Tinnitus - Science topic

No change is sound, but the releasing suction causes a brief dizzy sensation. The sound is actually nerve damage, not a real auditory sound. Dizziness, pressure related on the balance functions of the middle ear. I have lived with tinnitus for 30 years due to a fistula in the cochlea.

For the selection of frequency in case of rTMS for tinnitus it is necessary to stimulate the relevant cortex. If less frequency is selected it would not stimulate the specific cortex eg. Temporal lobe as because the relative thickness of the temporal bone is stimulated by frequency around 1Hz.

And if we set a higher frequency it would overstimulate the cortex. That will produce more tinnitus.

So traditionally 1Hz is used with a variable result. But research may be take place to reduce the variability in outcome whether this explanation is correct or not.

A cohort study with rheumatologist may be taken up to conform.

It has a definite relation

I can give you literature in abundance on this

I think the mechanisms of action of all those methods are still poorly understood. I know the TMS is used with good results but much More research is needed to answer your question. Please note that (as far as I know) no one of these methods are approved by the legal entities to be used as treatment options in that disease...

Thank you for your answer, complete yet understandable for the layman I am in these subjects.

I will keep you posted if further developments occur.

Regards,

Etienne

It would be better if you refer to the salt and not to commercial name of the drugs in question. Names depends on the country and world region.

Best regards

I feel both group shoud undergo audiometry test and also Tinnitus handicap inventory for sevirity of Tinnitus . i would be better if your could check the ralations among tinnitus severity and reaction time.

Andrew, You are too hasty in your mistaken assumption. There was nothing sarcastic in my thoughts or words. Compliments from me are not easy to come by, take them when they are given. Jonathan

Hi Adam Szewczyk,

In theory, every environmental factor that can induce hearing impairment can lead to accompanied tinnitus as well. (e.g., noise-induced, acoustic trauma, viral infections, ototoxic drugs, and vestibulotoxic drugs, etc.).

Therefore work environment with exposure to loud noise requires effective ear protection to avoid occupational risk for hearing impairment.

Best,

Amiel

If I were to consider electrical treatment in these conditions (which I regard as aspects of a single syndrome, Meniere Spectrum Disorder) my first choice would be ECT. I believe ECT works by shocking the vestibular system, hence resetting its control over the autonomic nervous system and over the formulation of body image which is at the basis of pain control.

Please elaborate, sir.

I think endolymphatic hydrops is triggered by reduced perilymphatic pressure, hence anything that increases middle ear aeration is like to lead to dehydration and to likely perilymphatic hypotension.  So, mild hydrops, especially a feeling of ear blockage or pressure, or audiosensitivity, occurs after grommet insertion, patent eustachian tubes and even perforated eardrum.  So, grommets could easily make early Meniere's worse.

Tinnitus volume may fluctuate with certain eye movement -intermittently-, jaw & neck movement including teeth grinding and yawning.

Javi Otero 

Perhaps tinnitus is also similar in causation. It is plausible that there is a persistent pre-tinnitus activity (innate evolutionary) that is filtered into awareness as “tinnitus” when there is malfunction of the central executive blocking mechanism (BG -the physiological barrier of Sacks).

Such occurrences have been reported (See Larson PS, Cheung SW: Deep brain stimulation in area LC  controllably triggers auditory phantom percepts.  Neurosurgery 70: 398 – 406, 2012)    and

Larson PS, Cheung SW. A stroke of silence: tinnitus suppression following placement of a deep brain stimulation electrode with infarction in area LC. J Neurosurg. 2013 Jan; 118(1):192-4. PMID: 23082889.)

Most of us is subconscious. What enters our (private) conscious is prioritised (of survival value) - sensations, thoughts/feelings/emotions,? tinnitus  - all filtered from subconscious

The basal ganglia (BG) are primarily involved in facilitating “the decision” at any given time; they help to determine which of several possible behaviors the prefrontal cortex (PFC) is to execute. In this sense the BG keep the “non-enabling decisions” out. The BG thus plays a major role in inhibiting behaviour suggested by the “primitive urges”.

The BG is influenced by signals from many parts of the brain, including the prefrontal cortex (PFC), which is involved in prioritisation of the current task goals (and maintaining focus).

The BG have a limbic sector whose components are assigned distinct names: the nucleus accumbens, ventral pallidum, and ventral tegmental area (VTA).

