The Bionics Institute Claim They Have Found a Way of Objectively Measuring Tinnitus

[2noist]

I fail to understand how objectively measuring tinnitus has anything to do w/ helping people w/ this problem. It's like saying you know the road you have to walk on has now been objectively measured, and it's exactly 10 miles long. That doesn't help you on your long walk at all.

Maybe you should educate yourself. It's not about helping YOU on the spot, it's about helping researchers to find a cure and eventually helping you. Currently they only have access to subjective measurements which are very much prone to the placebo effect - and ruining clinical trials...

Objectifying Tinnitus - The Bionics Institute

 

[Nick47]

I fail to understand how objectively measuring tinnitus has anything to do w/ helping people w/ this problem

@momus, it's absolutely critical!

1) The placebo group response in tinnitus is usually high and very subjective. By having and objective measure, the placebo response can be actually measured and would be much smaller.

2) Companies and investors are wary of 1) and therefore not keen to develop treatments, so less R & D.

3) Individual clinicians can accurately measure how you respond to treatments already available, that work for some people (Clonazepam, Gabapentin, Cyclobenzaprine, Amitriptyline, Deanxit, tDCS or cocktails) and monitor these treatments.

Like blood pressure, diabetes, eye tests etc, they still have a placebo group, but with objective measurements the responses to treatment and placebo can be objectively measured.

 

[Joeseph Stope]

I'd go one step further. An objective measure of tinnitus is like a way of "seeing" tinnitus. The cochlea, the auditory system and the brain by their nature, don't lend themselves to easy viewing. They are quite inaccessible.

Up till this the only way of "seeing" tinnitus was by sacrificing the patient and then viewing his extracted cochlea, dissecting it and viewing the state of the inner/outer hair cells, stereocilia and synapses.

Oh wait. I believe that Frequency Therapeutics had some method of using the discarded cochlea from cochlear implant operations...

But all this is kind of awkward and unwieldy.

However, this presupposes that the cause (or that the main cause?) of tinnitus lies in the cochlea. There is evidence that for some patients it might be elsewhere: the brain, the nerves, the jaw etc.

A proof of the existence of tinnitus would also be instrumental in compensation and or disability claims, workplace safety etc.

 

[UKBloke]

I fail to understand how objectively measuring tinnitus has anything to do w/ helping people w/ this problem. It's like saying you know the road you have to walk on has now been objectively measured, and it's exactly 10 miles long. That doesn't help you on your long walk at all.

Firstly, your road metaphor is completely fallacious. Objective measurement has nothing to do with the length of the walk we're all on. If anything, it's more a metric for the sensation (or pain) that the walk along that road is causing us.

Secondly, having an objective measurement for that sensation, flushes out the vermin (including some in academia troublingly) that try and sell cure-alls to alleviate it.

Specifically where tinnitus is concerned, an objective measurement also holds well-funded professors and 'experts' of tinnitus to account. Absent the gauntlet of an objective method to validate their work, these are the people who've enjoyed too much of an easy ride over the years, and quite frankly an objective measurement will finally hold their feet to the fire and ensure they either shit or get off the pot.

Does all this help us sufferers in the short term? Probably not. But that's not the point here. We have a responsibility to encourage and support the kind of parallel research that will hopefully pave the way for future generations to have access to verified treatments (if not cures). Isn't that the 'zen' thing to do?

 

[Nick47]

I'd go one step further. An objective measure of tinnitus is like a way of "seeing" tinnitus. The cochlea, the auditory system and the brain by their nature, don't lend themselves to easy viewing. They are quite inaccessible.

Up till this the only way of "seeing" tinnitus was by sacrificing the patient and then viewing his extracted cochlea, dissecting it and viewing the state of the inner/outer hair cells, stereocilia and synapses.

Oh wait. I believe that Frequency Therapeutics had some method of using the discarded cochlea from cochlear implant operations...

