Is Tinnitus Caused by Damage?

http://tinnitus.org/

This site says tinnitus is not due to damage. Yet many people continue to say it is. What is the truth?

Here are some quotes from that site:

Think, now, how much of this treatment depends on being able to believe that tinnitus results from normal compensatory changes in the hearing mechanism, rather than irreversible ear damage. ​

So if it's not irreversible ear damage, then what the hell are we doing spending millions of pounds on a 'cure' which is based on the premise that there is some damage?

While it is important to have a proper examination by an ear specialist, those professionals who themselves believe that tinnitus is an ‘ear’ phenomenon cannot help your tinnitus. ​

Nobody can help, least of all these professionals.

We are in a difficult situation where the classical training of tinnitus being due to inner ear damage is still very dominant. ​

Yes it is dominant however this was written several years ago. Its even more dominant now.

Few have an understanding based on the Jastreboff neurophysiological model ​

Does anybody want to try to comment on these quotes? clearly there are contrasting and contradictory views about this.

 

This site looks like a bunch of hogwash.

It mentions:
''Many accounts and treatments of tinnitus are based on outdated ideas. Many of the support groups are simply phobic training camps! Read the articles and references on this site (and Jastreboff’s) and make up your own mind.''

And then they go cite Jastreboff's model...

Yes tinnitus is caused by damage to the auditory system one way or another.

 

It doesn't look like a "bunch of hogwash" to me - but I do have serious problems with one or two aspects of it that I find to be incredibly misleading.

Well, there I agree 100%.

And I also look forward to when we have a cure - so TRT will be an outdated idea. But unfortunately as yet that day has not arrived.

 

@Dr. Nagler

Perhaps my definition of outdated differs from yours. The fact the TRT remains the only ''standard'' treatment so to speak makes it still relevant today that I agree.

However from a time perspective many people will find ideas/concensus from 20+ years ago quite ancient.

Out of curiosity, which aspects in particular do you find misleading?

 

I do not see TRT as the "only standard" treatment. CBT can be considered standard as well. So can PTM; indeed PTM is the preferred treatment in the VA system.

For tinnitus I definitely hope that will be the case. But I think it's foolish to hang your hat on that hope. Why suffer even one more day than is absolutely necessary??!! At least that's how I see it.

You mean with the tinnitus.org site?

Well I find one aspect to be grossly misleading, and I find another aspect to be absolutely unforgivable.

For grossly misleading, there is a sentence that reads as follows:

"The final stage of habituation is when the signal is no longer detected, and cortical neurones are unresponsive."​

To me that means the final stage of habituation is when you are unable to detect your tinnitus even when you purposely listen for it. (That is what happens when cortical neurons are unresponsive.) But if that were true, then habituation (or by extension TRT) would be a cure, which is most definitely not the case.

So in my opinion the fact that he misleads his readers is a real problem.

Now, as far as what is to me absolutely unforgivable ... is the fact that when I pointed out to Hazell how misleading that sentence was (figuring that he likely misspoke), he would not change it.

 

The American Tinnitus Association's position on some of the topics and quotes addressed on tinnitus.org is unambiguous:

Sensorineural hearing loss is, by far, the most common cause of tinnitus. Some researchers believe that subjective tinnitus cannot exist without some prior loss of hearing.

-- Causes, ATA.org
​

So, at its core, the ATA's position is in alignment with most medical practitioners and healthcare enthusiasts who generally find Tinnitus to be a symptom, rather than a disease, and as a symptom it may have numerous causes; however, unlike some established bodies, like the American Academy of Otolaryngology, ATA's research over the past 40 years have led it to conclude that all subjective tinnitus has its origins in loss of hearing (a distinction without a meaningful difference, says hospitals like Massachusetts Eye & Ear Infirmary, which argues that everyone suffers from some potential conductive or sensorineural hearing loss, and as a consequence, everyone is capable of experiencing Tinnitus).