Emotional stimuli dependent on the Darwinian hierarchy for survival gain most priority into this system. In other words, evolutionarily, the brain is always on high alert for perceived threats. Significant neural machinery has thus evolved to ensure survival. Recruitment of this machinery in a particular situation denotes a survival instinct corroboration of that particular situation by the organism. The emotional salience of tinnitus is undoubted.

Volumetric and other imaging techniques confirm the involvement of non auditory areas in the region of the cortico (– prefrontal) –limbic areas. Tinnitus studies report reduction in cortical matter. Similar reduction is reported in addiction studies and is usually interpreted in this circumstance as a reduction of prefrontal control of the limbic areas leading to the excessive “craving” in addiction.

Unfortunately we do not have information on hypersensitivity, but the possibility of a change in the growing stages is interesting. Expression of the origin of the trigeminal ganglion may be involved.

iwao

Christian Brandt

I agree

Tinnitus has 2 components: acoustic and nonacoustic (cognitive).The cognitive component exaggerates the acoustic component significantly. In other words, if the cognitive component can be controlled, it may be possible to ignore the acoustic component.

Thanks Bill, am interested in natural management of histamine excess not medication. In my experience all medication masks symptoms while creating a raft of new issues. 

In my clinical work with patients with tinnitus and hearing loss, with tinnitus and normal hearing, and hearing loss without tinnitus, I gave up on trying to determine an association. I did know that in most cases of tinnitus with hearing loss, the tinnitus was often resolved when hearing aids were worn. For those with tinnitus and normal hearing, hearing aids were inappropriate and tinnitus maskers were as often ineffective as effective. Of course, for those with hearing loss and no tinnitus, I often worried that hearing aids might be the trigger for tinnitus and in one case  I came in late (a hearing aid fit by  another practitioner had triggered tinnitus). 

So, in answer to your question, there may be a relation between tinnitus and hearing loss such that the tinnitus might be at the same frequency as the frequency of maximum hearing loss (assuming a NI notch). But, there is no relation for those with normal hearing (such as myself - I am listening to a 6400 Hz , or so, tone in my right ear while typing this and listening to television). 

As to research,, there is insufficient research to provide anything other than a vague answer to your question. It remains a patient-by-patient issue.

Dominik, any pressure related or pressure mediated headache may be increased through increased blood flow aka enlarged venous distension (as outlined with the Kelly Monroe doctrine). This effect is more pronounced if the autoregulation of the brain is impaired due to trauma, modified with vasodilator drugs (as Shao-Weih Hsieh pointed out) or the blood brain barrier is injured. Ventilation modifies vasoconstriction / vasodilatation by CO2 receptors, thus if you want to measure the effects of any intervention on cerebral blood flow, try to control for respiratory and positional effects.

The research that was the basis for my M.S.(1968) was looking to see the ideal place for injection of polytetrafluoroethylene (PTFE) to treat patulous Eustachian tubes. 

I developed a method for measuring ET patency in anesthetized dogs using an air flow system through a myringotomy. The back flow in a manometer would show the opening pressure of the ET. There were two possible places for the injection. 1. behind the torus tubarius  2.in front into the tensor veli palatini. The tensor injection reduced the patency without causing serous otitis media. The behind the torus injection did not change the patency as expected but produced serous otitis media in all dogs. The latter revealed that ET obstruction was not a necessary etiology for serous otitis media.

Clinically the PTFE injection was effective, but its exact placement in the human was difficult and lead to at least two deaths and was subsequently abandoned.

Clinically, now when expected, the diagnosis is confirmed with the ET insufflation of a boric acid/salicylic acid powder. If confirmed the patient can be instructed in self ET catheterization with insufflation of the powder as necessary. In some instances presumably by producing some chronic inflammation of the ET mucosa the symptom disappears.

Dennis Poe has been performing the leading edge endonasal contemporary surgical management.

Click the link

Hai Sir,

Management / Treatment

Eliminate tinnitus or reduce its loudness

Reduce the person’s reaction to the  tinnitus

Tinnitus retraining therapy (TRT)

Masking

Medication

Psychological treatments

Electrical stimulation

Biofeedback training

Surgical technique

Here something related to sound therapy

Sound Therapy

Sound therapy utilizes a basic property of perception.  We do not perceive the absolute value of stimulus, but rather the difference between the stimulus and the background.  A classical example would be the perception of the brightness of a small candle in a dark room compared to its brightness in the full sun.  The physical intensity of the candle is same in both instances but the candle appears to be weak in the sun.  Since tinnitus cannot be eliminated, sound therapy helps to decrease the difference between the tinnitus signal and the background neuronal activity.

