Why Isn’t TRT the Holy Grail?

[Juan]

Nah, tests can't disprove a middle ear issue. Current doctor knowledge of the middle ear is pitiful. It's rumored Silverstein recently came up with a device to measure stapes velocity. Silverstein after a lifetime in this in one of his seminars says maybe the inner ear and the brain causes the stapes hypermobility, or maybe it's the other way around, we don't know. So that's pretty much the state of otology. Sismanis is rumored to have gone in without any objective tests, just like Harold Kim. MRI is mentioned by the benzobuddies girl I linked to in the botox thread I posted here, where she gets cured of H by botox on the eustachian tubes she says, but she didn't want to explain further. So none of that is even close to a few theoretical fibers deep inside the cochlea. Some more obvious etiologies are observable though, on tympanogram or eardrum inspection while the event takes place, but a lot of angles and stories come up of no objective provable method.

I have been reading about otosclerosis and apparently it can affect the middle ear bone chain, including the stapes. The surgical approach has certain risks (like sensorineural hearing loss) and once the surgery is planned, the bones are pretty much checked and evaluated more closely at the moment of the surgery, as the surgery is progressing (and in some cases surgeons find out on that moment that due to complications they cannot actually perform the surgery). Before considering surgical treatment, the tests are just aimed at getting a diagnosis of possible otosclerosis, having a look at audiogram, tympanometry, CT scan maybe..

https://en.wikipedia.org/wiki/Otosclerosis#Amplification

The more I read about hearing issues that may be (even remotely) linked to causes of H, the more I realise that there aren't any real treatments. It seems some surgeries or treatments work only partially and pretty much by chance.

 

[GregCA]

I have been reading about otosclerosis and apparently it can affect the middle ear bone chain, including the stapes. The surgical approach has certain risks (like sensorineural hearing loss) and once the surgery is planned, the bones are pretty much checked and evaluated more closely at the moment of the surgery, as the surgery is progressing (and in some cases surgeons find out on that moment that due to complications they cannot actually perform the surgery). Before considering surgical treatment, the tests are just aimed at getting a diagnosis of possible otosclerosis, having a look at audiogram, tympanometry, CT scan maybe..

https://en.wikipedia.org/wiki/Otosclerosis#Amplification

The more I read about hearing issues that may be (even remotely) linked to causes of H, the more I realise that there aren't any real treatments. It seems some surgeries or treatments work only partially and pretty much by chance.

I have otosclerosis and had severe H prior to my surgery. I now have a titanium stapes. My H is mostly gone. T isn't, unfortunately, but I did regain some hearing through the air-bone gap closure.

Since I'm in the unlucky fraction who also has cochlear otosclerosis, my hearing is also being attacked by the disease in the cochlea, for which there isn't much treatment (fluoride is the main one - not working for me it seems). So I'm now left with a bit of air-bone gap, and a moderate sensorineural loss (45+ dB in the high frequencies) from the cochlear otosclerosis.

 

[Mithrandir]

@GregCA

Ronna Field was bad H before Silverstein discovered her "wiggly" stapes...

 

[Juan]

I have otosclerosis and had severe H prior to my surgery. I now have a titanium stapes. My H is mostly gone. T isn't, unfortunately, but I did regain some hearing through the air-bone gap closure.

Since I'm in the unlucky fraction who also has cochlear otosclerosis, my hearing is also being attacked by the disease in the cochlea, for which there isn't much treatment (fluoride is the main one - not working for me it seems). So I'm now left with a bit of air-bone gap, and a moderate sensorineural loss (45+ dB in the high frequencies) from the cochlear otosclerosis.

Hi Greg, thanks for your reply! how was your otosclerosis diagnosed? What tests did you take? Did you go for a blood test too? How did doctors know that there is also cochlear otosclerosis?

Could you tell me how your audiogram was approximately before and after the surgery?

I am quite worried because I had severe H and then it calmed down a bit. In the last few months H has gotten worse, I believe that in part due to noise, and my hearing in the high frequencies starts descending at about 5.000 and gets to around 55-60 db loss at 8.000. Last year I had about 35-40 hearing loss at 8.000, so there has been a significant and quick drop for me to around -60 dbs at 8.000.

For me is a bit hard to understand TV, as sounds are perceived a bit blurred, due to the high frequency hearing loss. It is easier for me to understand speech than TV. I read otosclerosis was associated in a way to H, because sounds over 70 dbs were perceived louder. However, I read that conduction hearing loss in the low frequencies is a symptom of otosclerosis and I do not have that.. I would need to get a new audiogram to check how my hearing is right now.

 

[lapidus]

@GregCA

Ronna Field was bad H before Silverstein discovered her "wiggly" stapes...

Was her problems in both ears?

Cause that's something that confuses me a bit. If the problem is "mechanical" and stemming from the middle ear, what are the odds that both ears have this dysfunction?

 

[Canador]

Was her problems in both ears? If the problem is "mechanical" and stemming from the middle ear, what are the odds that both ears have this dysfunction?

If it's a trait, about the same odds as any other that might occur on both sides of the body.

 

[Mithrandir]

@lapidus

Well each ear reacts differently. In my case, sensations are different between left and right ear. My accoustic trauma was closer to my right ear than my left ear.

