Your Input Matters: How Would You Like to Be Informed on Tinnitus Models?

[Hazel]

What are the neurological mechanisms behind tinnitus?
Do you want to learn more about the origins of tinnitus?

Dearest Tinnitus Talk members,

As part of our 2020-2022 Strategic Plan, we are planning to expand the Tinnitus Talk website to be more than just a forum. We want to provide the community with objective, reliable and evidence-based resources. This will save our users the time and effort of sifting through hundreds of posts to find the information they seek, or reading hundreds of academic publications. It will also provide a counterbalance against the multitude of unverifiable (and sometimes misleading) opinions on the forum.

The first resource we plan to provide is an overview of "tinnitus models." By this we mean the main scientific theories on the origins of tinnitus — in other words, the underlying neurological mechanisms that cause the tinnitus signal. It's one of the most frequently asked questions we see around here; people want to understand what's going on in their brain. At the same time, we have not found any existing, comprehensive overview of tinnitus models anywhere online, and certainly not one that is also understandable for lay people. Hence, we truly believe we can create something of value to this community.

For this project, we partnered up with the University College London (UCL) Ear Institute. Specifically, we are collaborating with @Tori Kok, a PhD student at the institute. We are also working with Kate Yukhnovich, a PhD student from Newcastle University. Both Tori and Kate have a neurology background and are currently pursuing a PhD on the topic of tinnitus. Furthermore, we found two senior tinnitus researchers —Dr Giriraj Shekhawat (UCL) and Dr Will Sedley (Newcastle) — willing to validate the information before it's published.

What we would like to know from you is the following: What format would you like the resource to be in? By this we mean, would you like the information to be presented in the form of graphics, videos, blogs, podcasts, etc.? Would you like it to be short or very extensive? Would you like it to be interactive somehow? Would you like the information to be tagged or categorised somehow? Is there any additional data you'd like to see (e.g. links to articles)? Well, you get the idea — we need inspiration from you!

Once we've received some ideas from you, we will be turning these into a poll to decide on the final format.

We hope to have the resource published by early 2021. It's still quite a bit of work to prepare the content and find a nice user-friendly way of presenting it. If you want to volunteer to work on this with us behind the scenes, get in touch!

 

[Tori Kok]

Hello everyone,

My name is Tori. I am a PhD student at the UCL Ear Institute. I am very excited to have partnered up with Tinnitus Hub to create useful resources on the science behind tinnitus. We will be running an engagement project over the next few months, so if you would like to get involved feel free to pop me an email at: tori.kok.18@ucl.ac.uk

I'm looking forward to reading your ideas in this forum thread so Tinnitus Hub and the UCL team can create something of real use to the tinnitus community.

Kindest regards,
Tori

 

[Greg Sacramento]

@Tori Kok,

Some underlying neurological mechanisms that cause the tinnitus signal are listed below, but there are lots of other professional views. Will you be using a resource such as this?

Tinnitus and underlying brain mechanisms
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063499/

Underlying Mechanisms of Tinnitus: Review and Clinical Implications
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886369/

For tinnitus causes, databases include -- NCBI, NIH, ScienceDirect, Jama Networks and Google Scholar which is a database. The problem is trying to find a specific cause(s) for an individual which may take reading many medical articles. Your expertise with assisting individuals with their specific complaints would be of benefit.

The do's and dont's of treatments for tinnitus types requires expertise at a high level. For example, knowing not to press a certain neck artery or vein with having pulsatile tinnitus. Another would be not to use certain meds or nasal sprays that are commonly used with tinnitus with certain vestibular conditions. The best resource may be specialized teams of interventional radiologists that can perform the correct radiological tests, after other specific condition testing has been done.

 

[Hazel]

Tinnitus and underlying brain mechanisms
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5063499/

Underlying Mechanisms of Tinnitus: Review and Clinical Implications
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3886369/

Useful resources, thanks! I don't think these provide a complete overview of all the relevant theories (especially since these papers are from 2012 and 2014), but we'll definitely check them.

For tinnitus causes, databases include -- NCBI, NIH, ScienceDirect, Jama Networks and Google Scholar which is a database. The problem is trying to find a specific cause(s) for an individual which may take reading many medical articles. Your expertise with assisting individuals with their specific complaints would be of benefit.