@Joeseph Stope, but why would you want to see the cochlear when that's not where tinnitus is generated. In most cases hearing loss in the cochlear is what 'can' trigger tinnitus, however it's not present there. All you would achieve is seeing the physiological state of the cochlear. You would need to look into the dorsal cochlear nucleus and the ascending networks to objectively see it.

You could look at someone's identical cochlear who didn't have tinnitus. Without the brain there is no sound perceived.

 

[Nick47]

Secondly, having an objective measurement for that sensation, flushes out the vermin (including some in academia troublingly) that try and sell cure-alls to alleviate it.

Specifically where tinnitus is concerned, an objective measurement also holds well-funded professors and 'experts' of tinnitus to account. Absent the gauntlet of an objective method to validate their work, these are the people who've enjoyed too much of an easy ride over the years, and quite frankly an objective measurement will finally hold their feet to the fire and ensure they either shit or get off the pot.

@UKBloke, I couldn't agree more. These scumbags look to profit off the desperate and needy and this would eliminate them, or most of them. Some of the worst are in the clinics calling themselves tinnitus experts, which in most cases they are not.

It's like someone who can not reduce a single diabetic patient's blood glucose levels calling themselves a diabetic expert. Poppy cock. Jastreboff has made a living off this absolute poppy cock.

Also, in theory, we may see treatments such as XEN1101 or similar being trialled for tinnitus with an objective measure.

The sooner we have these objective tests, the better. It is probably the most important research in tinnitus outside of the Shore Lab in Michigan.

Other than some pot shots in Pimozide and SAGE-547, the short term is really defined by the above.

Longer term, in many cases MUCH longer, equally or more promising treatments lie with hearing regeneration and invasive implants.

 

[DimLeb]

but why would you want to see the cochlear when that's not where tinnitus is generated. In most cases hearing loss in the cochlear is what 'can' trigger tinnitus, however it's not present there. All you would achieve is seeing the physiological state of the cochlear. You would need to look into the dorsal cochlear nucleus and the ascending networks to objectively see it.

You could look at someone's identical cochlear who didn't have tinnitus. Without the brain there is no sound perceived.

I think there is no researcher, doctor or any scientist in the field who has figured out where tinnitus is generated. There are theories of course, but they are not on solid ground yet. It's not pointless for the research to inspect the cochlea as well, since it does play a part in various pathologies that lead to tinnitus.

I've read, for example, that acoustic trauma can cause abnormal hydrops in the liquid of the cochlea so you may get an atypical form of cochlear hydrops which of course can stay mysterious and unexplained for years and years. There may also be idiopathic hydrops that cause tinnitus and slight hearing loss. Or straight up Meniere's or whatever.

The research needs to investigate the relationship between the cochlea and the brain, because it's all one big system. If it's all in the brain and they can treat tinnitus through the brain, that's great. But I believe if the ear is degenerating for any reason (from outside or inside) over time, then any tinnitus treatment would be at best temporary. Could be totally wrong, but that's my opinion.

 

[Nick47]

I think there is no researcher, doctor or any scientist in the field who has figured out where tinnitus is generated. There are theories of course, but they are not on solid ground yet. It's not pointless for the research to inspect the cochlea as well, since it does play a part in various pathologies that lead to tinnitus.

I've read, for example, that acoustic trauma can cause abnormal hydrops in the liquid of the cochlea so you may get an atypical form of cochlear hydrops which of course can stay mysterious and unexplained for years and years. There may also be idiopathic hydrops that cause tinnitus and slight hearing loss. Or straight up Meniere's or whatever.

The research needs to investigate the relationship between the cochlea and the brain, because it's all one big system. If it's all in the brain and they can treat tinnitus through the brain, that's great. But I believe if the ear is degenerating for any reason (from outside or inside) over time, then any tinnitus treatment would be at best temporary. Could be totally wrong, but that's my opinion.

@DimLeb, do you not buy into the findings from the Shore Lab or the successful trial results from those findings?