 

[lapidus]

@lapidus

Well each ear reacts differently. In my case, sensations are different between left and right ear. My accoustic trauma was closer to my right ear than my left ear.

Yeah, mine too, everything started in my right ear but somehow moved to the left over time. But I asked you what the case with Ronna Field was, did she had in one or both ears?

 

[Mithrandir]

@lapidus

I don't know you can ask to her.

 

[lapidus]

@lapidus

I don't know you can ask to her.

But I don't even know who it is

 

[japongus]

But I don't even know who it is

At Hyperacusis Sufferers facebook group, write ronna martinez on search bar and you'll find me talking to her trying to understand her case

 

[japongus]

Do you think "stress/type a personalities/anxiety" interacts with your "tonic contraction" research since it seems that people like this are more prone to tinnitus in general (perhaps even noise induced?) Or is that idea in general BS. I've seen people link studies supporting the synaptopathy theories, concluding that people with anxiety/type a personality etc, are more vulnerable to synaptopathy, because of raised cortisol/glutimate levels especially at time of acoustic trauma, saying these chemicals can prevent the synapses from healing.

Nah. Stress I suppose can cause it, in a temporary manner, like drug addiction can, or coffee addiction, or alcoholism who knows. But when writers start getting serious and start to come up with calculations to evaluate tonic tensor tympani contraction it seems like a purely mechanical problem. So vessels, a eustachian tube that's too closed and causing CO2 to bubble about, fullness and pressure, and a bunch of other reasons could be behind clonic or tonic contraction.

The problem with synaptopathy is it has the word hyperacusis tagged on to the research surrounding it, so it's latched on more easily. The case for raised cortisol glutamate don't quote me on it but I assume could be also made for the middle ear, where a ton more muscles lie about, and which is closer to an acoustic impact than a couple of fibers sitting behind the bone. The little research on tonic or clonic contraction barely mentions hyperacusis in passing, and none of the writers meet in flashy conference to compare notes. One of its main writers is Westcott who has no personal experience in tenotomy or botox and quotes the noob Jastrebluff to say the stapedius can be seen on an acoustic reflex test, and quotes a paper on voluntary eardrum movement to say tensor movements can be seen on impedance testing.

 

[japongus]

I have otosclerosis and had severe H prior to my surgery. I now have a titanium stapes. My H is mostly gone. T isn't, unfortunately, but I did regain some hearing through the air-bone gap closure.

Since I'm in the unlucky fraction who also has cochlear otosclerosis, my hearing is also being attacked by the disease in the cochlea, for which there isn't much treatment (fluoride is the main one - not working for me it seems). So I'm now left with a bit of air-bone gap, and a moderate sensorineural loss (45+ dB in the high frequencies) from the cochlear otosclerosis.

How much hearing did you regain and how much stayed with you due to the cochlear otosclerosis?

Was the improvement in H a lot bigger than the hearing regain?

 

[lapidus]

@japongus
You might find this interesting. They've developed a new non-invasive technology to look into the middle ear (ignore the headline, it's obviously a mistake by the journalist, it's not about the inner ear).
http://atlantic.ctvnews.ca/ctv-news...-offers-detailed-look-at-inner-ear-1.3237168#

 

[japongus]

@japongus
You might find this interesting. They've developed a new non-invasive technology to look into the middle ear (ignore the headline, it's obviously a mistake by the journalist, it's not about the inner ear).
http://atlantic.ctvnews.ca/ctv-news...-offers-detailed-look-at-inner-ear-1.3237168#

Yeah I was already shown this by ornitoring. The thing is I dunno how laser would do anything to spot tonic contraction as it can only be compared to when the contraction isn't tonic, so before the theoretical injury. If they're clonic contractions maybe it can help if the laser makes milisecond pics...

 

[Contrast]

and even a debate as to whether TRT is a bonafide cure or by stark contrast, pure fallacy.

when would contrast say something like that? *sarcasm

People disagree about everything from politics to science...no doubt including the countless researching for a cure to tinnitus today. If you get 100 scientists in a room there won't be unanimity.

it's good when scientist disagree that means they are thinking, but no scientist should put pallative medicine before curative medicine,
*typing noises

 

[TuxedoCat]

it's good when scientist disagree that means they are thinking,

Spot on! Exactly why more basic researchers in the tinnitus field are needed!

 

[Contrast]

Spot on! Exactly why more basic researchers in the tinnitus field are needed!

disagreement is awesome, one thing I get upset is "ARAMT "arguments refruted a million times
such as "bent hair cells cause tinnitus" that make their way and just hold back research.

it's a fact tinnitus is neurological and usually occurs in the dorsal cochlear nucleus after hearing loss and strong likelyhood is a phantom sensation to compensate for a loss of hearing. the genesis and long term effects of tinnitus are murky and need more research but the few facts confirmed shouldn't continued to remain a mystery.

I don't think actual researchers are bring up refuted arguments, but people on the forums and local ENT's are, and even though I personally disagree until more evidence comes it is not impossible for tinnitus to be semi-peripheral if something is missing or alternative genesis of tinnitus exist.