SaluSTIM — tVNS Therapy Device

@tVNSPatient Regarding whether tVNS might be effective without some kind of sound therapy, I asked Nathan at TTC to clarify the advice he gave to me in light of the following quotation that I found:

"Our control experiments demonstrate that VNS-directed plasticity is driven by the repeated association of VNS with tones, and not by VNS alone. " From p.104 of
http://www.utd.edu/~kilgard/EngineerKilgardNature2011.pdf

He gave me quite a lengthy reply, which clearly took some time to write. I got the impression that he believes in tVNS and is genuinely trying to help. The core of his answer was that when he advised me trying tVNS alone he was referring to potential benefits for other issues that I had mentioned to him (depression and fatigue). He also said that

"...you will not be able to get the full benefit of the combined therapy for your tinnitus (without tST or as you have mentioned- some other tonal stimulus)."

I found this clarification useful for myself as reducing the volume of my tinnitus is my primary motivation.

Yesterday I performed tVNS for two sessions of approximately an hour each. Through both sessions I listened to the first of the tone sequences very kindly provided by @Steve in a link above (thanks Steve ). I found the experience very relaxing and although there were no major changes noticeable in my tinnitus, I did feel it was possibly a bit softer afterwards (maybe placebo or just 'cos I was so relaxed). I think I might adopt these tones as my sound therapy for a while (possibly adding a notch) as the response I had to ACRN was a bit scary with hindsight.

P.S. Would love to get an update from @Dawn Whinetaker if you are around Dawn. How is it going now?

 

Well, if you need tonal stimulus, it probably needs to be custom to your particular tinnitus.

That presents a problem for various reasons, some people will not be able to pinpoint it and for some people it's so high that and kind of scooping out the frequencies is pointless. Also... are these mp3 ´s or pure wave format?

 

Yes, that's the problem I keep coming back to. When I try to pitch match, 8kHz (or sometimes 8.5) is most often where I feel it centralises. I notched Steve's first musical neuromodulation file at 8kHz earlier and did a session with that. I am probably fooling myself, but I'm getting quite a positive feeling when I use this file, despite not being able to identify a definite change in my t. Probably just relaxation 'cos I'm flat on my back for an hour getting dreamy.

My hearing drops quite a bit from 9.5kHZ up to 12 where I stop hearing anything unless it is turned up further than is probably safe. So I also added a bit of eq to those upper frequencies and tweaked the bass up a bit as well.

They are mp3 but I don't envisage that being a problem as they are discrete tones without overlap, so there should be no significant loss of information as I understand the codec.

 

If I remember correctly an mp3 will have cutoff at 16 kHz.

 

I am also not too happy about them trying to get me to rent the device without tonal stimulation.
I was not looking for a stress reliever or anything other than a device to lower tinnitus.

 

My hearing has cutoff way below that.

Yeah, that is a bit cheeky. Maybe take it up with him, see what he says?

I need to do some more looking into the Microtransponder human research to learn about the tones they used. I have a vague memory of reading something about them just using two fixed tones for anyone's tinnitus. Which if true might offer hope for your high pitched t and my hard to pin down noise. I'll check it out soon, stuff to go do now unfortunately.

Edit: Found this on a brief search, so not quite what I thought, notched tones seems the way forward:

The MicroTransponder team utilizes this natural response system by directly stimulating the vagus nerve while playing a sound, which tells the brain to “pay attention” to that sound. This simultaneous pairing of a specific tone with vagus nerve stimulation (VNS) strengthens auditory neurons representing that tone. Consistently pairing VNS with all other tones except the tinnitus tone, reduces the expanded representation of the tinnitus tone. Over time, the brain learns to ignore the tinnitus tone.
http://www.tinnitustrial.com/?page_id=100

 

Sorry, maybe I am a pessimist but I am wondering how these kind of toys could reduce the hyperactivity of neurons

 

This thread has confirmed what I already thought.

It would be good if someone could do a side by side comparison with a TENS unit and the TVNS device.

Key points:

1. This method will only work if the cause of the tinnitus is neurological (tinnitus has many causes)
2. Tinnitus feeds on your attention, anything that distracts you is likely to give you measurable symptomatic relief as long as you are not monitoring your T.
3. This treatment is speculative, if re-wiring your brain really is a solution you might be worth your time looking in to cheaper methods like meditation or stimulating the vegas nerve naturally by performing the valsalva maneuver.

In other news I have been told by a new doctor who is a Hearing Therapist on the NHS to not frequent this forum , look anything up on the internet at all and to stay away from apps and other speculative treatments. She simply advised me to relax and try some meditation exercises.

I am kind of disappointed with this but at the same time she isn't entirely wrong. The more we attend to our T the worse it gets. In the mean time she has referred me for more tests just in case it is curable which I was happy with.

 

Can you stimulate the vagus nerve with the valsalva? Did not know that, any more info on that?

 

http://www.webmd.com/heart-disease/...aneuvers-for-a-fast-heart-rate-topic-overview

Vagal maneuvers that you can try to slow your fast heart rate include:

• Gagging.
• Holding your breath and bearing down (Valsalva maneuver).
• Immersing your face in ice-cold water (diving reflex).
• Coughing.

