Why Isn’t TRT the Holy Grail?

Acoustic trauma has been linked to straight up myoclonus in some of the little pathetic literature we have on myoclonus.

I believe correct me if I'm wrong that a few of the successful patients from Silverstein are from acoustic trauma. Of course the Silverstein institute isn't asking the correct questions to get the patients to describe in detail what their symptoms and causes were, but we're getting them out of the patients themselves on facebook.

Grommets and botox literature is very sparse, 2 for each case that we know of (1 and a half for botox) when it comes to hyperacusis, and right now we don't know if they were from acoustic trauma. But it's highly possible they were.

So I don't know where you get this notion that acoustic trauma would be central in origin and destination.

 

Isn't recruitment where they're deaf at such high decibel level that you have to scream so they can hear you? I could've sworn I saw someone describe recruitment as loud tinnitus instead of silent deafness but maybe I dreamt it?

The issue is maybe recruitment is a myth, maybe it's just an enlarged cochlear aqueduct that can create a spectrum of symptoms through different interactions across the ear? And that no one's bothered to look into it because there's no direct money in it.

Like when I read that sensorineural hearing loss can be mimicked by the middle ear.

 

Oh, what I had read in some post is someone using the term recruitment to describe where the hearing is damaged at certain frequencies, but as a result, they actually hear those frequencies louder, however in a distorted manner, which would probably describe what I experience. They may have well been using the term in an incorrect manner though.

I think this is where I first saw the term recruitment used

and after searching I found this thread again comparing recruitment and reactive tinnitus
https://www.tinnitustalk.com/threads/recruitment.5864/

 

There is another reason that "Negative Thinking" is associated with tinnitus. And it's difficult to treat with counseling.

On this forum are two repeating themes:

1. A good number of people come here after their tinnitus worsens. So they are dealing with what they now consider a degenerative condition.

2. A number use the word “suicidal.”

Certain tinnitus counseling may work for improving *mild* negative associations, along the same lines as getting over a fear of spiders (“Yes, the tinnitus is there, but it’s not life-threatening; it doesn’t mean you are going deaf; people get used to it, and it doesn’t interfere with their lives. In many cases it gets better, and we’re going to help you with that,” etc.).

But many people on this forum are far beyond this. They have severe or worsening tinnitus and possibly hyperacusis. These people are far less likely to be encouraged by the above ideas, because their negative associations are much different:

“My tinnitus has gotten much worse, and my world is falling apart, because I can’t do most of the things I used to. So I’ve lost my friends and my social life. I’m stumbling at work and barely clinging to my job. I’ve spent all money trying to fix this, and my marriage is crumbling.”

To these people, tinnitus becomes the International Symbol for Disaster. The racket in their head—which worsens when they least expect it—is the *reason* that their once-wonderful life is falling apart. These “negative associations” are not dreamed up; they are real-world results, and it would be nearly impossible to convince anyone otherwise.

Counseling this level of trauma goes way beyond sticking smiley faces on the refrigerator. Doctors who successfully treat such patients are usually experts of the highest order, and I wonder how many TRT practitioners have the training and experience to handle this.

 

The experts have proven beyond a shadow of a doubt to not be experts at all. First of all why would counseling ever take into account its own failures, if doing so is giving into ''negative thinking''? That's like expecting a twitter account to argue with itself. And second of all they've had decades to chat with surgeons and neurotologists and they never came up with anything even remotely along the lines of Sismanis or Silverstein (or Hain), in fact they actively argued against those hypotheses.

 

Your Post and others are evidence that you are a "Negative thinker". Unless you adopt are more positive attitude to life and tinnitus, I don't believe you will move forwards. Please read the post below.
All the best
Michael

I Would Rather Be Happy Than Right

Many years ago when I first got tinnitus, I was going through a difficult time like many newbies do. I read a newspaper article that helped to change my thinking and put me on the road to habituation. It mentioned 19 out of 20 medical conditions couldn’t be cured. At this moment, tinnitus is one of them.