Yes, I've also read the same as you regarding loud noise exposure causing temporary hydrops. It was an animal study, wasn't it? My point really is that sound can only be processed in the brain from the signals it gets or doesn't get. I suppose it's a case of whether we accept Shore's et. al. work as evidence or theory. You can probably tell I accept it as evidence but I didn't until a treatment based on those findings produced positive results in human clinical trials. From that point I moved from a theory with some findings to evidence.

Now the objective fMRI is measuring the knock on activity as the tinnitus goes from the DCN to the IC to the Auditory Cortex, Thalamus, Frontal Lobe and everywhere else it goes.

I have to say, with my tinnitus being highly sound reactive, I perceive it always as coming from my middle/inner ear, but that's just my perception and I also get the ear drum spasms and vibrations.

 

[UKBloke]

It is probably the most important research in tinnitus outside of the Shore Lab in Michigan.

Agreed.

 

[DimLeb]

@DimLeb, do you not buy into the findings from the Shore Lab or the successful trial results from those findings?

Yes, I've also read the same as you regarding loud noise exposure causing temporary hydrops. It was an animal study, wasn't it? My point really is that sound can only be processed in the brain from the signals it gets or doesn't get. I suppose it's a case of whether we accept Shore's et. al. work as evidence or theory. You can probably tell I accept it as evidence but I didn't until a treatment based on those findings produced positive results in human clinical trials. From that point I moved from a theory with some findings to evidence.

Now the objective fMRI is measuring the knock on activity as the tinnitus goes from the DCN to the IC to the Auditory Cortex, Thalamus, Frontal Lobe and everywhere else it goes.

I have to say, with my tinnitus being highly sound reactive, I perceive it always as coming from my middle/inner ear, but that's just my perception and I also get the ear drum spasms and vibrations.

Yes, I do buy into the findings. But the treatment is very early in its course and not many conclusions can be drawn yet. Until it happens in the real world, I consider it a theory with some evidence in my mind. There is tinnitus from all kinds of causes and things get only more complicated due to absence of objective measurement and diagnosis. For example, in my case, I heard at least 3 different reasons why I got tinnitus from doctors.

Is there only one tinnitus that can be treated with only one treatment regardless of the disease? Are there many kinds of tinnitus based on the disease (which we need to identify first) that require different treatments? Is it a mixture of both instances? Could tinnitus from Meniere's, for example, be treated with Dr. Shore's device? Until we answer questions like this, it all is very uncertain.

Otherwise, I pray (wish really hard tbh because I don't believe in gods or so) every day that Dr. Shore's device will work for most, if not all, tinnitus there is. It would be just great if it is all the DCN and also drugs like XEN1101 etc will work as well.

I just think the ear itself is important too, because there is also TTTS, ear spasms (I have them too to a degree), distortions, dysacusis etc which are nasty on their own.

 

[ZFire]

I'll be frank, this is the only thing in the field of tinnitus research that holds the utmost significance for me, yes, even more so than Dr. Shore's device. Objective measurements for tinnitus will be a major breakthrough if it ever comes to fruition.

These attempts at trying to solve tinnitus in the dark and hoping something will stick is getting quite tiresome to see. How much longer must we persist in this manner?

 

[Nick47]

I'll be frank, this is the only thing in the field of tinnitus research that holds the utmost significance for me, yes, even more so than Dr. Shore's device. Objective measurements for tinnitus will be a major breakthrough if it ever comes to fruition.

I agree. Updates on this seem lacking. There is no timeline that they are working towards either. In a video they said they wanted to use it with existing treatments in clinical trials.

 

[GregCA]

These attempts at trying to solve tinnitus in the dark and hoping something will stick is getting quite tiresome to see. How much longer must we persist in this manner?

Until we find a better way?

I'm quite happy that we are not waiting for objective measurement before we deepen our research and knowledge. The perfect is the enemy of the good. It'll be great when we have the ability to have an objective measure for tinnitus, but I'm grateful for the stuff we are doing until then. Lots of major discoveries in science have come from "shots in the dark", or unexpected outcomes.

If anything, I'm kind of sad that we don't have more experimentation going on. The funding for T research is quite small.