Just put "vagus nerve valsalva maneuver" in your favourite search engine . There are also some Yoga and other videos on Youtube like this one to do with the vegus nerve and the heart.

Carotid Sinus Massage

 

I understand also that you can also achieve vagus nerve stimulation through controlled breathing, although I'm not sure how the effect compares to tVNS. It does make sense though that people are able to use mindfulness and meditation to ease their tinnitus if that's the case.

 

A quick update from me. I did about a week using Steve.'s tones notched at 8k for 2hours a day (with tVNS). At first it seemed to be helping, and the spike I'd been having settled down pretty much (maybe coincidence). Then doing the treatment seemed to start aggravating my t slightly for an hour or two after treatments. Last Saturday I woke up with my t quite calm, and was feeling fairly good. I did one two-hour session Saturday afternoon (previously was doing it in two separate sessions). After this two hour session my t was horrible, and I decided to have break for a few days. It stayed bad for a few days, but is pretty settled again now.

I do think my tinnitus is not best suited to this treatment as it is not strictly tonal and I think covers a fairly big frequency range. I'm not quite ready to give up yet however, as this treatment does seem to do something to me. I'm thinking that next I might try using some music or Steve's tones with a low-pass filter applied to perhaps remove all frequencies above 5kHz. Hopefully this would mean that I avoid stimulating any frequency where I have some tinnitus - so hopefully I would not make it worse again. Not sure whether it would improve things though. I think ideally I would be stimulating above and below my t, but I cannot identify with confidence any frequency that is definitely above all of my t activity, but that I am still able to hear properly.

Any thoughts from anyone welcome, on whether the low-pass filter might or might not be a good idea, or on anything else.

 

@dboy I was trying out using tones with a gap around my T and I felt the same thing, it spiked more. I think they feel better for me across the frequencies. I know that the research says that you remove the T tones but i'm not sure if stimulation all over is just as good. A lot depends on the personal reaction I feel.

I haven't properly looked up the reasoning behind the removal of tones or the playing of a select few either side, I'd like to look deeper though at the theory.

 

Thanks @Steve. Yes, maybe I'll try the tone sequences unmodified again soon. I just applied the low pass filter to an album of piano music that I like, so I'm gonna try that next. When I used the 'plot spectrum' function on those tracks, most of the action was below 5k anyway of course, but I put them through the filter anyway. What I noticed was that the frequencies were less evenly represented in terms of amplitude than in your musical neuromodulation files, which I suspect might make your files better.

Also, I seem to remember reading that for notched sound therapy, white noise was more effective than music. Not sure whether that also applies with tVNS.

Have you considered trying tVNS yourself? I know you have quite an interest in sound therapies. I didn't start another thread for DiY tVNS myself as you suggested because I'm currently using the Salustim, but it would be great to have more people trying this, especially after some tentative good results from @RicoS.

 

@dboy I do want to give it a go. Time is my enemy, just don't seem to have enough to try all the things I want to.

White noise is more effective, always has noise across the frequency spectrum where music changes all the time and might have nothing in certain areas for a time. But you could also use a river, rain or some other constant type of noise in the same way of it is relatively equal acros frequencies.

 

Thanks... will give these ideas a try.

 

Just a little update regarding the use of the tVNS device....You cannot use sounds created by AudioNotch. Well you of course can but they are different from the ones TinnitusTreatmentCentre gives me.

I show you an example:
This is sound/music I got from TinnitusTreatmentCetre (You see the big black bar....that is the area that is notched)


Now a track from AudioNotch:


They both target the area of my base T which is at around 3074. but you can clearly see that the AudioNotch created files notch a smaller area than the sounds created by TinnitusTreatmentCentre.
I therefor only use sounds I get from the supplier of the tVNS device. I know a lot of people try various sounds and notch them self , but to be sure that it works based on the protocols of TinnitusTreatmentCentre I will only use sounds notched by them.

It just for information to let you know that there are different ranges you can notch sounds. People who are familiar with music mixing etc would know that but I think a lot of you will not.

I will post more when I'm a couple of weeks in with the therapy!

 

What you experience is a zwicker tone https://en.wikipedia.org/wiki/Zwicker_tone
It is normal for people to experience this. I also have it when I'm using the tVNS with soundtherapy and the zwicker tone will subside after a few seconds/minutes.
It was also said to me that this probably would happen during the treatment


It is also mentioned on the AUDIONOTCH site : Some users have correctly detected their tinnitus frequency and listen at a safe volume level, and despite this, they experience an increase in the volume of their tinnitus. This may be due to a psycho-acoustic phenomena known as a "Zwicker tone".

 

Thanks @RicoS, some useful info there! I think I've experienced the Zwicker tone, although I don't think it covers the occasion my t took a few days to settle down last week. Interesting also about the notch width - that example from Audionotch does look very narrow if I interpret the info correctly! When I made notched files myself in Audacity I used the 'Band Stop' filter plug in for Audacity and went with a one octave notch - although I then applied that several times to get a slightly wider notch with steeper sides/gradients (hope that makes sense, not quite sure of the correct terminology). Should have been no sound between around 6.8kHz and 9.9kHz according to software.