Many people with intrusive tinnitus experience anxiety, depression and low moods. With time they often improve and some with the help of medications eventually habituate and can be weaned off meds. Others may experience spikes in their T, which can make them prone to mood swings. These people still manage to find a way through it with determination, character and inner strength.

There are others that will accept nothing less than a complete cure and therefore, never be able to habituate to tinnitus even if they had the best treatment in the world. This is mentioned in the TRT (tinnitus retraining therapy) book, written by Professor Pawel Jastreboff and Jonathan Hazell, and I agree with them. My experience as a Tinnitus support contact, has involved talking to many people on the telephone and on tinnitus forums. Unfortunately, some people want to drag everyone else down with their pessimism.

Just as there are positive thinking people that are prepared to try and make a life with their tinnitus, negative ones prefer to sit and do nothing. Moaning and groaning and feeling sorry for themselves. Some blame the world and every health professional and medical organisation for their misfortune in life and that is the sobering truth, and it can be difficult for them to change.

There are those reading this post that won’t like my comments and can't wait to jump on the keyboard to unleash their fury. Just before you do take time out and think. Ask yourself and be honest. What have you achieved with all your negative thinking? Absolutely nothing. Even if you are right it doesn’t make for a fulfilling life and it is possible with tinnitus. Perhaps it’s time to change your strategy to one of positivity.

Michael

PS: There is nothing wrong with being occasionally negative especially with a condtion such as tinnitus. However, everything must be kept in balance, and therefore one must try not to let negativity become all-consuming.

 

Counselling cannot help everyone with thinitus because there are some people that cannot be helped. However, if a person is willing to try a lot can be achieved. Please read the post below. If you click on my Avatar and read my post in Started Threads, titled: My experience with tinnitus. You will see that I have had very severe tinnitus and know how debilitating it can be.

Positivity and tinnitus

For some people prolonged intrusive tinnitus can be very stressful and at times debilitating. This can sometimes lead to depression and a person may need to go on a course of antidepressants. I have often been asked in tinnitus forums and via email “It is great if you’re able to be positive, but simply telling someone to be more positive about tinnitus isn’t going to change anything”. I want to clarify here and now, that isn’t what I mean.

Thinking more positive about tinnitus and bringing positivity into your life takes time it isn’t achieved overnight or by simply thinking to yourself “I must be positive about my life”. If a person wants to improve the quality of their life they have to be prepared to try and help themselves, because there is no wonder drug or operation that can cure tinnitus at this time. Unless a person faces these facts they will forever be trawling the Internet going from forum to forum complaining why there is no treatment for tinnitus when actually many of these people want a complete cure.

I once read a newspaper article that mentioned: nineteen out of twenty medical conditions cannot be cured. Someone once told me “I don’t want to be positive about tinnitus, I hate it. Being positive wont make it go away. This is true, however, thinking more positive and bringing positivity into your life will reduce the perception on how you relate to tinnitus. CBT and TRT are based on having a positive attitude, without that these treatments aren’t effective.

Long before CBT, TRT and the Internet came on the scene Doctors have been telling tinnitus patients, there’s no cure you’ll have to learn to live with it. Most of us know this is easier said than done. So how does one start to think more positive about their tinnitus and to bring positivity into their life?

The fact that someone with tinnitus is reading this page suggests to me their tinnitus for today at least isn’t so intrusive that they are unable to function, for that I’m pleased because this is something positive, instead of lying in bed on medication doing nothing. If you are able to work that’s even better as your tinnitus isn’t so severe you’re incapacitated. I see this as something positive in a person’s life. Being able to earn a living and support yourself. Therefore, you’re able to do all the daily tasks one needs to survive in this world. You may have some difficulty granted, but you’re still achieving and that's progress.

