New University of Michigan Tinnitus Discovery — Signal Timing

@brokensoul

Not true it's for somatic tinnitus only, this is what Susan Shore told me a week ago:

"Our first trial included those with noise induced tinnitus so I would predict yes."

 

As far as I know it was understood that you most likely need to have tinnitus with a somatic component or at least it would work better if you did. It does not matter how the tinnitus is induced I believe. I believe there is some link between modulation and the hyperactivity in the DCN, in the sense that if you can modulate it, you certainly have DCN hyperactivity.

Anyhow, all the better if it works for tinnitus which cannot be modulated in any way. That would be great news for those who can’t modulate their tinnitus. The way I currently understand it though is if you can modulate it, you have a higher chance this is going to work for you.

Feel free to enlighten me.

I’m happy though that I can modulate my tinnitus by jaw movement and biting. It gives me some hope this could really help me. Can’t wait to see the results of the second trial!!

 

Also, I’m not sure if my understanding is correct, so feel free to correct me.

I do not have somatic tinnitus. It is not caused by any physical problem in my back, neck or jaw. My tinnitus is likely caused by ototoxicity.

I do however have tinnitus with a somatic component, meaning I can modulate it by moving some body part. In my case the jaw, which means I would use the trigeminal nerve stimulation with Susan shore’s device (stimulation on the cheek). The same target Lenire uses actually, but they stimulate the trigeminal nerve through the tongue.

I believe it’s a subtle difference that causes some ambiguity and I think Susan even uses this definition incorrectly at times?

Is this correct or do I misunderstand?

 

It is for somatic tinnitus but they have been working hard to treat noise induced tinnitus as well.

She even said it here:

“We’re definitely encouraged by these results, but we need to optimize the length of treatments, identify which subgroups of patients may benefit most, and determine if this approach works in patients who have nonsomatic forms of the condition that can’t be modulated by head and neck maneuvers,” Shore said.

We’ll see, hope for the best.

 

@brokensoul Where is the source for this information?

“and has tinnitus herself.”

Thanks.

 

Noise induced tinnitus can have somatic components.
I wish I can modulate mine. Seems like non somatic tinnitus will be more difficult to treat.

 

That's usually what people mean when they use the term "somatic tinnitus", they don't mean it was caused by an issue with the jaw/neck/head but that moving the jaw/neck/head can affect it.

Shore also defined somatic tinnitus as: "Somatic tinnitus is clinically observed modulation of the pitch and loudness of tinnitus by somatic stimulation." source

Noise-induced hearing loss can lead to somatic tinnitus.

"2.2 Changes in Somatosensory innervation to the CN after cochlear damage
Multisensory neurons in general have a propensity for receiving cross-modal compensation following sensory deprivation (Allman et al., 2009). This susceptibility is manifest in the CN as an increase in the number of VGLUT2-positive terminals in CN regions that receive somatosensory inputs. In contrast, the number of VGLUT1-positive terminals decreased (Fig. 6). Together, these changes signify an enhanced somatosensory influence on the CN after auditory nerve denervation of the CN (Zeng et al., 2009). This altered balance of inputs from auditory and somatosensory structures affects bimodal integration, imparting greater strength to the somatosensory inputs. One physiological consequence of the increased number of VGLUT2- positive inputs is that DCN neurons become more responsive to somatosensory stimulation following cochlear damage (Shore et al., 2008).

 

I can only increase loudness, pitch seems to stay the same but the hiss becomes "fuller" and more enveloping, as in the bandwidth seems to increase...

I can do that by clenching, jutting my jaw, and pushing against my head with my palm and trying to push back using my neck muscles.

You reckon that's somatic? There's little doubt my tinnitus comes from noise exposure, even though my audiogram to 8kHz is quite normal for someone my age (33).

 

They are testing for noise induced tinnitus with somatic components. She does not know well if it works for noise induced patients with non somatic forms. I asked her via email many months ago.

