Tinnitus Models — Learn How Tinnitus Originates

[Hazel]

Where does tinnitus come from?
Most of you might know that the triggers for tinnitus lie in both the ear and the brain, and that hearing loss is one of the causes. But what are the exact mechanisms at play? Well, there's no one answer to that question, but we will try to give you the lay of the land.

How can you learn more?
Attached is the first version of a brochure that we worked on for the better part of 2021. In essence, the content provides you with an overview of the main current theories on how and where tinnitus originates.

Who is this for?
The aim is to provide you with a deeper dive than the currently available lay resources on this topic, which tend to be 'dumbed down' significantly. At the same time, we want to save you the effort of going 'down the rabbit hole' and spending dozens of hours reading tough academic papers (unless you want to do that of course ). The target audience is therefore curious lay people with a keen interest in the science behind tinnitus.

Who created this?
The content was created by two neuroscience PhD students, Tori and Kate (full accreditations below). We cannot stress enough how awesome these two people are for giving so much of their free time to this project! I (@Hazel) worked closely with them throughout the process. Our Patient Expert Panel, consisting of five knowledgeable and respected Tinnitus Talk members, provided feedback on the draft content. Finally, the content was validated by two senior tinnitus researchers.

Content Creators:

• Tori Kok - PhD student, University College London, Ear Institute, funded by National Institute for Health Research, Biomedical Research Centre (NIHR BRC)
• Kate Yukhnovich - PhD student, Newcastle University, funded by RNID and the Masonic Charitable Foundation

Content Validators:

• Professor Raj Shekhawat, Flinders University
• Dr Will Sedley, Newcastle University

Is the content 100% final?
No. However much time you put into a resource like this, once it's published, we expect some of you will tell us about parts that are unclear, confusing, incomplete, or even incorrect. So, we will improve based on your feedback — please tell us what you think down below!

What else are we planning?
In future, we want Tinnitus Talk to be more than a forum. We aim to provide more educational resources, and house them on a separate section of the site. This will also allow us to use different formats, styles, and interactive tools to make the content more accessible and engaging.

 

[Johan001]

Wow, this looks really good.

 

[Stacken77]

I think this is very interesting, especially when they compare different theories with patients who's seen improvements after having the auditory nerve(s) sectioned. I know that auditory nerve section has been discussed on the forum a few times, but I don't think I've ever seen a user on here who's gone through with it and reported anything back.

 

[ZFire]

Thanks for this brochure. It was well written and the format is nicely designed. The researchers do a great job not overcomplicating the tinnitus research and proposed theories. Makes it easy to follow for dummies like me.

The more I think about it, the more I do feel like tinnitus may be more related with the networks in the brain than what was initially thought. When I'm going to sleep and I'm in that state where I'm barely conscious and about to fall asleep, I swear... it feels like my tinnitus is completely gone in that moment until I fully regain consciousness and then thats when the tinnitus starts to pick up again. I wonder what that could all mean...

 

[LGuapo]

This is great. Thank you to the authors and contributors.

 

[Nobody19]

This is awesome, I hope something similar can be done for hyperacusis and TTTS.

 

[dd314]

Not addressed: Why cutting the ear nerve stopped tinnitus in half the patient population.

1: Cochlear nerve section for intractable tinnitus — (144/151 resolved)

2: Partial or total eighth nerve section in the treatment of vertigo — (80% resolved)

3: The effect of vestibular nerve section upon tinnitus — 6% to 61% resolved (mean 37.2%, standard deviation 15.2)

4: Selective cochlear neurectomy for debilitating tinnitus — (45% to 76%)

 

[Hazel]

Not addressed: Why cutting the ear nerve stopped tinnitus in half the patient population.

1: Cochlear nerve section for intractable tinnitus — (144/151 resolved)

2: Partial or total eighth nerve section in the treatment of vertigo — (80% resolved)

3: The effect of vestibular nerve section upon tinnitus — 6% to 61% resolved (mean 37.2%, standard deviation 15.2)

4: Selective cochlear neurectomy for debilitating tinnitus — (45% to 76%)

Thanks for the useful overview! Are you suggesting we add this in somehow? I feel like it would be a bit of a sidetrack to our main purpose of providing an overview of theories on how tinnitus originates. But perhaps I misunderstand your intention...