It is still better than someone that is visually impaired or severely disabled and unable to earn a living. Or, people with severe tinnitus that are depressed and on medication and unable to work. So by looking at our own circumstances and seeing what we’re able to do and achieve we can think more positively about ourselves. There is nothing more satisfying than being independent and I suggest you hold onto those thoughts.

If you live by yourself consider getting a cat or a dog so your home environment won’t feel so lonely. If you have a partner and family think about spending some quality time with them, as this can help reinforce your sense of belonging, and the love that binds you together, then your tinnitus won’t make you feel so isolated. Sometimes opening up sharing your thoughts and how you feel can help immensely and keep negativity at bay.

I have just given a synopsis of what I believe can help a person’s quality of life improve with positive thinking. It doesn’t happen overnight but a lot can be achieved when one is prepared to try. By moving forwards and taking one day at a time you can occasionally look back and see how far you have come.

Michael

 

Sounds like positivity can reduce the suffering one endures from tinnitus, but not the tinnitus itself.
However statements like "there are some people that cannot be helped" doesn't help anybody.

Stay positive Michael, stay positive.

 

I subscribe to Libermanns theory for many reasons,mainly because in the case of acoustic trauma and worsenings etc it does all make sense when compared to other studies into the after affects of excessive noise.

There have been studies that showed mice who were exposed to high levels of noise had their haircells fully recover one month after the trauma.This shows that haircells do have the capability to heal themselves following a trauma,haircells are a lot tougher than what many of us here may think and the evidence for that is all around us in everyday life.

Builders exposed to stupid amounts of noise every single day don't lose haircells every single day,if they did they'd be deaf before lunchtime but most never experience problems until much later in life if at all!

But,someone with T can worsen from a noise not even loud enough to piss off any haircells or cause hearing loss,noises not even loud enough to cause a TTS so why is that?Why can T or H get worse from nothing where someone with normal hearing loss can go to concerts,clubs and not experience any immediate change or worsening?

My uncle has hearing loss,but he still fires his rifle every single day and continues to work in a noisy council yard and has done so for decades and he doesn't experience a worsening everytime from these noises.I'm sure in the long run his hearing won't be the better of it but he doesn't experience any symptoms if you get me.

Look at all the people who have hearing loss and no T,they go to clubs/concerts without thinking twice but when or if T shows up its a different game,now going to a club leads to louder T and possibly Hyperacusis.

So why does the person who has regular hearing loss not experience H?But the person with hearing loss and T can?The Brazilian study into T showed that all the participants with T had a lower tolerance to sound than those without it so that shows that T and H are very closely related,@Foncky is a good example of that.
I hate to name drop you Foncky but for the sake of arguement your situation is proof in point,you have a degree of hearing loss but you also have T and H,your hearing loss isn't as bad as my uncles but he doesn't have T or H so why do you experience it and he doesn't?Why does people with great hearing experience T and H following a nightclub and for the life of me it all points at another form of damage,one that can occur independently or alongside haircell loss and that's synaptopathy or hidden hearing loss.

This term is only starting to get recognised now,there isn't even a test in ANY audiology department to detect it,so because they can't detect it its not there according to them and this is why the brain is blamed for T,H myclonus etc.

The look at your cochlear health,then skip a major part that being your auditory nerve and jump straight to the brain and blame that simply because your hearing is"perfect"and"undamaged"according to what your audiogram/OAES/DPOAES etc say which only test haircell health and not what's underneath it i.e the auditory nerve fibres.

As I said before,when the hidden hearing loss test that they're currently developing gets rolled out this will all change,teens with normal thresholds will now also be told that they may have synaptopathy and not just pawned off and told everything is perfect when it isn't like they do now being told such things as"T and H is your brain,here's a pair of WNGS,your H will be all but gone in a year after its desensitised"which is outright dangerous in my opinion,it's only a half ass diagnosis.

