Fluctuations in Tinnitus Intensity — What Is the Explanation?

Discussion in 'Dr. Stephen Nagler (MD)' started by Tinniger, Dec 1, 2019.

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    1. Tinniger

      Tinniger Member Benefactor

      Location:
      Germany
      Tinnitus Since:
      06/2017
      Cause of Tinnitus:
      increasingly uncertain, maybe noise, maybe somatic ?
      Many tinnitus sufferers report considerable daily fluctuations in their tinnitus intensity.

      Me, too.

      What explanation do you have for this?
       
    2. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      Great question, @Tinniger, and the answer is ...

      I don’t know, and I don’t care!

      Now please don’t get me wrong. I care very much ... about you. Indeed, I care very much about every single person on this board.

      But as to why your tinnitus fluctuates? I don’t care a bit about that - and I wish you wouldn’t either. Why? Well, in my opinion, the first step in overcoming tinnitus is when you have finally figured out that you can’t figure it out at all. So until such a time comes that research yields a true cure for tinnitus, the best we can do - as I see it - is overcome the tinnitus we happen to have. And that begins with no longer wondering why our tinnitus does this, or why our tinnitus does that ... because as soon as we think we might have an answer, our tinnitus will change the question. You can’t figure it out, and you can’t outsmart it. So why try! At least that’s how it has always been for me!

      I realize that you were looking for a straightforward answer to your very good question and not some off-the-wall philosophical harangue. But that’s the very best I can do.

      With apologies and sincere wishes for quieter days ahead -

      Stephen M. Nagler, M.D.
       
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    3. Dr. Nagler

      Dr. Nagler Member Clinician Benefactor

      Location:
      Atlanta, Georgia USA
      Tinnitus Since:
      04/1994
      @Tinniger, I'm not sure if this will help, but let me offer you a bit of an explanation regarding why it is so difficult to pinpoint the factors involved in tinnitus fluctuations.

      Draw a circle on a piece of paper. Pretend for a moment that the circle is a face, and draw a square where its right eye would be (the eye on the left as you are looking at the face). Now draw a circle where the other eye would be. OK. Forget the face, and consider the large circle to be the brain. Label the eye that's a square the "Tinnitus Generator," and label the eye that's a circle the "Auditory Cortex." So now comes the explanation:

      The Tinnitus Generator (the square eye) is the part of the brain where the tinnitus originates as an electrochemical signal of some sort. We know that tinnitus originates in the brain. The square represents that place, wherever it might be. Someday we may actually be able to pinpoint it, but now the best we can do is indicate it schematically. The Auditory Cortex (the circle eye) is the part of the brain responsible for conscious perception of all sound.

      When a tree falls in the forest, for instance, it makes a sound wave, which is mechanical energy. When the sound wave reaches the hair cells of the cochlea, the sound wave is converted to an electrochemical signal. The electrochemical signal that originated as the sound wave from the falling tree is then propagated along the auditory nerve into the brain and is then transmitted within the brain to the Auditory Cortex (the circle eye), at which point it finally becomes a sound. This process happens almost instantaneously, so it sounds like the falling tree makes a sound, but all it really makes is a sound wave. If that process is interrupted - say you are wearing 100% effective ear plugs, or say you aren't in the forest at all - there is a sound wave, but (for you) there is no sound because the electrochemical signal does not reach your Auditory Cortex.​

      Tinnitus, as opposed to a tree falling, is not associated with a sound wave at all. Tinnitus begins as an electrochemical signal in the square eye - but somehow it has to reach the circle eye, or you do not perceive it as a sound. So draw an arrow from the square eye to the circle eye. The arrow represents the pathways within the brain along which the tinnitus signal must travel before you perceive it as a sound.

      The problem is that there are some 86 billion neurons (nerve cells) within the brain, and a goodly number of them (many millions, perhaps billions) are involved in the aforementioned pathways. Those pathways (and hence the neurons within them) all have the ability to process and modify the tinnitus signal on its way from the square eye to the circle eye.

      What you referred to in your initial post as "fluctuations" is a small part of this processing and modification. And as you can imagine, the variables are countless. Which is why it is, to my way of thinking, impossible to explain precisely what factors are involved in tinnitus fluctuations. For some folks the fluctuation may be all but unnoticeable. For others they may be related to stress, fatigue, activity, diet, etc. Indeed, much of it is likely related to neurochemical factors that are yet to be discovered. Now add to that the fact that the pathways are constantly rewiring themselves functionally and even sometimes structurally.

      Researchers may someday come up with the answers. But until that time, as I said in the second post in this thread, "You can’t figure it out, and you can’t outsmart it. So why try!"

      All the best -

      Stephen M. Nagler, M.D.
       
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