 

[ZFire]

I'm quite happy that we are not waiting for objective measurement before we deepen our research and knowledge

I'm not happy because we keep having to depend on subjective and unreliable self reporting measures to assess treatments which has gotten us literally nowhere.

We're trapped in this frustrating perpetual cycle of disappointment with each new 'promising' tinnitus treatment that comes our way. When you look at Research News threads from years ago, it's just depressing seeing the initial hopefulness in some people, only for the despair to set in once it turns out to be another letdown. The cycle will repeat itself. We can break out this cycle of repeated disappointment and failure by introducing objective measurements. That will allow us to swiftly eliminate ineffective treatments. Separate the pretenders (who are out to make a quick buck) from the genuine contenders in a timely and orderly fashion.

lots of major discoveries in science have come from "shots in the dark", or unexpected outcomes.

It's the year 2023 and we still have nothing to show for. These researchers still can't even come up with a universally agreed-upon definition for tinnitus. Instead, they give us silly terms like 'tinnitus disorder'. It's almost as if they are surrendering and are attempting to shift tinnitus towards the realm of psychology.

 

[UKBloke]

I'm not happy because we keep having to depend on subjective and unreliable self reporting measures to assess treatments which has gotten us literally nowhere.

We're trapped in this frustrating perpetual cycle of disappointment with each new 'promising' tinnitus treatment that comes our way. When you look at Research News threads from years ago, it's just depressing seeing the initial hopefulness in some people, only for the despair to set in once it turns out to be another letdown. The cycle will repeat itself. We can break out this cycle of repeated disappointment and failure by introducing objective measurements. That will allow us to swiftly eliminate ineffective treatments. Separate the pretenders (who are out to make a quick buck) from the genuine contenders in a timely and orderly fashion.

It's the year 2023 and we still have nothing to show for. These researchers still can't even come up with a universally agreed-upon definition for tinnitus. Instead, they give us silly terms like 'tinnitus disorder'. It's almost as if they are surrendering and are attempting to shift tinnitus towards the realm of psychology.

I think another issue with tinnitus research where there's an absence of objective measurement for the condition is that it also appears to have become dogmatic. I think this is particularly problematic for those early on in their research years as it's tending to perpetuate the situation.

 

[tpj]

I'm not happy because we keep having to depend on subjective and unreliable self reporting measures to assess treatments which has gotten us literally nowhere.

We're trapped in this frustrating perpetual cycle of disappointment with each new 'promising' tinnitus treatment that comes our way. When you look at Research News threads from years ago, it's just depressing seeing the initial hopefulness in some people, only for the despair to set in once it turns out to be another letdown. The cycle will repeat itself. We can break out this cycle of repeated disappointment and failure by introducing objective measurements. That will allow us to swiftly eliminate ineffective treatments. Separate the pretenders (who are out to make a quick buck) from the genuine contenders in a timely and orderly fashion.

It's the year 2023 and we still have nothing to show for. These researchers still can't even come up with a universally agreed-upon definition for tinnitus. Instead, they give us silly terms like 'tinnitus disorder'. It's almost as if they are surrendering and are attempting to shift tinnitus towards the realm of psychology.

I understand your frustration @ZFire but it seems like as with anything to do with tinnitus, getting an objective measurement is such a slow and drawn out process.

 

[Joeseph Stope]

I'm not happy because we keep having to depend on subjective and unreliable self reporting measures to assess treatments which has gotten us literally nowhere.

We're trapped in this frustrating perpetual cycle of disappointment with each new 'promising' tinnitus treatment that comes our way. When you look at Research News threads from years ago, it's just depressing seeing the initial hopefulness in some people, only for the despair to set in once it turns out to be another letdown. The cycle will repeat itself. We can break out this cycle of repeated disappointment and failure by introducing objective measurements. That will allow us to swiftly eliminate ineffective treatments. Separate the pretenders (who are out to make a quick buck) from the genuine contenders in a timely and orderly fashion.