Liberman has shown that these fibres can be damaged by noises not loud enough to damage haircells,so if we get someone who already has T and it gets louder from using a vacuum cleaner wouldn't this back up his claim?Someone without T isn't going to get T from using this vacuum cleaner but someone who has already damaged these fibres will all without any threshold shifts.

If we move into the auditory nerve we now fall into a new category and that's peripheral neuropathy which usually comes with a whole host of symptoms many of which can be easily matched with those of H patients myself included.It may help explain why people experience TTTS alongside their H,it's enervated by the facial nerve which is directly connected to the auditory nerve,if it's been damaged who knows what effect that may have on the facial nerve not to mention ALOT of H patients experience face pain and or neuralgia symptoms alongside their H.Funnily enough when a H patient recovers these symptoms tend to go away with it?Desensitised?No,the nerve simply healed and thus the symptoms went away like with any nerve based injury.

I know everyone has their own view and beliefs on T and H but these are mine,I agree with them because they make sense to me like simply no other theory can.I could write pages upon pages of why I'm certain Liberman is on the right path but I think I've already written enough for now.

 

With tinnitus and Hyperacusis and low mood and depression and loosing confidence and self worth and not sleeping and stress and anxiety-
It's all about having choices to help people how to cope.
Also some people are elderly and some live alone and some have no internet or support.

Some people cope ok and some really struggle and need people to talk to how they are feeling.
CBT and TRT, Samaritans,mental health,ENT,Audiology,doctors,sycologists,family and forums all play a big role in helping Tinnitus and Hyperacusis and our mind...so promoting them all gives everyone choices....lots of love glynis

 

Bill, would you please do a favor and find out about your uncle's food intake?

Thanks.

 

He eats a crap tonne of meat that's what I do know,reason I know this is because the reason he fires that gun so often is because he's a hunter who basically eats what he kills.

Now I don't want to get into detail because I'm sure many here are opposed to hunting etc myself included and would rather not hear this(You've been warned)but his garage is like a slaughter house.He has fridges full of rabbits/squirrels/deer you name it and that's pretty much what his diet consists of,his kills with a side of vegetables for dinner every single day.

 

Bill,

I had a hunch you were going to say that...

I know a number of people who fit that profile, and who have absolutely no tinnitus--even after decades of noise exposure (I can hear their guns and machinery miles away).

Over the years, I've developed an idea that these people are *loaded* with B vitamins, and other nerve-protecting nutrients from the meat. Also, they are eating unprocessed, organic meat--nutritionally about as fresh and potent as it gets.

In contrast, I know people who've spent their lives eating lots of veggies and bottles of supplements, yet they have severe tinnitus. Maybe such diets are too sparse to protect the nervous system.

Something to think about...

 

It's something I too have looked into,reason being is that another uncle of mine who I've mentioned here a few times has a similar story.

He developed T at the age of 18 from a shotgun being fired right next to him,he was a vegetarian up to this point.
My grandmother,his mother,sees a good steak as the cure to just about everything(typical Irish mother)and got him to start eating good amounts of meat for dinner everyday and he did.

So this began something of a routine from there on out,Monday to Friday he eats the best quality steaks and raw livers you can buy(grandmother wouldn't have it any other way)and on the weekends he switches to a fresh cod dinner on Saturday and a bowl of homemade Irish stew on Sunday which also contains healthy amounts of meat and then repeats the process over and over again and has done so for just about 30 years now.

He has been to concerts/clubs/loud bars/horse racing festivals you name what's loud and he's done it 50 times over and to this day his hearing has never worsened and nor has his T as a result.

It is something to think about.

 

Myoclonus has been usually described as a symptom associated to disorders of the nervous system, so it is a symptom, and not a cause of hyperacusis. I have read that the nervous system is part of the central processing of sound.