Almost all research and clinical trials that I have seen operate from the position of the "greatest good," in that believing that most people who suffer from Tinnitus must also have acquired Tinnitus from some potential damage to their auditory pathways, and therefore the most promising treatments should address these deficiencies that cause the neurological symptoms.

But they may all be wrong!

Only, there is a huge flaw in this particular approach, best exemplified by a news report released last week on Boston's WBUR:

The findings suggest that tinnitus is more complicated than scientists thought. It might not stem simply from an isolated defect in the auditory cortex, the part of the brain that perceives sound.

“We found essentially that almost all the hearing parts of the brain are involved,” Gander says, “plus a number of other areas of the brain related to processing emotion and memory and attention.”

-- "Finally Researchers Finding New Clues About Tinnitus." WBUR, May 8, 2015.
​

This has long been a hypothesis by authorities on Tinnitus -- those of us who experience it, as much as those who research it as their passions -- but now, it's been definitively shown on a few scans. It also provides clues as to why Tinnitus is so hard to treat - it's not just a symptom that's expressed in a single way; it's a symptom that takes a lot of things to work in concert to produce: memory, emotions, neuropsychological responses, etc. This theory of multivariate chaotic convergence also explains the less-common causes of Tinnitus - like TMJ and Ototoxic reactions - because these sorts of neuromuscular inflammatory and endocrine system disturbances have multiple fail points that are impacted to produce phantom sounds.

So, to sum it up: No. Despite the overwhelming consensus, Tinnitus is not caused by just damage; it is expressed by the disharmonization of brainwaves and neurological patterns that are caused by a number of aggravating factors which have yet to be identified. This explains why many people who have hearing damage don't have Tinnitus, whereas some people who have relatively minor hearing loss experience profound awareness of their Tinnitus.

 

Almost everyone who has tinnitus has some form of auditory damage. The auditory system goes for beyond hearing thresholds on an audiogram. It cannot be used as a tinnitus diagnostic tool. Only about 10-20% of tinnitus patients do not show reduced hearing thresholds on a normal, clinical audiogram. This does not mean that their auditory system is functioning properly, as evidenced by the presence of phantom sounds or other related aural symptoms (hyperacusis, ear pressure). In fact, it is now believed that almost every person afflicted with tinnitus have reduced auditory input sent to the brain:

http://www.actiononhearingloss.org....st-blog/tinnitus-and-hidden-hearing-loss.aspx

As for multiple areas of the brain being involved in tinnitus patients, this is not surprising. The phantom sound itself can only be due to activity in the auditory cortex, as far as our understanding of the brain goes. Now, tinnitus related distress, anxiety is not for the auditory cortex to process. This goes as well as actively thinking/monitoring one's tinnitus (is it louder today? is this just a spike? did the sound change from yesterday? did this loud truck cause more damage to my ears?). This all generates brain activity outside of the auditory cortex. Shut down the sound itself, and the rest of the brain activity needs not exist anymore.

Anyways that's my take on it. Feel free to criticize.

 

what do you think of the book written by him? what was his response when you pointed out the sentence?

 

there are plenty of people who have tinnitus and no damage. plenty who have damage and no tinnitus too.

no it doesnt. it doesnt explain anything. theres no such thing as disharmonisation of brainwaves. where are you getting these funny words

 

the mystery is some peoples tinnitus (probably rarely) goes away after months or even years. and everyone experiences some temporary tinnitus. It can last just a few seconds or after a loud event, for longer.

 

It is certainly possible, but highly improbable, that once you've had chronic tinnitus it will ever spontaneously resolve.

The ATA maintains, and even the recent studies in Boston confirm, that damage on some level must be present in order for Tinnitus to be expressed. However, damage alone does not cause Tinnitus. There are other factors, expressed in other areas of the auditory pathways, and in non-auditory centers of the brain (such as emotion and memory) that have to misfire in order to cause Tinnitus. That's the discovery here discussed in the WBUR article I linked. FWIW, this isn't exactly breakthrough because MEEI has long published about this suspicion, but it's the first time that brainwave scans confirm this sort of behavior.

