Need for an Objective Measure of Tinnitus

A conversation I had recently with someone in Pharma really hit home for me the importance of having an objective measure for tinnitus.

For any company looking at the problem of tinnitus the only way of measuring improvement right now is to ask a series of questions. There is MRI and the like but who can say the part of the brain we should be measuring change within?

Because the perception of tinnitus is subjective you are entirely at the mercy of the individual. So many things could affect us that it's a little bit of a lottery whether you will see improvement or not. If we had a real "cure" drug it would be obvious. But in reality a treatment is going to have a certain effect that has to be measured by relying on the patient supplying a set of answers to a set of questionnaires.

It's pretty unreliable. As a Pharma I would be nervous about doing tinnitus research until there was a real objective measurement that I could rely on.

This leads me to think that development of an objective measurement for tinnitus is one of the most important things we need right now, to attract more interest and funding into research.

 

Except for privacy laws (at least in the U.S.) restricting access to patient medical records. Even accessing my own patient records requires signing a few legal documents.

Oh that dude definetly has tinnitus. All that time spent on race karts . . .

 

Snafu with Google's Deepmind and NHS.

 

I had a TIA, the MRI shows damage in my brainstem, you hit the nail in the head. I say my ears are shrieking for England, but it's the brain going berserk, not the ears.
Today I'm having a dreadful spike, self inflicted by a theatre visit, even though I fully protected my earswith plugs. Hate it, but I'm hopeful it will fade to its normal loud (as opposed to super loud), tones soon....

 

I can access my medical records (and my children's records) via a portal as well. Even have an app on my phone for one medical facility that enables me to review my MRI scans, all bloodwork, doctor notes, email my medical team, etc.

But, I had a recent surgery and for access to those files I had to go to the hospital, show proof of ID, and sign paperwork. My follow up visit with the surgeon logged much of it through the portal, but I had to work through the hospital to get specific details regarding medications I received and the anesthesiologist's notes.

 

Whoops! That's a pretty big mistake.

 

You may know more about his secret agenda than me, but the text you quoted simply states that he said "This test is open to abuse by those wishing to fraudulently claim disability benefit", which seems to indicate he is targeting abuse.
Remember that abuse contributes to making us legitimate sufferers not receive the appropriate care. It's because of abuse that we are looked at with suspicion when we come in saying "I can't work! This noise is killing me! I can't concentrate!". Cutting down on abuse doesn't seem like a bad idea.

 

Well that is exactly what this guy is trying to figure out isn't it? It seems reasonable to explore ideas that help weed out the abusers from real sufferers. You could clearly argue about his implementation (i.e. startling people with loud sounds), but the high level goal seems reasonable to me.

It's not mutually exclusive with researching a cure: the efforts to find a cure aren't halted because some guys work on ways to detect abuse. I'd also prefer a cure, but in the absence of it, I'd like it if legit sufferers could get help to go through life with such condition.

 

I don't think an objective measure could achieve anything more than say "yes that part of the brain lights up when the dye passes through (or whatever)" but then you move on to measuring the extent of disability from individual to individual. We all know our own perception of it, but how many of us have experienced not being taken very seriously by Care-givers? Then add in a bureaucratic disincentive to recognizing the problem exists in different degrees for different people (he can work, why can't you? Your objective results are the same). Its akin to scoring chronic pain syndromes. Some will always cope differently to others, whether it be from psychological mechanisms, or subtle tinnitus sound perceptual differences. I may manifest the same brain changes as Greg, but he may perceive it as a screeeech to my simple screech. Objective measures of perception won't be coming anytime soon and yet that is precisely what we need (Questionnaires aren't really objective).

An efficient and cost-effective model of objective baseline proof for the existence of tinnitus would be a good starting point though. A brain change that isn't detected in non-sufferers for example. @GregCA is the link-master. You seen anything like this?

 

This is actually how they "measure" tinnitus in animal models. It is know as "
Gap-Prepulse Inhibition of the Acoustic Startle Reflex." I am suspicious that they are even making the correct conclusion from this response. Apparently I am not the only one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4411996/

My focus is getting folks better, but I think you are on to something:

On the other hand, EEG, especially QUANTITATIVE EEG (qEEG) does seem to be effective at showing objective signs of tinnitus and its distress.

Can EEG Measure Tinnitus? [CR Neuromodulation]...