Grommets.. in person I only know one case of a girl with hyperacusis that had grommets inserted because she had wax etc and conductive problems, and she did not have a good experience with the grommets, actually said that they made her worsen. Grommets are used to fix pressure alterations linked to conductive problems, so they are not originally designed to fix any accoustic trauma but just pressure problems.

Reinforcing the eardrum, using grommets etc to fix H induced by accoustic trauma are probably poor trials to fix a central problem as if it were a mere conductive and peripheral problem.

 

Silverstein is seeing improvement in H patients with the use of round window reinforcement,personally I have spoken to about three former patients each saying the noticed a good improvement post surgery.Two of them had their H caused by acoustic trauma the other I don't know for sure but she does also have T so that's a clue I guess.

Personally I think there's far too much emphasis on the CNS when it comes to H or myclonus,as I said above they look at the cochlea and if it appears to be in good order they completely skip over the auditory nerve and jump straight into brain territory and decide the cause must be here with little evidence to back it up.

There's actually a video on YouTube,it's about H and it's called"A noisy life"
In it,a gentleman tells his story of H but what I found interesting is that his audiologist investigated his auditory nerve and discovered he had auditory dys-synchrony which is basically a malfunction of the auditory nerve.Look at his symptoms during the video,matches a lot of H patients I've spoken to and matches mine quite closely also.

I often wonder,had they not discovered this problem with his auditory nerve would they have told him it was a central processing problem?I never had my auditory nerve evaluated simply because the test is far too risky for someone with H so as a result I was told it was a central processing problem only for me to develop peripharel neuropathy symptoms two years later with no neuropathy to be found in my peripheral nervous system,the only nerve they can't check is my auditory nerve.

After my peripheral nerve symptoms showed I developed TTTS and my H increased along with my T and then in came hearing distortion.

 

My understanding of recruitment phenomenon is that sound can't be heard until it reaches a certain volume at which time it becomes extra-loud. The simple example is the proverbial old man who says "Speak up", "what?" (then you lean closer and yell and he says) "alright, alright I'm, not deaf you know". I wonder if those of us who have big issues with small sounds where certain frequencies within sounds cause us discomfort are actually suffering recruitment at a micro level.

 

@bill 112 you can name drop me anytime
Your knowledge is impressive.

@PaulBe yes recruitment is that. You don't hear a thing until it's too loud, very annoying. Cells surrounding the damaged frequency are busy doing their own job, until they have to help the cells responsible for the damaged frequency. So the gain goes up in an instant. The surrounding cells are "recruited". At least that's the theory nowadays.

 

ROFL! You seriously just censored fappy the antimasturbation dolphin! And then you went on some kind of circular thought diatribe only an autistic half-wit such as Jastreboff could fabricate, sure, but you really did feel the need to edit out poor old Fappy! Don't you realize all the good work he's been doing against the evil forces of masturbation? Michael you will be condemned to eternal seventh hell for your rejection of Fappy's positive thinking! Was it the link with organized religion you worried about? That praying and Fappy shouldn't be in the same sentence? Just like that other master of negative thought, the Flying Spaghetti Monster? What did Jastrebluff do, combine autistic Japan with autistic preacherydoodaa to come up with these eternal condemnation of the negative thinkers?

I'm quite sure I laid out the facts to you above, just likeover with Rob over at chat-h, who by the way tried to answer me back with copout after copout . If you have reactive tinnitus/hyperacusis/vibration/thumps and there is strong indication Jastreboff doesn't know what he's talking about and he's misdiagnosing you, you don't stay with him just like you don't stay in Syria in hunting season. You also don't sit around and preached to by a guy like Jastreboff who is clueless about the physiology of the ear while he tells you it's just anxiety, if there's a real issue or if there are strong indications that it is a real issue.

Also you didn't address what I said, with all that vacuous resort to circular logic. I said that it's a disgrace that Jastreboff claims to not lower the tinnitus, to just make you used to it, but at the same time claims to improve hyperacusis. H can be the result of this T, H can be reactive T, H can be the result of reverberating T to the passage of sound through an area that should be silent. So how dare Jastrebluff claim such fraudulent logic with such blatantly contradictory and unexamined logic.

