Auditory Mirror Therapy for Treatment of Tinnitus

Reducing tinnitus loudness is the only thing that matters. With that, the THI score goes down automatically. We need treatments which target tinnitus loudness!

 

Well that's the problem right there. He was using earmuffs, not a mirror.

 

Wouldn’t it be easy enough to test this. You can buy headphones or earbuds with “ambient mode”, e.g. https://blog.taotronics.com/headphones/what-is-ambient-sound-mode-on-headphones/.

Then just swap the left and right and see if it works...

 

I don't get it. If I swap left and right, then the headphones also pick up the ambient noise on the left and right, how fully can you swap that?

 

@PeterPan, yes, that's exactly how they conducted the study. The headphones they used are referenced a few posts back (3M Peltor TacticalPro) so with a pair of those plus a few minutes with a screwdriver and soldering iron, it should be possible to replicate what they did.

 

Oops, you are right. And no manufacturer is going to include the swap feature because (almost) no one will have a need for it (and it also could have safety issues).

I wonder how hard it is to do this? These headphones aren’t cheap!

 

Well, actually it shouldn't be that hard to test. I have a mobile stereo recorder that you can connect headphones to. I'll set it up in the garden and then simply swap on the headphones, which allow enough outside noise to pass through (no over-ear headphones), left and right.

Let's see what comes out. I just think it does nothing in the direction of tinnitus.

 

Thinking out loud...

The Ramachandran mirror box therapy for phantom limb pain is essentially an optical illusion. But the power of utilising one sense to fool other senses has been clearly demonstrated. It's also reminded me of a strange funfair ride called, The Haunted Swing, that I went on as a kid.

One would enter a room and perch inside a gondola-like swing that held about eight people. When the ride started the gondola would gently rock back and forth, and as it did, the room would slowly rotate around the gondola. The effect of this illusion was such that within a couple of seconds it felt as though one was literally hanging upside down in the room defying gravity.

One negative but clearly powerful side-effect of this form of 'bi-modal stimulation' was that riders would often feel sick or even vomit. In such cases the guard's advise would be to just simply close one's eyes. I actually tested this out on more than one occasion and the cancellation of the woozy effect was immediate, albeit to the deprivation of sight.

Where tinnitus is concerned it's been proferred that "a change in the organization of the tonotopic map after exposing the ear to intense noise" occurs. It's also stated that, "By understanding how these changes happen, researchers could develop techniques to bring the map back to normal and relieve tinnitus".

Intriguing. Does the tonotopic map lie at the heart of tinnitus generation? Can it really be that spurious data within the map eventually become permanent giving rise to chronic tinnitus? We can't see sound but could we use a simple sound map with inversions in the same way mirror-boxing uses inversions in light to eventually fool the tonotopic map into resetting itself?

I truly believe in the power of these illusions. I also believe the answer to addressing the malady of tinnitus will come from something simple in nature as a wooden mirror-box for phantom pain, or haunted swing (without the vomit) for kicks. I'm also glad that Clas Linnman at least seems willing to stake his professional reputation on a more simplistic approach. Brave man. If, like Ramachandran, his invention looks like something cobbled together in the garden shed then so be it. I'd still be willing to give it a try!

 

I tested it for several hours (I'm unable to work because of tinnitus and I have time), in different volumes, more surroundings, less surroundings, different sounds.

What a surprise:
It has zero effect on tinnitus (I have classic chronic tinnitus).

 

Looking at the graphic in the original post, looks like you need to do it for at least 40 hours to start seeing some effect (the more the better). How did you get the mirror'ed headphones?

 

What do you mean exactly? Do you want me to answer: rotate the headphones 180 degrees?

 

Hi Toby. My understanding is rotating the headphones 180 won't work as this will also involve rotating the microphones and you will still hear external sound coming from the right in the right headphone.

The idea behind this treatment is that you hear ambient sounds coming from the left in the right headphone and vice versa. So, if someone is on your right and starts talking to you, you hear it in your left ear. So the brain gets auditory signals which conflict with the visual signals and this confuses the brain and maybe has an impact on the tinnitus.

In order to actually test this, you need to modify the headphones (e.g., through soldering) as no headphones on the market are likely to have this feature (it's a huge safety risk for starters!).

Although the test results in the graphic are from a "1-arm" test (i.e. no placebo), to me they look impressive and it would be good to get feedback from people who have the time to test this (although modifying the headphones may present a problem for the average user!).

 

Aha - there you go. I couldn't wrap my head around how they might set up an optical effect for sound But there you have it. Nice one Peter.

Edit - imagine what this 'therapy' would be like utilising the doppler effect coupled together with images of whistling trains going past, for example?

 

@PeterPan, I have a mobile stereo recorder Zoom H4N with simultaneous stereo headphone output. So I just turn the headphones left / right and let them half open over my ears so I get the ambient sounds 50/50.

 

I signed up on this forum just to share my approach. Without having read the paper in detail, I will be testing the mirrored left-right audio pass-through with headphones I have modified myself, for at least 40 hours in total.

Disclaimer: I will not take responsibility for any damage done to your headphones or to your ears when trying this modification!

I have bought the (relatively) cheap Sony WH-CH710N. Got them used for about USD 70. They have a pass-through audio mode that they call "ambient mode".

After opening them and inspecting some of the wiring closely, I realized that this is a relatively simple modification that can be done just with a phillips screwdriver, a soldering iron, and some patience!