Here are the notes from the video:
So what can we USE, NOW, from this study?
If you need to have HARD data that demonstrates you truly have severe, disabling tinnitus, qEEG with LORETA analysis may be able to do this for you. If you want further info. On referral to a qEEG provider, check with brainsinternational.com
Future Applications:
What if we could use the consumer-friendly and AFFORDABLE EEG units to help Diagnose helpful specifics of YOUR INDIVIDUAL Tinnitus? What if this could help you determine, WITH CLARITY, how well you would respond to a PARTICULAR tinnitus treatment.
What if TREATMENTS, or self-help therapies, could automatically change, or RECOMMEND changes, to your therapy for maximum tinnitus reduction, BASED ON real-time measurements in your brain activity?

Research and Reference:
“Functional Brain Imaging for Tinnitus”: https://www.youtube.com/watch?v=eLfJg...
Fundamentals of EEG Measurement, 2002: http://www.measurement.sk/2002/S2/Tep...
Number of neurons in human brain, 2009. https://www.ncbi.nlm.nih.gov/pubmed/1...
For referral to a qEEG provider: http://www.brainsinternational.com
Emotiv EPOCH - consumer-friendly EEG headset: https://www.emotiv.com/epoc/
Cognionics - Easy-to-use accurately EEG headset: http://www.cognionics.com/images/docs...

 

I have but I can't find the link anymore (looks like I will be demoted from my link-master status!) - it was a youtube video that showed exactly what you describe: through fMRI you could tell T patients apart from non T patients. It was the first time that we could fairly reliably tell them apart without actually requiring any information from the patient at all.

But that was the extent of it: I don't recall it being granular enough to detect intensity, let alone frequencies.

The other thing I recall is that it wasn't "bleeding edge technology": that video was made around 2012 IIRC.

 

It doesn't look familiar. IIRC if was a fairly long video (maybe 1h) where only a small section covered this (1 minute perhaps). It was on youtube. I've seen so many T-related videos on youtube that I'm a bit confused about which one's which.

 

Regarding objective measurements of tinnitus, a number of articles from the Frontiers Research Topic actually address the issue both directly and indirectly:

• http://journal.frontiersin.org/article/10.3389/fnagi.2017.00237/full
• http://journal.frontiersin.org/article/10.3389/fmed.2017.00086/full
• http://journal.frontiersin.org/article/10.3389/fneur.2017.00115/full
• http://journal.frontiersin.org/article/10.3389/fnins.2017.00148/full
• http://journal.frontiersin.org/article/10.3389/fnhum.2017.00022/full
• http://journal.frontiersin.org/article/10.3389/fnagi.2016.00221/full

I have personally ensured the distribution of two of the articles ("metabolic changes" and "alterations in brain structures") for that same reason.

 

Good analysis @Samir .
The startle sound is matched to the tinnitus. With the "prepulse gap detection," they are presented with a constant tinnitus-matched tone, which is removed briefly. If your tinnitus persists, you don't notice the matched tone being absent. A variation of this is where they have a constant sound, then a gap (no sound) just before the startle sound. The expectation is that those WITHOUT tinnitus will have LESS response startle. The idea, I believe, is that the break in sound is a more subtle warning, so the startle sound is less shocking.
You ask many carefully-considered questions. Unfortunately, I don't know many of the answers with this research.
The protocols are a bit difficult to understand. I became a bit disillusioned when my understanding seemed to reveal some likely gaps in their ability to determine the difference between a lack of response due to tinnitus vs.a lack of response due to hearing loss.
This is VERY hard research to do. I applaud them for their efforts.

 

An article about tinnitus and EEG:
http://www.sciencedirect.com/science/article/pii/S0378595517300321

 

Another article, about tinnitus and fMRI:
http://www.sciencedirect.com/science/article/pii/S2213158217302693

 

I am very sceptical that there will be objective ways to quantify tinnitus. I am actually sceptical when I read the term tinnitus and have in mind how many different manifestations there are. I recently spoke to a man about somatic tinnitus who said that if he does not move, he does not have tinnitus, but even chewing, swallowing, frowning, speaking etc. is accompanied by a hissing in his ear. Tinnitus is often not this beeping in the ear with e.g. 11380Hz as many people imagine it. Furthermore: Many tinnitus sufferers have strong fluctuations in the severity of their symptoms.
I think a quantification of measured brain activity is a completely wrong approach.