 

Silverstein does reinforcement of the oval and/or round windows, not of the eardrum. He also apparently checks for an excessively mobile stapes according to recent reports on facebook.

The nervous system can be peripheral. Myoclonus can be from damage to the peripheral system. It can be from otitis, it can be because the eustachian tube is injured, it can be because the jaw is injured, and so on. Some people that had tenotomies and sound sensitivity (that would classify them as either hyperacusic or misophonic on an LDL test led by Jastreboff) said they stopped feeling the myoclonus after the operation. And therefore the hyperacusis.

Liebermann might have come up with a theory about cochlear pain receptors, but he doesn't seem to have read about middle ear myoclonus. He probably wouldn't agree with Franz on tenotomy for meniere's because Franz's reasoning would be an enlarged cochlear aqueduct, not pain receptors.

Plus when would anything be specifically about the ear if peripheral nerves can't. Only when there's a hole in a bone or tissue, and when it's about fluids? What about when it's a myoclonus or a tonic contraction that's the result of a fissure in the eustachian tube, or from a punctured cochlea... is that also a central nervous system thing, I don't think so.

 

The problem I have with Liebermann is he doesn't take into account the existence of the middle ear. HW Pau in ''
Tonic contractions of the tensor tympani muscle'' that there are no markers for a contracted muscle, as opposed to a clonic one. And the authors of ''Specific activation of operculum 3 (OP3) brain region during provoked tinnitus-related phantom auditory perceptions in humans'' say it's the middle ear that can be doing phantom auditory perceptions. Damien Ponsot says the middle ear can be the one involved in pain transmission etc. Iirc, all Liebermann did was find pain fibers in the cochlea, but correct me if I'm wrong...

 

By the way @bill 112, I have TTTS too. Never thought about a connexion with facial nerve, interesting. I don't have facial pain.

 

Libermann isn't just about pain fibres in the ear,his research is about hidden hearing loss which is extremely important when it comes to people with noise induced T and H but yet still have amazing hearing thresholds,he's proven that it's not just as simple as losing haircells and that we actually lose hearing more subtly over time that no audiologist can currently detect.

This to me is huge,the reason being is that it takes a massive cloud of mystery off of T and gives us clearer insights into its underlying mechanisms.

How many times have we seen people arrive here saying that T just showed up one morning and according to their audiologist their hearing is amazing!No loss anywhere can be found but then this person later goes on to say that they lived a very noisy life but that"can't"be the cause because their hearing is perfect.This throws a big shroud of mystery over the whole thing,is it the brain?Was I stressed and that's causing it?Is it my blood pressure the list goes on and this person will probably spend months trying everything he can to find an answer whilst disregarding his hearing as being the cause because remember,that's perfect according to the audiologist.

The chances are he does have hearing damage,much more vulnerable and subtle damage that's currently undetectable by current audio metric tests and that's what Libermann is proving,that it's not as simple as haircells,there's an underlying factor that people are ignoring and that's the synapses.This can come on slowly over the years and only when T arrives does the person realise something is wrong with his hearing in the same way gradual hearing loss is subtle until you realise you can no longer hear your tv clearly.

With hearing loss they can detect it but if hearing loss isn't present but T is then it's classified as idiopathic or of unknown cause.If hearing loss is detected and T is present then the hearing loss is held responsible for T even though a subtle form of hearing loss may have been responsible for the T in the patient without normal hearing loss in the beginning.

So that makes T small fibre neuropathy or more accurately undetectable small fibre neuropathy.

What often presents itself with T?H and look up the symptoms of H and cross reference them with symptoms of small fibre neuropathy and they completely match but in their own unique way,honestly it's scary how similar they are.

