Tinnitus as a Vicious Cycle: Neuroplasticity and OCD

I know this might be controversial to some, but please hear me out. This isn't meant to downplay the fact that T causes distress, but simply another theory.

Here is what we know: Though T can start as a hearing or other ''ear'' problem, once it sets in, it rests in the brain.

Of all the things I've read on this condition (which is a lot), I've come to the conclusion that there doesn't seem to be a real correlation between Tinnitus and people's actual physical condition. For example, not all people who have hearing loss experience T, and not all who people experience T have hearing loss. Not all people who take ototoxic medication develop T, not all people who are exposed to loud noises develop T, and so on and so forth.

Most of us, at one time or another, have spent countless hours sifting through thousands of posts on here, desperately looking for concrete answers to questions like: ''Will this make my T worse?'', ''What can make my T better?'', ''Will my T go away?'', and even ''Is this T?'' or ''Am I imagining this?''. The cold hard truth always ends up being the same: Everyone's situation is different, no one can know for sure, and what has an affect on someone's T will not necessarily have an affect someone else's.

I think no one here can deny the following: The only common denominator for people with T is that people with T tend to worry about T, and the more you worry about T, the worse it gets. Yes, I understand, being as annoying as it is, having T will automatically cause you to worry about it, but let's leave the chicken vs. the egg theory aside for now.

I'm sure everyone here knows about Jastreboff's study, where he put several people in a quiet room, and 93% of them reporting hearing ''buzzing, pulsing, whistling sounds in the head or ears'' - sounds identical to those reported by tinnitus sufferers. Let's take this study and add a twist to it. Let's say everyone in the study except for one person lied and reported hearing absolutely nothing. How do you think the only person who admitted to hearing something would react after being told this information? That person would likely go home, start putting their fingers in their ears, ''listening'' for tinnitus, going to a quiet room, obsessing about it, being overly cautious around sounds, until sooner or later the tinnitus would be all they could hear.

It is at this point in my post that I would like to talk to you about Neuroplasticity. For those who are unfamiliar with neuroplasticity, it is basically the cutting edge of ''brain science'', and it refers to ''changes in neural pathways and synapses due to changes in behavior, environment, neural processes, thinking, emotions, as well as changes resulting from bodily injury. Neuroplasticity has replaced the formerly-held position that the brain is a physiologically static organ, and explores how - and in which ways - the brain changes throughout life.'' In layman's terms, this basically means that your brain is like play-d0ugh, and that in theory, your brain can change based on where your focus is. Basically, energy flows where attention goes. If we apply that to tinnitus, the more we worry, obsess, or otherwise focus on it, the more we are strengthening the ''tinnitus'' neural pathways. To me, this is pretty much the science-backed reason for why our tinnitus gets louder the more we worry about it.

At this point I am unsure if anyone is even going to read this post, so I do not want to make it longer than it already is, so I will leave you with a final point:

In my case, I have noticed that my tinnitus spikes after I am exposed to loud noises, when I don't have my fan at night, when I am ice fishing on the (very quiet) river with my tuque on, and after jamming with my ear plugs in. I am, however, starting to challenge the idea that it is those events in themselves that cause my tinnitus to spike. I am starting to think that it is because when those events occur, I start to worry about how they will affect my tinnitus, and therefore start to focus on my tinnitus and make it worse.

I think the solution lies within somehow breaking the cycle of worry/obsession about tinnitus and slowly moving away from it.

I am really interested in having a discussion on this matter. If you made it this far, Thank you so much for taking the time to read my (long) post!

 

I agree with you to an extent. However, I think there's more to play than just neuroplasticity. The electrical/chemical reactions related to the auditory system play a huge portion to it. If you can treat and fix those I don't care how "embedded" the signal is in your brain, it doesn't seem plausible that it wouldn't leave on it's own eventually. Reason I say this is because I view it like getting a cut - yes, it hurts, but unless your nerve is DAMAGED, then the pain goes away eventually. Unfortunately, for those of us with cochlea damage from pills or loud music, the cochlea remains damaged, and the signal remains.

Fix the broken cochlea, and over time it would fade. That is how it should logically play out, I think.

I imagine in the short term we'll have to use drugs like Autifony & Trobal as basically a tinnitus aspirin until that one gets solved, since it seems much more difficult.

 

This is a good point, but what do you make of the people who have tinnitus with no hearing/cochlear damage
to speak of?

 

I think at that point you have an issue with your brain unfortunately, which seems difficult to fix to me

But what do I know, I'm just a guy who reads about this stuff... just your average keyboard scientist.