 

[dd314]

Thanks for the useful overview! Are you suggesting we add this in somehow? I feel like it would be a bit of a sidetrack to our main purpose of providing an overview of theories on how tinnitus originates. But perhaps I misunderstand your intention...

I don't know what I'm suggesting. Bu it means it wasn't "in the brain" for these patients. It was literally an action potential along a nerve fiber.

 

[star-affinity]

Thanks for this brochure. It was well written and the format is nicely designed. The researchers do a great job not overcomplicating the tinnitus research and proposed theories. Makes it easy to follow for dummies like me.

The more I think about it, the more I do feel like tinnitus may be more related with the networks in the brain than what was initially thought. When I'm going to sleep and I'm in that state where I'm barely conscious and about to fall asleep, I swear... it feels like my tinnitus is completely gone in that moment until I fully regain consciousness and then thats when the tinnitus starts to pick up again. I wonder what that could all mean...

I think it means the auditory system enters a different state when we are about to fall asleep and a some sound perception in the consciousness is "turned off" or lowered. Not sure I think it necessarily means tinnitus is only a brain problem. If trying to be conscious about it I think you would perceive external sounds as "fading out" when falling asleep too, no?

 

[Hazel]

I don't know what I'm suggesting. Bu it means it wasn't "in the brain" for these patients. It was literally an action potential along a nerve fiber.

Ah, I see. However, if auditory nerve section resolves tinnitus this doesn't necessarily prove that it's not "in the brain". It only proves that the trigger for tinnitus lies in the auditory nerve signals, and when you stop those signals completely the brain will stop creating phantom sounds. It's similar to how cutting off a river upstream will cause water to stop flowing miles downstream. Or another analogy would be stopping a chain reaction by removing the first link in the chain. But if your point is that an intervention at 'input' level can resolve the 'output' of tinnitus, for some patients, then yes you are correct

Also, did you see this table in our brochure? It explicitly covers the topic of auditory nerve section:

 

[OptimusPrimed]

Thank you all for taking the time to do this.

 

[AfroSnowman]

Thank you. This is a really great resource and I think it a good use of Tinnitus Talk resources to help develop materials like this. I just wish there was something I could do with with the information other than just understand my condition better.

Maybe 2022 will be the year we get a legit treatment.

 

[star-affinity]

On page 3 of the PDF I get a bit confused at the place marked up in the attached screenshot. "Of the" two times and where do I go after "...sound signal also crosses over to the"?

 

[Gb3]

Not addressed: Why cutting the ear nerve stopped tinnitus in half the patient population.

1: Cochlear nerve section for intractable tinnitus — (144/151 resolved)

2: Partial or total eighth nerve section in the treatment of vertigo — (80% resolved)

3: The effect of vestibular nerve section upon tinnitus — 6% to 61% resolved (mean 37.2%, standard deviation 15.2)

4: Selective cochlear neurectomy for debilitating tinnitus — (45% to 76%)

Are these even an option?

 

[dd314]

Are these even an option?

It's not about the option, it's about where the signal is coming from. And yes, it's an option for unilateral tinnitus -- if you're into gambling. But as @Hazel pointed out, they did cover that in the table.

 

[Hazel]

On page 3 of the PDF I get a bit confused at the place marked up in the attached screenshot. "Of the" two times and where do I go after "...sound signal also crosses over to the"?

That looks like a piece of the sentence is missing or something. Good catch! We'll fix it in the next version

 

[Gb3]

It's not about the option, it's about where the signal is coming from. And yes, it's an option for unilateral tinnitus -- if you're into gambling. But as @Hazel pointed out, they did cover that in the table.

I don't believe it is a procedure that is performed at this time. Am I missing something?

 

[dd314]

Ah, I see. However, if auditory nerve section resolves tinnitus this doesn't necessarily prove that it's not "in the brain".

Then why doesn't bringing someone into a negative decibel room do the same? At that point the only auditory input is breathing.