It consists of enrichment of auditory background by several different approaches - the introduction of additional sounds, increasing the volume of existing sounds, amplification of environmental sound by hearing aids. The background neuronal activity is increased, thus reducing the relative level of tinnitus. This reduces excitation level in sub cortical structures, limbic and ANS for the tinnitus. Low level, constant sound is used to avoid suppression of tinnitus.  Suppression of tinnitus is counterproductive to habituation. The characteristics of tinnitus perception need to be preserved. Level of sound should be just below minimum masking level.

All patients are advised to avoid silence.  All patients are advised sound enrichment, table top sound machines or ear level sound generators. Introducing extra sounds is an effective and convenient method of changing the strength of the tinnitus and therefore facilitating evaluation. Sound used for enrichment during day and night should be neutral, non intrusive, and not annoying.

The process of habituation is affected by the levels of sound selected for use in sound therapy. When the sound level is close to the threshold of hearing, this signal can actually enhance tinnitus through stochastic resonance: the enhancement of tinnitus signal by addition of low level random noise (Jastreboff 1999, Jasterboff & Jasterboff, 2000).

There are three main factors regarding the usage of sound, which influence the process of tinnitus habituation.

1.      External sounds should not induce any negative reactions (e.g. annoyance) because of their loudness or quality, as this would enhance activation of the limbic and ANS and consequently hinder habituation.

2.      If the tinnitus is suppressed (“masked”) habituation will never occur. to be effective, the intensity of sound enrichment should lie between the threshold for hearing it and the level at which partial suppression or masking ( the sound level that does not totally suppress the tinnitus, but partly alters) begins to occur. This level is typically described by patients as the “mixing” or “blending” point and the tinnitus patients perceive that the tinnitus and external sound start to interfere with each other.

3.      It should not attract any undue attention or interfere with communication or affect any everyday activities.

For majority of patients, sound therapy involves the use of instruments (wearable sound generators or hearing aids). Wearable sound generators produce a broad band noise that stimulates a reasonable wide range of neurons in the auditory pathways. These devices block the ear canal and so there is no interference with the environmental sound entering the ear. In addition, as a low level of sound (around 10 dB SL) is used, it does not interfere with normal hearing. For both sound generators and hearing aids, as open as possible ear mold fittings are needed to minimize the occlusion effect and the reduction of normal access for environmental sounds.

The fittings must be bilateral to avoid asymmetric stimulation of the auditory system, even when the tinnitus is perceived as being localized to one ear. Attempts to stimulate only one side in unilateral tinnitus frequently results in a shift of the perceived location of the tinnitus to the opposite side because of the strong interaction within the auditory pathways, and the asymmetry of sound stimulation. Instruments should be worn particularly in low level of background noise.

For majority of patients, the optimal approach involves the use of broad band noise generators that are worn behind the ear with an open fitting. This facilitates quick habituation. Advantages of BBN generators are:

o   They produce random neuronal activity that resembles spontaneous activity.

o   Sound level can be controlled by the user and sound level is stable.

o   Ear level devices are attached to the head. When the patient moves the head the sound for the generators moves also, which further facilitates the habituation to tinnitus.

o   It’s easier for the patient to comply with the sound protocol

It quite an old corporate sponsored study which was distributed by the need reps

The question is in regard to tinnitus matching and not hearing loss

First of all tinnitus is not a disease. It is a symptom stemming from one or several causes with a physical origin as well as an imbalance due to stress and mental dysfunction. To be able to help the patients we need to realize that tinnitus is a symptom. 

There is not a straightforward answer to your quesiton as I don't know the source of your record. My educated guess is that this is not an article but a chapter in the book of conference proceedings titled 'Tinnitus 91'.  The record has been imported into your Ref Manager as a different type of publication and the book title has ended up in the publication field.  You need to change the record template to one for a "Book Chapter" (Ref Manager may call it something sligthly different) and copy/paste into the template the information you have, along with the book information below, into the appropriate fields. 

Published/Created:Amsterdam ; New York : Kugler Publications, c1992.