To be clear, the aim with this project is not to outline all the possible causes of tinnitus (which could be hundreds) but the brain mechanisms involved. People can have different peripheral causes or triggers for their tinnitus, but likely what happens in their brain is pretty much the same (although the details on this remain fuzzy).

The input we're looking for here is: What format should our resource be in? In other words, how would you like to see the information presented?

 

[WillBeNimble]

I would recommend a video of some type, with closed captioning. It should be a bit more extensive, as being too general will put it on a similar level of videos already out there on the subject. I'd say something like a 2nd year of uni level of comprehension, maybe? Or maybe several levels, like the videos where they explain the concept at a grade school, high school, college level?

 

[Gabriel5050]

@Hazel, you said you want it to be more than just a forum. I can get behind this idea.

It could be a new section of the site where the information is displayed.

For format I think text would be best for multiple reasons. It's the most professional, less likely to be misunderstood like a graph, easier to understand and potentially translatable for non-native English speakers. Podcasts could maybe be added later on.

Also, I foresee potential for other types of facts and studies ending up in the supposed new section, too.

 

[Greg Sacramento]

The input we're looking for here is: What format should our resource be in? In other words, how would you like to see the information presented?

I think each subject matter - or condition discussed (written) should have a categorize file index with reference articles given. Reason for this would be high quality data or expression would have to come from a source, unless we conducted and concluded our own research. Graphic data from source could be compiled if not already and at times compared to our own poll data.

Example: https://clinicaltrials.gov/ct2/search/browse?brwse=cond_cat_BC09

 

[Autumnly]

What format would you like the resource to be in?

A simple PDF file would be great. You can easily download it, skim through it and send it to other people. A video would be nice as well and Tinnitus Hub could share it via their social media accounts.

Would you like it to be short or very extensive?

I'd say simple and succinct but not too watered-down. If certain parts can't be shortened, more extensive explanations are fine but a summary of the most important points (e.g. as bullet points) would be great.

Is there any additional data you'd like to see (e.g. links to articles)?

I'd be interested in a list with sources used for each tinnitus model.

@Tori Kok Thank you so much for being a part of this project!

 

[Thuan]

First, thank you @Hazel, @Tori Kok, @Will Sedley and Dr Giriraj Shekhawat for helping put a comprehensive information. It's been frustrating going through research papers in PubMed and other sites.

As for the information presentation, I would like two format: a) a PDF file for new tinnitus sufferers and b) a blog to post for updated research or discoveries on models. I would like these information to be extensive.

I would love a blog type because one of the most FRUSTRATING aspect of research articles is that they "recommend" further studies on this and that but many of the authors do not follow up on it or give updates or either is too difficult to find any updated follow-up research.

Thank you.

 

[TuxedoCat]

I would like the information in text form, supplemented with graphics where needed. A podcast with transcript would work as well. In both instances, it would be extremely helpful if a list of supporting references was included.

Thanks very much. Your efforts are going to fill a huge information gap for Tinnitus Talk members.

TC

PS- I just read a post by @SallyM about Gateway Biotechnology. They are working on a drug, GW-201, that acts on Calcium Channels. So, I hope this mechanism is incorporated into your review as well.

 

[david c]

I agree that a text-based format such as a PDF document would be the most useful primary format for information, though by all means supplement with Podcast, video etc. Also, clear sources for each statement would be useful.

I also think it's really important that there should be recognition that - as with any academic discipline - while there is general agreement about some things, there is uncertainty and often disagreement about other aspects of tinnitus. It would be useful to make clear what are theories rather than certainties and to highlight areas where there are still disagreements.

 

[Greg Sacramento]

Auditory Neural Plasticity in Tinnitus Mechanisms and Management

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349625/

"The pathology leading to tinnitus can be located anywhere from the ear canal to the auditory cortex. Tinnitus often occurs along with hearing loss resulting from noise and aging, and thus, cochlear deafferentation is thought to be a trigger of tinnitus while subsequent changes in the central nervous system are thought to be responsible for the maintenance of tinnitus. This process is also known as neural plasticity [21, 22]. Different neural models within the structures of the central auditory system have been established to interpret the possible mechanisms of tinnitus according to neuroimaging techniques such as electroencephalography (EEG) and fMRI. Hearing impairment leads to deafferentation, which is thought to increase the output of pyramid cells in the dorsal cochlear nucleus according to the hyperactivity model [22]. The inferior colliculus then receives the projection fibers from the cochlear nucleus and shows an increased firing rate, and neurons in the upper structures such as the medial geniculate body of the thalamus and auditory cortex also engage in neuronal hypersynchrony [23–25]. In such cases, the tinnitus is most often related to noise trauma and hearing impairment induced by previous use of chemotherapy drugs [26–28]."