 

I would challenge this assumption for the simple fact that everyone with Tinnitus has damage somewhere within the inner ear, be it cochlear damage or hair cells.
The fact of the matter is most T sufferers only get hearing tested within the speech range and I'm sure nearly all the time when it is tested above the speech frequency, up to 20,000khz, there is hearing loss!

 

Everyone without tinnitus also has damage somewhere within the inner ear. We lose 0.5% of our hair cells every year of our adult life - tinnitus or no tinnitus.

stephen nagler

 

Yes indeed, you are correct, thank you for elaborating on my point.

 

You should all watch this video:

https://archive.org/details/Redwood_Center_2011_09_21_Michael_Kilgard

For tinnitus and chronic pain they have found strong correlation between the amount of pain (tinnitus) and the amount of cortical sensory map distortion. In animals about 50% of them develop signs of tinnitus after an intense acoustic trauma. Despite the fact that hearing thresholds return back to normal (within 2 weeks) the map distortion remains (and the behavioral signs of tinnitus). So, animals with signs of tinnitus have map distortion and animals without signs of tinnitus do not have map distortion. While in both groups hearing thresholds seem to be normal.

Gregg Recanzone did some experiments with that and found: in order to drive plasticity in the brain you have to pay attention to a stimulus. Your brain start to allocate "brain real-estate" use lots of neurons to make some sense of a new stimulus. Trough selection mechanisms your brain start to select those neurons that are consistently the fastest and with the best "answer". In other words, you have learned something.

How would that work for tinnitus? Well, i guess if you have a whole bunch of neurons doing nothing because of hearing loss. The selection mechanisms will still "work". Neurons will keep trying to make new connections, despite the loss of input. Through attention, fear etc etc bad connections are also "selected". With persistent tinnitus as a result. It is like evolution in the brain (in other words, try allot of things and see what sicks). The model seems rather stupid, but it jus might be how nature works).

 

So here's something to think about (addressed to nobody in particular) ...

Since everybody who has tinnitus has hair cell damage, and since everybody who does not have tinnitus also has hair cell damage (i.e., since hair cell damage is the norm) - then why do we automatically assume that treatments directed at restoring or regenerating hair cells will be effective against tinnitus?

Another way to look at it ...

If it's snowing at the top of the mountain and somebody initiates a snowball rolling downhill, how is the fact that it is no longer snowing at the top of the mountain going to affect the snowball that has long since begun its descent?

I have no answers here. I only wish to remind everybody that tinnitus is more than a hair cell problem, which (I believe) is one of the points the OP was trying to make.

stephen nagler

 

Agree, but by no means is it only a brain problem, I think the chemical imbalance in the auditory pathways is the best theory which is why there is much hope for autifony!

 

Difficult, perhaps. Impossible, I refuse to think so.

Unfortunately I can't watch the video because I am at work, but you make a lot of important points. I can't tell whether you agree or disagree with me, but you are actually reinforcing my theory.

Like you said, your brain has learned tinnitus by paying attention to it. Yes, a lot of this is done unconsciously or uncontrollably, but if we go with what I was saying in my original post, I theorize that when we pay attention to our tinnitus by monitoring it obsessively, thinking of nothing else, thinking catastrophically about it, looking for a ''cure'', etc... , even though we are well intentioned, what we are actually doing is reinforcing the ''tinnitus'' connections and teaching the brain to focus on it.

Now, I don't claim to have the absolute fix to tinnitus, but what I do know is that:

1 - Neuroplasticity is a real thing. Our brain, even into adulthood, is an ever-changing organ that can be reprogrammed.
2 -As humans, we are blessed with the possibility to choose what we pay attention to. Paying attention to certain neural pathways will reinforce them, and not paying attention to other neural pathways will weaken them.

This means that if we begin with the conscious decision to focus on something else than our ''default setting'', although it will be extremely difficult in the beginning because of years or reinforcing ''bad'' neural pathways and not exercising ''good'' neural pathways, eventually, the ''good'' will get stronger and the ''bad'' will get weaker. It won't happen overnight, and it won't be easy, but it all starts with you making a decision. You hold the power!

Amen to that!

This is why it makes me sad to see folks on here saying they will never play music again, never go to a concert, never take an aspirin, never have a glass of wine, never go to a bar, and so on and so forth. Yes, it is good measure to protect your ears, but in reality, you would get hearing damage even by spending the rest of your days in a quiet room.

You gotta live a little!

 

A very good post, and within it the core of habituation. Neurons which fire together wire together, paying attention to your T (which is what happens when you have an emotional connection to a stimulus) mylenates the axons and dendrites of the neurons firing in a particular sequence (basically wraps a layer of insulation around them like a series of rings in the trunk of a tree) and they become more efficient at conducting that signal.