The wires controlling the speakers are the "RP", "RN", "LP", and "LN" ones, encircled on the photo above. I'm guessing these letters stand for "right", "left", "positive", and "negative", respectively.

To switch the right and left output, simply switch the "RP" wire with the "LP" one, and the "RN" wire with the "LN" one!



The photo above shows the wiring after switching the right and left speakers. I have also added some more kapton tape to avoid any unwanted side effects of the modification. Although it was also working without that.

If you want to repeat what I did, here are some steps for that:

1. Make sure the headphones are turned off.
2. We will only need to modify the left side of the headphones. Remove the left ear cushion by gently pulling outwards and off, going around the cushion in one direction.
3. Remove four Phillips screws to loosen the cover.
4. Prepare a credit card or other flat piece of plastic, pull the cover up a bit, then slide your plastic pry into the gap. Gently slide the plastic pry to both sides until you hear a "click" and the cover comes off completely.
5. Using isopropyl alcohol, remove the white silicone glue that is holding the black and white cables in place. Make sure that the black and white cables can move through the holes in the plastic freely.
6. Remove four more Phillips screws to open the inner cover. Carefully slide the inner cover along the black and white cables so you have more space to work with.
7. You will see the PCB that you see on the photos above. Desolder the wires and solder them back on switched.
8. Reassemble the headphones in reverse order.

WARNING: Doing this modification will break the active noise cancellation (ANC) on these headphones. Since you're effectively de-coupling the microphones from the speakers, you will get nasty and LOUD feedback noise when trying to use ANC. Do not use the ANC mode!

So far, I've only tested the modified headphones for an hour, so I can't comment on any medical effects. What I noticed is that the headphones will turn off after a while if not connected via Bluetooth. The ANC will turn on by default after turning on the headphones. What I'm doing now is simply keeping them connected to my phone, which keeps them turned on permanently.

The effect is pretty funny. Sounds will appear to be more "within your head", as you're effectively moving any stereo sound closer to the center. You will occasionally misjudge where sounds are coming from. Also, your voice will sound strange.

I'm thinking that the effect with these headphones is probably not as strong as with the 3M Peltor TacticalPro ones used in the study, because the Sony ones do not offer such a strong passive noise isolation. This means that using the "ambient mode", you will get about 50% of the real ambient noise that passes through the headphones and cushion, and 50% of the flipped left/right ambient sound that the headphones forward. If it proves to be the case that the modded Sony headphones are ineffective in changing my tinnitus, I'll probably look into increasing the passive noise isolation.

 

This is genius. Thanks for sharing. Please do update how you get on!

 

Is there an app that supports this model? I ask, because I have the WH-1000XM3 version from Sony which has a setting in their app to prevent them from turning off in the absence of an audio stream from the phone allowing them to be used standalone.

 

Unfortunately, the Sony WH-CH710N are not supported in the official app. I'm guessing it's a way for Sony to differentiate the cheaper from the more expensive models. I would also have liked to use the app to disable the ANC mode (since it is not working now).

If you're willing to open up your more expensive headphones, you might be able to do a similar modification, though!

 

This project does seem promising. My tinnitus got worse in my left ear, and my right ear quickly adjusted to the louder tone, and vice versa.

Only issue is some have monotonal and others have reactive/multitonal tinnitus.

Nonetheless, I hope the trial success.

 

How did the testing go?

 

I'm on holidays for a couple of weeks and didn't bring the headphones because of their size -- they don't fold. The few hours I did before that did not have any effect. I'll continue testing at home.

 

Research subjects are now being recruited for this device in the Boston area (Mass., USA):

https://rally.massgeneralbrigham.org/study/tinnitus_research_study

You can apply to enroll on that page.

From that announcement:

What we are studying

We are doing this research study to evaluate a new treatment approach to tinnitus, called auditory mirror therapy (AMT). Tinnitus is increasingly being recognized as a form of phantom experience, similar to the phantom limb pain that can be experienced after amputation. We are seeking people who have chronic (> 3 months) tinnitus. The study requires two hour-long visits to Spaulding Rehabilitation Hospital in Charlestown. You will get a device to use at home for three weeks along with at-home testing for your hearing and tinnitus.

Who can participate

• Chronic ( at least 3 months), tinnitus [ages 18-80, cited separately on that page]

Who cannot participate

• Significant alcohol or drug history (more than 7 glasses of alcohol per week) per self report
• Pregnancy
• Current or past history of major medical, neurological, or psychiatric illness as per self report (for example seizure disorder, diabetes, alcoholism, heart disease including coronary artery disease, psychiatric problems; drug addiction, respiratory problems, liver disease, etc.)
• Current or past history of balance-, vertigo (dizziness)- and/or vestibular (balance)- symptoms including Ménières disease
• Significant medication history

Enrollment expected to end Wednesday, Dec. 31

 

I will be going in for a meeting to possibly participate in this treatment. If there is not an NDA, I will share.

 

Don't share anything.

 

For those with access to this paper - does it overtly say that there was no reduction in tinnitus volume, or rather is it that the tinnitus volume was not measured?

 

May I politely say I'm calling bullshit on this one.

 

I just skimmed over the full text of the paper. Volume does not appear to have been measured in the study.

 

This is exactly why we never got anywhere until recently. Our condition deserves to be taken seriously.

 

Should I not do the trial?

 

If there is absolutely no risk, then do what you gotta do bro. Take one for the team, but only if there is no risk.