 

It seems to me there may be some ambiguity in how somatic tinnitus is understood by many, but I understood it as tinnitus caused by a physical problem in your back, neck, jaw, ...

I understand though what Dr Susan Shore means when she speaks of “somatic tinnitus”.

--

Somatic tinnitus

Somatic tinnitus is a type of tinnitus that is typically related to physical movement and touch. It can be generated by muscle spasms in the ear or neck, and by other mechanical sources. Although sound therapy can be used for somatic tinnitus, often times other management techniques, such as massage therapy can also be helpful.

Anything that causes the neck to twist, such as a pillow or turning the neck to look into a microscope, can be the source of somatic tinnitus.

Dental problems such as impacted wisdom teeth and popping of the jaw can also create this type of tinnitus.

Somatic tinnitus is also referred to as conductive tinnitus, meaning it is tinnitus caused by more outer functions, rather than sensory/neurological causes. Sometimes mechanical causes of tinnitus can be heard by others.

Source: ReSound


The somatosensory system is a part of the sensory nervous system. This is a complex network of sensory and neurons that respond to changes at the surface or inside the body. These changes can include movement, pressure, touch, temperature or pain.

Somatic (also called somatosensory) tinnitus (ST) is a subtype of subjective tinnitus, where changed somatosensory information from the cervical spine or jaw area causes or changes a patient’s tinnitus perception.

Since Levine’s first publication in 1999, several animal and human studies have found connections between the somatosensory system of the cervical (neck) and temporomandibular (jaw joint) area and the cochlear nuclei (CN), offering a physiological explanation for ST. According to these studies, cervical or temporomandibular somatosensory information is transported to the brain by neural fibres from cell bodies located in the dorsal root ganglia or the trigeminal ganglion. Some of these fibres also project to the central auditory system. This enables the somatosensory system to influence the auditory system by altering spontaneous rates or synchrony of firing among neurons in the CN, inferior colliculus or auditory cortex. In this way, the somatosensory system is able to alter the pitch or loudness of the tinnitus.

Source: BTA


Modulation of tinnitus characteristics such as pitch and loudness has been extensively described following movements of the head, neck and limbs, vertical or horizontal eye gaze, pressure on myofascial trigger points, cutaneous stimulation of the hands, electrical stimulation of the median nerve, and transcranial direct current stimulation. Modulation of tinnitus follows complex interactions between auditory and somatosensory afferents and can be favored by underlying somatic disorders. When tinnitus appears to be preceded or strictly linked to a somatic disorder, and therefore related to problems of the musculoskeletal system rather than of the ear, it is defined somatic tinnitus. A correct diagnosis and treatment of somatic disorders underlying tinnitus play a central role for a correct management of somatic tinnitus. However, the identification of somatic tinnitus may be complex in some cases. In this paper, after a general review of the current evidences for somatic tinnitus available in the literature, we present and discuss some cases of patients in which somatic modulation of tinnitus played a role–although different from case to case-in their tinnitus, describing the diagnostic and therapeutic approaches followed in each individual case and the results obtained, also highlighting unexpected findings and pitfalls that may be encountered when approaching somatic tinnitus patients.

Tinnitus can be evoked or modulated by inputs from the somato-sensory, somato-motor and visual– motor systems in some individuals. This means that the psychoacoustic attributes of tinnitus (loudness and pitch) might change-though often only temporarilyfollowing external stimuli, such as the forceful muscle contractions of head, neck and limbs, orofacial movements, eye movements in the horizontal or vertical axis, pressure on myofascial trigger points, cutaneous stimulation of the hand/fingertip region, and of the face; electrical stimulation of the median nerve and hand or finger movements. Modulation of tinnitus represents a good example of central integration in the central nervous system, following interactions between auditory and somatosensory afferents occur as early in the auditory pathways as in the cochlear nucleus, at the site of convergence of the projections from the auditory nerve and trigeminal and dorsal column ganglia and brain stem nuclei.