To stop paying attention to it you first need to strip it of an emotional valence. Once you don't care about your T then there is no reason for the conscious to focus upon it, it's just like the other thousands of signals hitting you pre frontal cortex. Your amygdala which attaches the "threat response" to your T does eventually get tired of the signal and stops stamping "THREAT!" on it with a big red rubber stamp when nothing untoward happens to you. Instead it reroutes it back to your Thalamus for noise cancellation. The old pathway to the conscious mind withers away due to lack of use and a new one sending your T signal back to your Thalamus connects up. To hear your T now you have to consciously listen for it which coaxes the neuronal node to open up slightly like a spring closing door. Stop listening for it and it springs shut again.

Except....when you worry about it then your conscious mind is constantly reminding your amygdala that T IS something to worry about and the signal route becomes more and more mylenated and established. No rest for the amygdala.

Even faking that you're not bothered about T will get the ball rolling, because of a process called embodied cognition your brain will adopt the belief that T is of no concern because... there are so many other brain areas (and there's lots) monitoring each other and themselves which eventually square the circle. They bring each other into line with your consciousness barking orders at them to do so. Like rowdy children, the most timid do what you order and once one acquiesces the rest tend to follow suit. The brain is bringing itself back to order so it can work as a whole like it's supposed to do.

Rowdy kid amygdala gets it from all sides from his peers and gets told to STFU and calm down like the rest of the brain.

 

I agree with you

I think so to. You have a whole bunch of neurons doing nothing other than just trying to make some meaningful connection. If you have lots and lots of neurons (because of temp. or permanent hearing loss) not really doing anything the probability of them making connections causing pathology increases (i guess). Funny thing is, the brain does not tend to change upon an extremely familiar stimulus (it is already able to give a correct and fast response, so why should it change?).

I am not sure, but I believe, once neural pathways are reinforced they are very stable (one cannot really unlearn them). For some reason I believe that habituation is just a neural network on-top. It is used to decide if a now stimulus is relevant to be continuously perceived.

I believe this is the advice chronic back pain patients get. I think it is the best advice possible, work through it. Most of the time there is no sign of any peripheral drive of the back pain. Combined with the fact that people with allot of pain have large sensory map distortions......the only way to learn the brain that it is wrong is to stay active.......seems logical to me...

 

Lets call this Top Down Management...

 

@Nic B , Let me know when you watched the video, I would like to have an open discussion about it.

@Dr. Nagler , have you seen the lecture of Mike Kilgard? If so, could you give your opinion about his view/theory?

 

I am familiar with his work at UT Dallas, but I have not seen the lecture you are talking about. Regarding the work itself (VNS, etc.), it is still too early for me to have formed an opinion one way or another.

stephen nagler

 

Wow dude, this is some next level understanding of brain function. I love it!

I truly believe the first (and hardest) step is this: ''To stop paying attention to it you first need to strip it of an emotional valence.'' In this case, a little attitude goes a LONG way. If there's one thing I've learned from the few years of reading posts on this forum, it's that the people who don't habituate are the people who have a constant negative and defeatist attitude - people who CHOOSE to believe that their situation is permanent, that it will get worse, that they will ''go crazy'' and ''won't be able to spend the rest of their lives like this''. It becomes a self fulfilling prophecy.

The bottom line is that it all starts with YOU, and this is good news because it means that even though changes aren't immediate, exactly how you pictured them, and without challenges, the power to habituate all depends on you.

Hmmm.. Maybe Dr. Nagler, Silvine, or someone who knows more about this stuff can chime in, but it was my understanding that though circuits never completely go away, they can fade to become essentially obsolete.

Let's see if I can explain this without sounding insane... Anything in the world, if not influenced by an outside source, has a natural tendency to follow the path of least resistance. This is observable in anything in nature; a river, an electrical current, an animal, etc... This means that by all comparison, we can assume that the brain works the same way.

To bring back Silvine's example, if at some point in the tinnitus signal route, the signal has an option between ''back to the amygdala to be stamped as a threat and focused on'' and ''ignore'', the signal will choose the beaten path (the path most used).

This is where I am at with my understanding on that matter. The part I haven't quite figured out yet is exactly what we can do to reinforce the ''ignore'' path and weaken the ''back to the amygdala to be stamped as a threat and focused on'' path.

If any kind of medication or psychopharmacological intervention is effective on a long term basis, I feel like it would be something that would help change our perspective on the whole thing, giving us a ''shortcut'' or a ''window'' to do the work (which we ultimately have to do either way). Something to make the brain more malleable, at least temporarily.