It's the year 2023 and we still have nothing to show for. These researchers still can't even come up with a universally agreed-upon definition for tinnitus. Instead, they give us silly terms like 'tinnitus disorder'. It's almost as if they are surrendering and are attempting to shift tinnitus towards the realm of psychology.

I'm mightily cheered to see the plethora of different studies going on in the pursuit of a cure. I can recall the days where there was pretty much diddly squat going on and if there was, with no internet you never heard much about it.

But the pursuit of a cheap, convenient, non-invasive, objective measure of tinnitus has me very excited, even though it seems years, or maybe a decade, away. Just think of the effect this will have on all the other tinnitus research efforts. If they are bull, they will be dispatched pretty quick and the research money can be concentrated on the the therapy/cures that are shown to be promising.

MyTwoCents.

 

[ZFire]

I understand your frustration @ZFire but it seems like as with anything to do with tinnitus, getting an objective measurement is such a slow and drawn out process.

Yeah, I totally get what you mean. It's like everything about tinnitus moves at a snail's pace.

I think another issue with tinnitus research where there's an absence of objective measurement for the condition is that it also appears to have become dogmatic. I think this is particularly problematic for those early on in their research years as it's tending to perpetuate the situation.

Like you, I just want to see more accountability. The sooner we can objectively measure the results of different tinnitus research projects, the more effectively we can evaluate their outcomes and hold them accountable.

 

[Nick47]

Multimodal assessment of tinnitus using functional near-infrared spectroscopy and psychophysiological measures

Objective: To use a multimodal approach to classify individuals with tinnitus from controls, and individuals with mild versus severe tinnitus.

Design: We have previously shown feasibility of a non-invasive imaging technique called functional near-infrared spectroscopy (fNIRS) to detect tinnitus-related changes in cortical activity and classify individuals with tinnitus from controls, as well as individuals with mild versus severe tinnitus. In this study we have used a multimodal approach by recording heart rate, heart rate variability and skin conductance, in addition to fNIRS signals, from individuals with tinnitus and controls.

Study sample: Twenty-seven participants with tinnitus and 21 controls were recruited.

Results: Our findings show, addition of heart rate measures can improve accuracy of classifying tinnitus severity, in particular loudness as rated subjectively. The f1-score, a measure of classification accuracy, increased from 0.73 to 0.86 when using a support vector machine classifier for differentiating low versus high tinnitus loudness.

Conclusions: Subjective tinnitus is a condition that can only be described by the individual experiencing it, as there are currently no objective measures to determine tinnitus presence and severity, or assess the effectiveness of treatments. Objective measurement of tinnitus is a critical step in developing reliable treatments for this debilitating condition.

 

[RBajaj]

Is there no way to visualize the cochlea "in action", i.e. hair cells moving etc. with today's technology?

 

[DebInAustralia]

Update:

The Bionics Institute are extending their algorithms to include a trial at an unnamed audiology practice.

More updates to come apparently, as per Dr. Mehrnaz Shoushtarian.

 

[Nick47]

Update:

The Bionics Institute are extending their algorithms to include a trial at an unnamed audiology practice.

More updates to come apparently, as per Dr. Mehrnaz Shoushtarian.

Thanks @DebInAustralia.

Looks like they may be testing it with some sort of pre-existing treatment that works for some patients.

 

[DebInAustralia]

Update:

The Governor of Victoria is hosting an event for the Bionics Institute on July 2 to celebrate 45 years since the first cochlear implant. The Bionics Institute has invited me, but I am waiting for an official invite from the Governor of Victoria since they are hosting.

Once my invite is confirmed, for those who are interested, post your questions here, and I will endeavor to get some answers.

 

[Joeseph Stope]

Update:

The Governor of Victoria is hosting an event for the Bionics Institute on July 2 to celebrate 45 years since the first cochlear implant. The Bionics Institute has invited me, but I am waiting for an official invite from the Governor of Victoria since they are hosting.

Once my invite is confirmed, for those who are interested, post your questions here, and I will endeavor to get some answers.

My, my, Deb. Meeting with the Governor of Victoria. You are hobnobbing with the great and the good in the corridors of Power, and that can only be a good thing.