 

[Stacken77]

Then why doesn't bringing someone into a negative decibel room do the same? At that point the only auditory input is breathing.

If I'm not mistaken, there are numerous studies that indicate that sound deprivation do induce phantom sound, especially in the attenuated frequency range.

I'm not questioning the authenticity of the referenced studies, but if auditory nerve section actually do work for a significant proportion of the tinnitus population, it would be a viable treatment now, which it isn't.

Still think the procedure is very interesting, and I'd love to see if anyone on here has done it.

 

[dd314]

If I'm not mistaken, there are numerous studies that indicate that sound deprivation do induce phantom sound

I've had earwax removal take 70% of the volume away. It almost certainly has to do with the domain of awareness; I don't believe it it actually generates tinnitus but reveals it.

 

[hanks]

Who is this for?
The aim is to provide you with a deeper dive than the currently available lay resources on this topic, which tend to be 'dumbed down' significantly. At the same time, we want to save you the effort of going 'down the rabbit hole' and spending dozens of hours reading tough academic papers (unless you want to do that of course ). The target audience is therefore curious lay people with a keen interest in the science behind tinnitus.

I didn't read the document yet, but you pinpoint a point that seems extremely important about online resources.

I'm pretty sure that support communities have very positive aspects, but the information is often incomplete, fragmented, scattered, not sourced, subjective, biased.

And as you say, it often demands a lot of time and effort to get qualitative information. The latter also sometimes is "medical gibberish" (I tried to read some serious medical articles; no way I'm understanding anything in here...), and I hope your document will achieve this: a clear but in-depth explanation about tinnitus that led to a better understanding (and understanding leads, in some way, sometimes in acceptance).

I'll come back after reading it...

 

[Gb3]

Do they still perform auditory nerve sections for tinnitus?

 

[OptimusPrimed]

Do they still perform auditory nerve sections for tinnitus?

Maybe. In the Netherlands you can get a CI for tinnitus.

 

[Gb3]

Maybe. In the Netherlands you can get a CI for tinnitus.

Does your hearing loss have to be severe?

 

[AndrewDavid]

This is good but still not enough detail. Love the frequency ranges. But where is the cilia mapping? We need to break this down as far as possible.

Organ donors apply, further the cause.

 

[Hazel]

This is good but still not enough detail. Love the frequency ranges. But where is the cilia mapping? We need to break this down as far as possible.

Are you volunteering to flesh this out further?

 

[Greg Sacramento]

"When tinnitus appears to be preceded or strictly linked to an underlying somatic disorder and therefore related to problems of the musculoskeletal system rather than of the ear, the term "somatic tinnitus" or "somatosensory tinnitus" has been proposed."
Somatosensory tinnitus: Current evidence and future perspectives
​

There are two forms of tinnitus. One is of the ear and the other is somatic which happens to be for 30% with tinnitus. There are over a thousand cases where a somatic physical problem has been solved, and the somatic type tinnitus has gone away. A patient had severe tinnitus for years, and within 20 minutes of Sternocleidomastoid treatment the tinnitus immediately resolved.

With all forms of tinnitus, the somatosensory system consists of the two main paired pathways that take somatosensory information up to the brain: the medial lemniscal or posterior pathway, and the spinothalamic or anterolateral pathway. The somatosensory pathways are made up of a relay of four neurons.

What else are we planning?

In future, we want Tinnitus Talk to be more than a forum. We aim to provide more educational resources, and house them on a separate section of the site. This will also allow us to use different formats, styles, and interactive tools to make the content more accessible and engaging.

This would be helpful to group classify between somatic and hearing loss tinnitus or crossover of both. Also, most that develop pulsatile tinnitus already have either hearing loss or somatic tinnitus; high blood pressure and stress are the largest contributors.

 

[UKBloke]

Hi @Hazel, dunno if this has been raised or not but just noticed a typo on the contents page.

P.S. this is a brilliant document.

 

[Harder Calm]

New paper: "The blinking eye as a window into tinnitus: A new animal model of tinnitus in the macaque".

Notably the authors list includes Josef Rauschecker, who was on the Tinnitus Talk Podcast in the past.