At the risk of losing my credibility, I think there could be value in MDMA or psychedelic assisted TRT/CBT/psychotherapy in this situation.

I will find time to watch it this weekend and get back to you!

 

The link in the post by @Sjoerd is apparently no longer working, but I found a YouTube video on Kilgard's work with neuroplasticity. Maybe it's the same one.

Harnessing Plasticity to Understand Learning...

 

It has been offline for some reason....it is a shame. Your video seems like a summary of that presentation (I will watch it tonight).

 

I just read this interesting article of Neuroplasticity:

http://articles.mercola.com/sites/articles/archive/2015/09/12/neuroplasticity.aspx

Video is interesting too:

Any thoughts to applying this to T?

 

Sound base therapies and vagus nerve stimulation have been trying to do that for decades without much success. It turns out that the sensory functions of the brain are not very plastic and it's mostly a good thing. You really don't want to change the way your auditory system works. If this happens, for example after an acoustic trauma, this so-called neuroplasticity is the reason you end up with tinnitus and/or hyperacusis.

 

This subject is fascinating, and I don't doubt much that I hear about tinnitus; however... Here's some food for discussion:

Many people have had excruciating pain in their backs or limbs for years, due to nerve impingement. The minute the nerve impingement is relieved, the pain is often GONE. Why didn't the years of supposed brain "memorization" continue to keep those people in pain?

In addition, some people have had severe tinnitus for years. One day, their jaw is put in just the right position, and bingo, tinnitus gone (some people can turn their tinnitus on and off this way). What suddenly happened to all those neurons and wirings and firings and memories that were supposedly keeping the tinnitus going?

 

Well, you're alluding to two different kinds of neuropathy in your metaphor: there are neuropathies that arise from direct compression of nerves, and neuropathies that arise from occult or insidious nerve damage. The prognosis and treatment are very different.

Though this is an area which still needs much, much study, I think it's safe to assume that tinnitus is no more homogenous than neuropathy. So, there may be cases of tinnitus from direct compression or structural problems which will resolve instantly if the physiological cause is removed... and other cases which arise from different kinds of neurological deficits which are much harder to treat, barring some kind of regenerative technology.

 

In both cases, I was referring to nerve impingement.

Anyway, is there a difference in the way the brain perceives those two signals--impingement vs damage? I thought this subject involved the brain's creating a memory in response to "hearing" a continuous tone, and subsequent locking in of the memory.

My question is this: If it's true that the brain, after "hearing" a continuous tone, hardwires it into memory, then why does the tone so easily and quickly vanish in cases where the cause is suddenly removed?

 

Perhaps there are multiple levels of not-hearing, just like there would he multiple levels of not-seeing your nose in front of your eyes.

If you take a minute to notice it, you'll see your eyes notice your nose. Beyond that, there are 2 ways of not-seeing your nose:

1) chop off the nose
2) let the mind not-see the nose.

Both have the same ultimate effect (you're not noticing your nose) but with different mechanisms. Perhaps T can be the same way: truly removed, or with the brain no longer reporting it to your attention

 

We usually don't notice any body part until it malfunctions. If my nose started flashing like a strobe light, it would take some effort to overlook it.

 

Rudolph the Reindeer overcame even this

 

Can you present evidence?

 

One concern about all this:

Any treatment or method that silences tinnitus in the brain, or encourages people to forget they have the condition as much as possible, can still leave the original source--such as damaged hair cells--vulnerable to more damage, which could reactivate the tinnitus all over again.

I know of many people who were doing so well with their T, either from lessening or habituation, that they actually, really did forget about it, only to later bring it all crashing down with sound exposure.

I'm not knocking anything that could improve T, but...

As blessed as the relief might be, wouldn't treatments that attack T at the brain level be treating a symptom that hides the vulnerability of the cause? Would this be similar to the person with a bad knee who pops aspirin and plays tennis?

 

Blujay, I see your point, and I think that the answer to your concerns lies within the fact that after a while, you will start protecting your ears to noise exposure out of habit, as opposed to because of tinnitus paranoia.

I did the same thing as anyone else at first. I tried to shelter myself from any noise, being constantly obsessed with my T. At this point, my Tinnitus hardly bothers me at all. I still play music, I still go to concerts, but one thing has changed. If now actually PREFER wearing ear protection when partaking in these activities. First, I now realize how unbelievably loud a heavy metal concert can be. I guess my ears got used to not having 120 db of distortionned guitars pumped directly in to them, and now if I don't have ear protection, I actually find it too loud. Same thing for using a grinder when I have a tiling contract or any other super loud noise on the construction site. At this point it's less about worsening my T and more about the mere fact that... it's too loud!

Try it out, you'll see.