The terms I'm using are certainly funny, and they're not appropriate to be sure because the alternative medical community uses them extensively when they don't have substantial scientific bases to describe them. But the underlying behaviors here - misfiring neurons - can be observed as happening across the brain, and not just in the auditory center. That's the problem, and this understanding is giving scientists clues at long last that Tinnitus is not at all exclusively related to hearing damage, but it in fact is related to a perform storm of factors - most of which are not at all understood.

You should read the ATA article ("Causes") and the WBUR news release, for details about the understanding and breakthrough, respectively. But, bottom line, the more we learn about Tinnitus, the less we realize we truly understand it.

 

T is solely caused by hearing loss. Period. Now you could ask what about those that have no hearing loss? How can you tell that they do not actually have some hearing loss? How accurate is a standard hearing test nowadays anyway? Perhaps the damage of one single hair cell alone is enough to acquire some degree of T. Even if you couldn't perceive it 'cause it's too subtle (silent).

Keep in mind, 90% of those that acquire hearing loss get T. Same goes for those that lose a limb they get phantom pain. It's all about the nerves. If we acquire nerve damage our brain simply can't handle it. The brain desperately tries the make up for the lost signals. It doesn't get that the damage is beyond repair and that we suffer greatly.

Now why are there so many other areas simultaneously active in the brain of T patients?
Isn't it obvious? The auditory cortexes do affect other areas in the brain. Why? How come that music can stir our emotions so profoundly?
We have music, we have poetry, acting, we have voices, take a movie for example now imagine there was no atmospheric background music how would that feel? What happens when we hear someone crying or laughing? It's all on an emotional level. We are sensual beings.

Simply put, the sense of hearing is a very, if not the most, powerful sense we possess. Hence no wonder we suffer greatly. Well, those of us that have loud T, that is. It's all about the volume! Let me ask you this, do you think your neighbor would complain about your music (at 2 am in the morning) if they couldn't hear it through their walls? So it's common sense that volume matters. If my T was faint in the background, I wouldn't complain as much as I do here or suffer as greatly.

What about those that claim that volume doesn't matter?

They do not mean it literally, what they mean is: it does not matter to them. And why should it? They can't hear it. Nobody can hear it, but you. Moreover, if they told you from the beginning that volume indeed matters they would discourage and disgruntle potential clients. It's like coca cola were to admit publicly that they essentially just sell sugar water, which is actually profoundly unhealthy when being consumed on a daily basis. Long term side effect is diabetes. Still it's being sold like bread.

However, there's one more factor perception is reality. What does this actually mean?
It means there are T patients that know nothing about T or psychology and they may actually experiencing mild T but believe that they have killer T. In that case, and let me be clear only in that case, psychology can be prudent. For instance, if you turn the faucet on can you still hear your T? If not, your T is probably not that bad at all. That's just one example and the list goes on. At some point you figure if you really have killer T or not. Unfortunately I do.

Now we can all go on speculate and debate on how one day there will be a final real treatment for this insane ailment like they did 20 years ago, look at them now, but that won't change one thing. If we all were scientists, wasting our time with a solution for hearing loss, maybe we would do something fruitful. Unfortunately, most of us just waste their lifespan with mundane things; like arguing here. So there's little to no hope.

What about those that do research right now? I could go on for books about them but it's a waste of time.

Last but not least, a cure is as realistic as the possibility of us humans colonizing other solar systems in 2015. I know, call me a realist.

 

i can easily hear my T when the faucet is on and over the tv and many other sounds.

 

So you know what that means.

 

What does that mean" explain???

 

I don't think so. I have perfect hearing (above average, actually), no ear drum damage, no issues in the brain/face/nerves/eyes, etc. No loud concerts. Just a sudden onset of tinnitus with a misdiagnosis of Meniere's Disease. I think the reason there is no cure is because they don't know what causes it. Some people DO have tinnitus because of damage, others don't. Maybe one day there will be a cure but I won't hold my breath. I'll learn to live with it

 

How can you tell?
There are over 20.000 frequencies and probably millions of hair cells.