What appears to be missing is the pagination of the chapter.  If you don't have this elsewhere you will need to ask your Librarian to assist you with finding this as many referencing styles require it.  I hope this helps.

Hi David,

Tinnitus is related to a range of psychological issues including distress, anxiety, depression, and personality disorders.

Check through the following papers.

1.  E. Ooms, R. Meganck, S. Vanheule, B. Vinck, J.-B. Watelet, and I. Dhooge (2011), “Tinnitus severity and the relation to depressive symptoms: a critical study,” Otolaryngology—Head and Neck Surgery, vol. 145, no. 2, pp. 276–281.

2. E. Ooms, S. Vanheule, R. Meganck, B. Vinck, J. Watelet, and I. Dhooge (2012), “Tinnitus severity and its association with cognitive and somatic anxiety: a critical study,” European Archives of Oto-Rhino-Laryngology, vol. 269, no. 11, pp. 2327–2333.

3. B. Langguth, T. Kleinjung, B. Fischer, G. Hajak, P. Eichhammer, and P. G. Sand, (2007) “Tinnitus severity, depression, and the big five personality traits,” Progress in Brain Research, vol. 166, pp. 221–225.

4. A. McCormack, M. Edmondson-Jones, H. Fortnum et al. (2014) “The prevalence of tinnitus and the relationship with neuroticism in a middle-aged UK population,” Journal of Psychosomatic Research, vol. 76, pp. 76–56.

5. J. M. Malouff, N. S. Schutte, and L. A. Zucker (2011) “Tinnitus-related distress: a review of recent findings,”Current Psychiatry Reports, vol. 13, no. 1, pp. 31–36.

6. H. Bartels, S. S. Pedersen, B. F. A. M. Van Der Laan, M. J. Staal, F. W. J. Albers, and B. Middel (2009) “The impact of type D personality on health-related quality of life in tinnitus patients is mainly mediated by anxiety and depression,” Otology and Neurotology, vol. 31, no. 1, pp. 11–18.

Of my daily experience, i met some patients coming in my clinic for their tinnitus. I do my best to rule out any risky underneath cause like tumoral cause particularly if tinnitus is unilateral. I found that most of these patients seen before by private ENT doctor who put them on ginkgo for 2 -3 months & all of them experienced no improvement of their tinnitus.    

"do you have any experience .."

No, and even if I had, personal experience would be unreliable. Proper controlled drug trials would be needed.

Acceleration (change in head velocity) is detected by the vestibular organs in the inner ear. Hence any sudden change in velocity, as with closed - and not open - head injuries is liable to overstimulate or damage the vestibular system (concussion). A widely overlooked cause of damage is a leak from cochlea to middle ear (perilymph fistula), which may occur on either side, and cause Menieriform symptoms. The clinical syndromes of perilymph fistula and post-concussion "neurosis" are identical (Grimm).

LLLT has been used to treat tinnitus for the late 15 years; however, several placebo-controlled clinical trials have failed to demonstrate clinical efficacy.

Is there an english or spanish version of this question?

Tinnitus is a very common symptom affecting at least 10% of the general population, while among the hearing-impaired, the proportion increases significantly to 70-85 percent. People with tinnitus often describe it as a perception of ringing, whistling or buzzing in one or both ears. It can be intermittent or continuous in nature and its intensity can range from just a noticeable hissing sound to a roaring noise that affects all the aspects of life. Tinnitus mainly leads to various psychological disturbances and can alter person’s day to day routine activities, which sometimes leads to disturbance of peer / social relationships. There are various effects of tinnitus such as fear, depression, frustration, anxiety, emotional devastation, sleep disorders, poor concentration, annoyance, tension in the head & neck, irritability and feelings of panic.

Despite of its high incidence, pathophysiology of tinnitus remains incompletely understood. Patients with tinnitus present a variety of symptoms, and as a consequence, wide ranges of therapies are available for treatment. Although many of these therapies are effective when applied to individual patients, no study has yet been able to confirm one. Most successful management programs employ multimodal strategies designed to address the specific needs of each patient. A recent study titled “Role of self induced sound therapy: Bhramari Pranayama in Tinnitus” has been published in one of the renowned journal ‘Audiological Medicine’ in UK, described combined therapy (Bhramari Pranayama, Masking therapy and Ginkgo biloba) as being advantageous in treating patients with tinnitus (Pandey et al., 2010).