To my layman's question:

As I understand it the drug discovery and testing process is time consuming and expensive. It runs as follows.

1. Some scientist or ENT discovers or gets a hunch about some molecule.
2. They test it in a petri dish, test tube, etc.
3. They make some graphic design on the computer of the molecule so as to theorize how it interacts and "does its stuff."
4. They conduct animal tests.
5. If it's safe enough, they conduct human tests on young, healthy subjects.
6. No dead bodies? No adverse reactions? They do their tests on patients. The larger the samples, the safer the conclusions.
7. Correct me here: they do tests on the efficacy of the new pharmaceutical.
8. If it's as good as or better than what's available, it gets to the marketing stage, and we get it once our ENT has heard about it. (ENTs appear to be most influenced by their peer ENTS rather than the marketing men.)

So all this costs time, time, time, and money, money, money.

Question: Will this objective measure of tinnitus cut out all the testing? Will it measure how loud the subjective tinnitus is? Will it open the door to a treatment for hyperacusis?

You don't know? No bother. I'm used to disappointment at this stage.

 

[Nick47]

UPDATE: The Bionics Institute have used cochlear implant patients with the device turned OFF & ON to measure brain cortical responses.

Main results: Changes in subjective ratings of loudness were significantly correlated with changes in node strength, averaged across occipital channels (r=-0.65, p=0.01). Changes in both loudness and annoyance were significantly correlated with changes in diversity coefficient averaged across all channels (r=-0.79,p<0.001 and r=-0.86,p<0.001). More distributed connectivity with the implant on, compared to implant off, was associated with a reduction in tinnitus loudness and annoyance.

Significance: A better understanding of neural mechanisms underlying tinnitus suppression with cochlear implant use, could lead to their application as a tinnitus treatment and pave the way for effective use of other less invasive stimulation based treatments.

→ Cochlear implant induced changes in cortical networks associated with tinnitus severity

 

[Joeseph Stope]

So, if I understand correctly: The subjects would hear nothing if the cochlear implant device was turned off—meaning they would be deaf and could only hear the tinnitus. Measurements were then taken of the dorsal cochlear nucleus in the brain, as well as the neural networks. After that, the process was repeated with the cochlear implant device turned on, and the results were compared. Do I have that right?

 

[Nick47]

So, if I understand correctly: The subjects would hear nothing if the cochlear implant device was turned off—meaning they would be deaf and could only hear the tinnitus. Measurements were then taken of the dorsal cochlear nucleus in the brain, as well as the neural networks. After that, the process was repeated with the cochlear implant device turned on, and the results were compared. Do I have that right?

Not from the DCN, but from higher levels of the brain using a device that measures tinnitus activity.

 

[Joeseph Stope]

Not from the DCN, but from higher levels of the brain using a device that measures tinnitus activity.

Thank you.

 

[Nick47]

So, if I understand correctly: The subjects would hear nothing if the cochlear implant device was turned off—meaning they would be deaf and could only hear the tinnitus. Measurements were then taken of the dorsal cochlear nucleus in the brain, as well as the neural networks. After that, the process was repeated with the cochlear implant device turned on, and the results were compared. Do I have that right?

Here is a simplified write up of the findings.

→ New publication shows Bionics Institute researchers can objectively measure tinnitus changes in individuals

This is what @DebInAustralia alluded to in January of this year.

 

[UKBloke]

Here is a simplified write up of the findings.

→ New publication shows Bionics Institute researchers can objectively measure tinnitus changes in individuals

This is what @DebInAustralia alluded to in January of this year.

Thanks for the update; it looks quite encouraging.

"Firstly, it provides definitive evidence that the tinnitus diagnostic tool developed by our researchers can detect changes in tinnitus severity"

I wonder if this opens up further avenues to measure "reactive tinnitus"?

"our upcoming clinical trials of emerging treatments in collaboration with clinician researchers"

It's great they're now seemingly at the point of using this tool to measure treatment efficacy. I wonder what these "emerging treatments" are?