"Increases in oscillatory activity in the auditory cortex and thalamus have been observed [29, 30], especially in the gamma band oscillatory of the auditory cortex [31, 32], and highly active areas have also been found by fMRI [33, 34]. It has been suggested that tinnitus perception is based on low-frequency oscillations that cause a lateral inhibition imbalance between the normal auditory area and the area with pathological low-frequency activities, thus resulting in high-frequency gamma oscillations [35]. The increases in low-frequency delta band oscillations seen in tinnitus have been replicated in the laboratory along with the reduction in alpha band oscillations [36, 37]."

"In addition to the above connections within the auditory pathway, a network structure is formed between auditory and nonauditory structures, and this can account for the perception, emotional response, or other reactions to tinnitus. For example, the somatosensory pathway can activate the pyramid cells of the dorsal cochlear nucleus and increase their output [38, 39]. Also, the fibers projecting from the medial geniculate body to the amygdala might facilitate emotional responses to tinnitus. This is because the lateral amygdala receives inputs from neurons in the medial geniculate body and the auditory cortex, and the basal amygdala projects into the hypothalamus in return, thus forming the amygdala auditory feedback loop [40]. EEG measurements have demonstrated enhanced oscillatory electrical activity in the amygdala of tinnitus patients, and the amygdala has been shown by fMRI to respond more strongly to acoustic stimulation in blind individuals for whom the acoustic environment is more important [41, 42]."
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Most researchers of public biomed companies that are working (stage 2 and 3 clinical trials) on emotional - non benzo - non taper medication per anxiety and emotional response as mentioned above, believe that a "network structure is formed between auditory and nonauditory structures, and this can account for the perception, emotional response, or other reactions to tinnitus."

 

[FlyRedwithMe]

Hi,

I am brand new-And I would be thrilled to just see links that lead me to intelligent studies and even real products that help people. I am currently researching apps that I can work through Bluetooth or CIC hearing aids that fully support bluetooth training that will teach me to focus elsewhere.

During the day I have pretty good control, but at night when things get quiet and I try to unwind for bed, my nightmares start happening when I am awake. I want to READ a book, sleep without some other sound blaring in my ear to "Focus" on to get rid of the constant high pitched squeal; the one that can get so loud it sounds like it is setting off my left ear!

I will be reading a whole lot of discussions on this site, starting now! I am so glad I found you.

 

[Julien87]

Good morning and thank you all very much for your work!

My input regarding the form:
I would prefer either texts with graphics or relatively short (10/15 minutes) videos with English subtitles.

 

[Bill Bauer]

What format should our resource be in? In other words, how would you like to see the information presented?

A forum post, with all of the information summarized using bullet points. Make it as short as possible, and maximize the info provided per unit of effort (which can be achieved by minimizing the effort) - so no need for interactivity.

 

[Zugzug]

Several ideas:

1) Most people want to combine the theory with things to try. While there isn't really evidence that supplements help, it would be interesting to connect the logic behind why someone would try something. Thinking about trying NAC? Why?

2) An emphasis on why people's brains can have varying levels of reactivity. Perhaps this is implicit after the tinnitus models are explained, but if part of the goal is to share with others, I think the viewer should see that tinnitus is not a one size-fits-all.

3) Graphics of the process from inner ear to brainstem to auditory cortex with clear explanations.

4) The connection between the amygdala and the auditory cortex. This also begins to discuss hyperacusis.

5) The upsides and downsides of treating with SSRIs. Stress is bad for tinnitus so serotonin can help calm people down, but serotonin also increases activity in the DCN. Patients are in a tough spot.

 

[twa]

I like the idea of an interactive format. I also like the idea of categories or tags to locate easily locate information.