You know, a sudden onset of T can have many causes it's not all just about loud music/sound waves. For instance, I did protect my ears always and had impeccable hearing. Still, I got it extremely! Sudden onset while lying in bed.

You may got it via a virus or bacteria or autoimmune disorder. Who knows?

 

cause of T is for example constantly damage or patology/patalogical process in INNER EAR, also just pressure from middle ear shit like cholesteatoma and e.t.c.
ephemeral problems with vessels is for grandfathers and grandmothers
also T in theory maybe nerve damage, but is facticaly imporsible, from the birth unless

 

because they don't know what causes it

Thats right. They bastards and must burn in hell or cleaning the streets, is not doctors, just money eaters.

 

Have you had unusual amounts of stress in your life and can you think of 1 very loud incident that you did not protect yourself ever in your life (1 party, 1 concert, 1 fire alarm, etc? ) Severe tinnitus doesnt just happen for no reason, but it is insidious in the sense that the trauma can precede tinnitus by many years and lay dormant until triggered by stress/emotional pressure or another loud incident.

 

wheres the evidence for that?

 

My intellect and experience.

 

I've seen no evidence that tinnitus lays dormant. How would anybody be able to test that theory?

 

I agree that Tinnitus is in the Ear or Brain or inbetween, and caused by damage or compression or a Virus or a protien, or brain abnormalities.

 

Caused by a protein??? What?

A protein is just a collection of amino acids...they makeup a significant portion of all living things.

 

It that directed at me?

Anyway, I definitely had unusual amounts of stress prior to the onset of T (mainly sleep deprivation) but since my hearing loss is so extreme and I still hear bubbling something physically must be damaged.

 

My tinnitus started just after I spent half an hour hitting a crowbar with a hammer at about head height, and it has not stopped since. The intro to the tinnitus.org page in question starts off with " tinnitus and hyperacusis distress are NOT due to damage that can’t be fixed" it doesn't say it's not due to damage- it says it's not due to damage that CAN NOT BE FIXED. This statement is more about the fixability than therories about the cause.The page is obviously an advertisement for a product they want to sell, so any claims of being able to fix tinnitus without evidence based research is unlikely to be true.

Although there is no evidence based research that supports a cure yet, I don't think a cure is impossible or even unlikely (I have nothing to sell). As for the cause of sound caused tinnitus, i am leaning towards the phantom pain theory. Phantom pain usually refers to amputated limbs that although gone still seem to give the person considerable pain. Some limbs are amputated and cause no phantom pain. The difference, apparently, is limbs that are severed while IN pain continue to hurt, those severed while not in pain have no phantom pain. Really interesting, but a little disturbing story about a phantom forehead itch- http://www.newyorker.com/magazine/2008/06/30/the-itch tells of a doctor that removed or deadened more and more of the neuron pathway of the itch, but the itch remained. The link here to tinnitus is the little receptor hairs die while sending the 'very loud noise is being felt' message.

Sound caused tinnitus like mine began with harsh noise that killed my highest pitch sound receptors WHILE they were in pain. As most people will know neurons have exitatory and/or inhibitory properties. My personal theory is sense receptor cells send the pain message to the brain, the brain says 'thanks for the warning', then waits for the 'off pain' message- the all clear. If the sense receptors die or are cut off before they send the all clear- the brain thinks the sound or feeling is still there. If the brain's end point for sensory input requires an off message before resetting to 'no input' then they will remain 'on'-translating the lack of message as constant pain/itch or sound. There is an interesting TED talk with a guy using a mirror treatment to fool the brain into thinking the phantom limb that feels clenched relaxes. . I don't know very much about what cells have or do not have inhibitory properties, but I do know eye receptor cells have inhibitory properties, which is how we see white when all colours are present in equal amounts. If eyes can do that, why not ears.