I hope the treatment is still going well for you... I'm quite excited looking forward to your next update.

 

I recently got the SaluStim device. Have been using it 9 days now, I seem to have a ten percent reduction. The nasty sting is gone, it's a bit more bearable now. I have had tinnitus 19 years now. Will keep people posted, just thought this could help some people. My tinnitus is a constant noise all the time.

 

Nice one! I'm surprised there are not more people willing to try tVNS out.

My quick update: I've tried a few approaches to creating sound files and applying a low pass filter at 2.5kHz seems to be the one that doesn't spike my t at all. (To recap: notched music seems not useful for me because of the broadband, multi-tone nature of my t). I'm now using this, although unfortunately it does not seem to be helping a great deal. I feel that it maybe has a mild effect... that I have less days where tinnitus really gets to me. But that might be because I have had a lot of spikes recently and so when it is not spiking I feel relieved. There is certainly no big reduction of the order of 26dB which I vaguely remember reading to be claimed in some study or other (probably early studies for the invasive VNS approach)

A couple of weeks ago I was having a side effect. I had started to push the intensity up a bit so that it was actually hurting my ear (I guess too keen for something to happen). My t was spiking and I also had a week or so of insomnia that was not simply from the t being loud. Also, I had a buzzy, headachy feeling most of the time that might just have been from the tiredness although I am not convinced about that. It got too much, I stopped for a few days and was back to normal after two. I started again and kept the device on a lower setting with no problems since.

Sorry I cannot give more positive news. Although what I said about the side effect might put a few people off trying, please remember that I turned the intensity up further than advised and the symptoms completely went away after I stopped for two days. I have had no big decreases in volume, but sometimes now I feel it is a little bit damped down. I'm planning to keep using it until my three month rental period is up and then re-evaluate.

 

People misuse the word "spike" here whole time. For most people "spike" means louder T for hours or maybe even days even though the spike should mean what the spike actually means (louder T for couple of seconds) I'm not sure what @dboy meant there though.

One of the doctors/scientists, who have been fiddling with notched music, said that the smaller the notch is the better it should be for you T (in theory). So if you can match your T pitch exactly the smaller notch will be better since it will stimulate "healthy areas" more close to T frequency and disrupt the tonal T. The smaller notch is especially important in the higher frequencies (8k and above) because if you keep notching the music/noise for 1 octave or 0,5 octaves you end up cutting the whole upper region of the frequency range and your T will get stimulated only from the frequencys "underneath".

If you can't match T exactly, then its better to use broader notch to diminish the effect of little mismatch.

 

@Zechariah in my post #81 directly above yours I was referring to spikes lasting several days, which I attribute to using tVNS plus sound therapy without yet finding an appropriate sound therapy (considering the wide range of frequencies at which I have tinnitus activity going on).

These were not bad spikes, but the volume of my tinnitus did go up for several days. I also had a very distressing two month volume increase/spike from around mid-August to mid-October (approximately), and also another one that lasted a few days after being caught in some very windy weather while walking, so the combined effect of all these now is that when my t is its normal (still fairly horrible) self I feel kind of relieved.

I hope my use of the word spike is acceptable - I use it in the sense I see most people using it. Language is constantly evolving and difficult to pin down - it usually means what people understand it to mean. If you think people are using the terminology wrongly could you perhaps clarify/show why?

 

Well I haven't attempted to correct it because so many are using it. IHMO spike means spike which is increase in T for couple of seconds, maximum of couple of minutes (aka. zwicker tone or fleeting tinnitus).

On the other hand if T volume increases for several hours or days, I'd call it temporary increase (in volume).

But I'm just an engineer who likes to reserve the word "spike" for really short duration things

 

I would have to agree with the spike thing

 

Fair enough - the meanings of words do change with the context and I can appreciate you coming at it that way. I guess I come at this more from the humanities angle where word meanings can be more fluid/metaphorical and if people share the same understanding of a word then that is what it means (for them at least). Also, the thing about duration seems relative to me: plot a graph of tinnitus volume and any temporary tinnitus increase will look like a spike if the time axis is adjusted to a suitable scale. But I'm not arguing at all with the way the word is used in the context of your profession, just suggesting it can be used in other ways too.

What do you mean @RaZaH? You seemed to be using the word spike in your blog earlier today to indicate a volume increase of at least a few hours:

 

Yes, because it is used as such

 

OK, thanks. I guess that is kind of what I was getting at. Hope it is settling down for you anyway.

 

Yup, I understand this. Spike is tinnitus community term. And for outsiders it may be confusing. It was for me at the beginning when several days of increased T was described as "spike". This is actually one of the reason why I dislike using the term "spike" to describe increase in T volume which has lasted longer than couple of seconds/minutes.

I see your point with adjusting the time scale but that is another whole story. So it seems that my 1,5 years lasted T is just a spike

 

Yeah, at first I was like "I never get these spikes people keep going on about"