn't really want to walk out of the door just yet.
Than he checked my ear again and said there was a beginning ear infection and walked me out of the door..
I never had an infection he just wanted to get rid of me..