Somatic modulation of tinnitus may be associated to underlying somatic disorders. When tinnitus appears to be preceded or strictly linked to a somatic disorder, and therefore related to problems of the musculoskeletal system rather than of the ear, it is defined somatic tinnitus.

Source: TinnitusJournal

 

In regards to Dr. Susan Shore’s bimodal treatment: Yes, you have “somatic tinnitus”.

Yeah, that’s what I thought. Thanks for confirming.

Check the tinnitusjournal.com link above for a list of neck and jaw maneuvers you can do to find out if you have somatic tinnitus or tinnitus with a somatic component. Everybody should go through the list to find out if bimodal treatment might work for them (or at least if it has a higher chance of working).

I can easily modulate it with jaw movement, but not at all with neck movement. If I clench my teeth with earplugs in or with my head against a pillow, I even get an additional sound

 

@brokensoul

Check this.

 

I doubt that releasing tension in the jaw can make your tinnitus permanently better.

Somatic tinnitus means you can modulate your tinnitus most often with the jaw. That's because the trigeminal nerve runs to the DCN which is the first station after the cochlear. If you have cochlear damage the DCN runs havoc.

I had SSHL and my tinnitus is very somatic.

And I hope that this therapy and Lenire can help this form of tinnitus.

 

I don’t know where I got that from. Could be a misunderstanding on my side. I apologise if it’s not correct.

 

What are the details on the second trial?

The first trial had 20 participants I believe. How many participants does this trial have?

 

She believes it will also straight up help NIT folks as well. Somebody reached out to her to ask this, and she guessed that it would. She isn’t the kind of person callously/aimlessly instill hope with this kind of claim.

 

Hold up. If pressing on my tragus influences my tinnitus but jaw movements don't, does that mean i have somatic tinnitus? I just assumed it was a function of taking away sound masking by covering my auditory canal more.

 

I’m hoping that this might help calm down my reactive tinnitus before regen meds hit the market. It sure would make a vast difference in my quality of life at the moment...

After reading through her papers I feel much better about her device than Lenires.

 

Is she still thinking they might commercialize it before entering phase 3?

 

Tragus... nature’s ear plug....

Isn’t that just some cartilage...? Depending on how hard someone presses I suppose it would start to involve a whole host of head/neck muscles and then get a somatic influence.

I yawn, and go from a constant single fire alarm to about 4 fire trucks with their sirens blaring... lol.
I press my tongue to the root of my mouth, and get a higher pitch and it’s louder... except this same noise came on me unexpectedly yesterday after doing nothing but driving... I wonder where this medical malpractice will take me. :-/

 

I might be wrong but because it's a "Class II" device it only needs two phases of test in clinical trials.

 

She’s still aiming for commercialization this year but it’s doubtful considering phase 2 results will only become available this summer. Hopefully first or second Q of 2021.

 

This thing cannot come fast enough.

It really does seem the most promising of the various upcoming solutions thus far.

 

And I have only been waiting 20 years lol.

 

Just got the word from Dr. Susan Shore that it likely will help with synaptopathy and hair cell damage.

Also it doesn't has to be somatic at all.

 

Phase 2 sounds like it’s going swimmingly. Fucking needed this after the FX-322 “decade” comment.

 

Can you share the exact mail?

You mean she said that this device will likely also work if the cause of tinnitus is due to hair cell damage or synaptopathy?

I suppose that is irrelevant as she tries to suppress the auditory signal passing through the DCN.

I’m still pretty clueless as how this could actually work to suppress the tinnitus signal specifically.

 

My tinnitus is not noise induced and it's very somatic. I can even stop it by clenching my jaw. I don't think that the cause matters.

 

Given Lenire’s seemingly low responder results and hearing regeneration being years away, this is probably our best and most realistic hope for the near future.

Wouldn’t be surprised though if it would still take several years for her to complete the design and to commercialise and release it.

 

So you get silence by clenching your jaw? You lucky ***. Mine does the opposite, it becomes louder.