Hearing loss doesn't cause T,synaptopathy does and that's what makes Libermann so important.
Just go through all the threads here and you'll see literally hundreds of threads where people often ask the question"why does some people with hearing loss not experience T but others with much milder hearing loss or no hearing loss do?"
To me Libermann has just answered that question for us,because person A didn't lose synapses where as person B did hence why he experiences T and the other doesn't.

It just clarifies everything it really does,for me it takes 90% percent of the mystery straight out of the equation and the answer is much more simple than we possibly thought,T and H's mechanism mights just be that simple.

And we can see this reflected around us,mainly in CI patients as Libermann pointed out to me.That patients receiving these implants have NO haircells whatsoever and may experience T before receiving the implant,but once these fibres are stimulated a lot report that their T subsides significantly whilst activated and slowly increases again in volume once it's been turned off,that's a major clue and he showed me numerous examples of this.

On a side note,a symptom of small fibre neuropathy is muscle spasms or over response to stimuli,to me that's a clue into why TTTS develops alongside T and H

 

I have left an explanation as to why I believe TTTS occurs alongside T and or H in my above post

 

Great post, Bill.

If the above is true, doesn't this create a similar question, which is, "Why do some people lose synapses from loud sound while others don't?"

 

How can doctors see how the middle ear functions (stapes, bone chain, etc)? I mean, how it responds over time in the presence of noise?

Is there a test for that other than, maybe, an MRI?

What I feel after a single loud noise exposure is pressure and, after a few hours, I sometimes feel something quite mechanical, like the bone chain hitting one another, it is just one second in which there are several high-pitched sounds (4-6 sounds), it sounds a bit like gear teeth, and it sounds a bit like a tiny bone hitting another, and then I feel better. So I am wondering if it can be observed.

 

But my point isn't Liebermann vs. Jastreboff or Liebermann vs. the brain. The problem I have with Lieberman is he doesn't address the rest of the ear, he only focuses on this theory of cochlear synaptopathy he came up with. The middle ear can be the cause of some of these things through tonic contraction, the inner ear can be cause of some of these things through an enlarged cochlear aqueduct. The eustachian tube can be a cause of these things through broken up nerves. The trigeminal nerve is linked with the tensor tympani or something like that. People with ear infections ie in the middle ear get tinnitus and hyperacusis. No tests can disprove or prove issues in the middle ear and yet many more nerves and pain fibers and tissues and muscle fiber sets sit around and link up to it than in the cochlear bone. I had an acoustic impact and I share plenty of T and H (and ''misophonia'') symptoms with people that went on to have confirmed middle ear issues. Confirmed only because of a tenotomy done through mere patient description not externally observable traits.

 

Nah, tests can't disprove a middle ear issue. Current doctor knowledge of the middle ear is pitiful. It's rumored Silverstein recently came up with a device to measure stapes velocity. Silverstein after a lifetime in this in one of his seminars says maybe the inner ear and the brain causes the stapes hypermobility, or maybe it's the other way around, we don't know. So that's pretty much the state of otology. Sismanis is rumored to have gone in without any objective tests, just like Harold Kim. MRI is mentioned by the benzobuddies girl I linked to in the botox thread I posted here, where she gets cured of H by botox on the eustachian tubes she says, but she didn't want to explain further. So none of that is even close to a few theoretical fibers deep inside the cochlea. Some more obvious etiologies are observable though, on tympanogram or eardrum inspection while the event takes place, but a lot of angles and stories come up of no objective provable method.

 

Do you think "stress/type a personalities/anxiety" interacts with your "tonic contraction" research since it seems that people like this are more prone to tinnitus in general (perhaps even noise induced?) Or is that idea in general BS. I've seen people link studies supporting the synaptopathy theories, concluding that people with anxiety/type a personality etc, are more vulnerable to synaptopathy, because of raised cortisol/glutimate levels especially at time of acoustic trauma, saying these chemicals can prevent the synapses from healing.