Would It Make Sense to Distinguish Between Tinnitus Caused by Noise and Other Forms of Tinnitus?

These two subgroups may have different symptoms, different damage, and different treatment options.
What do you mean?

 

Obviously not an interesting idea.....

 

Excluding physical causes such as otosclerosis, jaw concerns, acoustic neuroma or Meinere’s disease, I am unsure the cause matters.

Acoustic trauma, viruses, and ototoxicity can cause similar nerve damage. Symptom variation comes from the extent of the damage and if there is hearing loss or hyperacusis. Hearing loss and hyperacusis play a role in symptoms and long term treatment options, but how the loss happened is irrelevant.

It’s continually claimed on TT that ears damaged by acoustic trauma are more susceptible to noise damage. Yet I have not seen any factual data to support that claim.

Ears damaged by ototoxic medications are just as susceptible to damage from loud noises and vice versa. One variation may be lifestyle. For example, someone who acquired tinnitus from attending frequent heavy metal concerts may be more likely further damage their ears unless they change their lifestyle and stop attending concerts or wear ear protection.

But as someone with viral hearing loss, I would be thrilled to read actual data showing I am not susceptible to acoustic damage. Yet that that’s opposite of what any specialist or audiologist has told me.

 

I have simply assumed this. I hadn't considered that T caused by illness or medication might also damage the ear and make it more susceptible to noise damage.

However, I still think that distinguishing between noise-induced T and other forms of T might be useful.

 

But why would it be useful? Excluding the conditions I mentioned, ototoxic, viral and acoustic trauma can cause similar damage and are treated the same. Risk of additional damage is the same, too.

It’s nice to know what caused tinnitus simply from a personal perspective, but ultimately it does not matter in terms of avoiding more damage or treatment.

 

Specialists and audiologists told you that you are susceptible to acoustic damage? My experience with tinnitus specialists is different. They usually recommend not to protect the ears more than people with healthy ears.

 

What I've learned so far is that noise destroys hair cells in the ear. Do viruses and ototoxicity also destroy these hair cells? I was under the impression that T from viruses and ototoxicity caused a different type of damage, but produced the same symptom.

Knowing the cause would be useful if some causes are curable, or at least treatable. Some people might expect relief if the cause can be eliminated. Noise damage seems to be one of the causes that leave permanent damage.

 

Do you have any proof of this assumption?
In my opinion, ototoxicity is poorly understood. And in the case of noise damage, the same electro-microscopic images of broken hairs from hair cells are always displayed. And the tinnitus experts say the cochlear is not the problem, tinnitus develops in the brain... Well, what now?

 

Yes, I am susceptible to acoustic damage from loud noises.

Do we need to protect our ears more than people who have no hearing loss? Well that likely depends. Everything at 6k and above is essentially gone for my right ear, so I very clearly have fewer healthy ear hair cells than most people my age. Hearing damage is typically cumulative, and I would prefer not to rush my loss of 4k so I wear an earplug for situations above 80dB.

 

Yes, ototoxic medications and viral SNHL destroy hair cells in the ear too. Like acoustic trauma, the outer (or higher frequency) hair cells are destroyed first by ototoxic drugs.

For viruses, the damage can vary based on where the inflammation is. However, given the shape of the cochlea, the inflammation is most likely to impact high frequency hair cells first.

Ototoxic and virus damage can be permanent as well.

Yes, knowing the cause is helpful — if the cause is jaw issues, Ménière’s disease, etc.

 

Does this mean that when a medication causes T to get louder, more damage is being caused to the hair cells? I had to take an antibiotic once and my T went up for a few hours following each dose.

 

Maybe we should discuss with citation of scientific papers.
In my opinion it would be very helpful to be able to show haircell damage in living patients.
I believe that there are a lot of tinnitus sufferers who don't know, whether they have any cochlear damage.
Btw., there are tinnitus sufferers, who have pulsatile tinnitus from vascular disease, e.g. dissection of A. carotis. There for sure is no cochlear problem..., - o.k. it would be a very unlikely coincidence...

 

It’s not an assumption. Higher frequency hair cells can be damaged by ototoxic medications and viruses just like they can be damaged by acoustic trauma from loud noises. As I mentioned above, the damage starts with higher frequencies due to their location on the cochlea/acoustic nerve. This is why when cancer patients receive ototoxic medications, their high frequency hearing is regularly tested for signs of loss.

Yes, the claim is that tinnitus develops in the brain. The thought is that it is the brain’s response to the lost frequencies. For example, I have lost multiple high frequencies. My brain realizes it’s not receiving those sounds from my ear, thus it responds by filling in the missing pieces. At least I think that is the rationale.

Our brain can do this with lost vision, too, like in Charles Bonnet Syndrome where individuals have visual hallucinations: http://www.visionaware.org/info/you...to-eye-conditions/charles-bonnet-syndrome/124

 

Possibly, if the antibiotic was ototoxic.

 

Pulsatile tinnitus falls into the same category as a more physical on going cause, like I previously mentioned with otosclerosis or jaw damage. In these cases, yes, the cochlea is typical undamaged.

Are you asking for a scientific paper proving that ototoxic medications damage hair cells? There are countless studies referencing this, it’s common knowledge among medical professionals. Here’s one article:
http://www.cochlea.eu/en/pathology/surdites-neuro-sensorielles/ototoxicite

The link is rather interesting, it breaks down what damage is done by different causes. There are some discrepancies, but most causes involve hair cell damage.

You can show proof of hair cell damage in living patients by showing nerve damage on their audiogram. Or do you mean actual imaging of damaged hair cells? I agree, any advances in inner ear and cochlear imaging would be beneficial.

Of course, some tinnitus suffers do not know whether they have cochlear damage because their audiograms show no loss. Some members often refer to the possibility of hidden hearing loss, either losses in high frequencies not tested or losses missed by current testing practices. Again, any advances in medical technology would be helpful. Not necessarily to figure out the cause but to look toward a cure.

 

I think the brain faithfully interprets the information delivered to it by the auditory system. If that system is broken out of shape then that is what the brain's interpretation reflects. Damage may occur anywhere along the pathway, but in the end the brain delivers up what it gets.

 

@Tinker Bell
Thank you very much for your kind answers.
I did a survey here. About one third of all participants were sure that their tinnitus was caused by noise. Another third were certain that noise had no influence. But at least a third were unsure.
Typical case: a young man who also shook his head wildly at a dance event. And woke up the next morning with loud tinnitus.
Well, is he damaged by noise or does his tinnitus have something to do with his cervical spine?
Similar case: whiplash injury in a car accident. Simultaneously loud airbag bang.
Noise damage or something somatic?