Tinnitus

[drew]

Here are a few pages of deposition testimony by a head and neck surgeon a few years ago. The gentleman was about to, or had just, retired, but was going to be teaching an informational class about tinnitus to his HMO's members, and so I think was quite primed to address the subject when the question came up:

2 Q. In a fairly simple way, can you explain the
3 relationship between them, how the hearing loss is
4 thought to cause the tinnitus?
5 A. I think you already know that I can't do it in
6 a few words.
7 Q. Understood. Just as best you can, the way that
8 if you were explaining it to my mom.
9 A. Tinnitus is the conscious perception of a sound
10 that's occurring in your head.
11 If you think about it, mother nature has an
12 interesting problem with sound that she doesn't have
13 with vision. We don't manufacture any light in our head
14 but the inside of our head is a noisy place. There's
15 breathing sounds. There's joint sounds. There's muscle
16 sounds. There's vascular sounds. You might think that
17 mother nature would put the inner ear in a quiet place
18 in the head but you can argue that she puts the inner
19 ear in the noisiest place and then she adds extra sound
20 and you can ask why.
21 One explanation is that a noise that's
22 consistent is easier to process than where there's a lot
23 of fluctuation.
24 And we were talking earlier so I am going to
25 ask you have you ever listened to a sea shell?

1 MR. D******: Yes.
2 THE WITNESS: Have you ever heard the ocean?
3 MR. D******: Yes.
4 THE WITNESS: Did you ever wonder where that
5 sound came from?
6 MR. D******: Yes.
7 THE WITNESS: Where did it come from?
8 MR. D******: I don't know. Where?
9 THE WITNESS: It's coming from your inner
10 canal. It's coming out your ear canal, pouring off the
11 surface of the shell, coming back in and you're aware of
12 it. Distortion products of otoacoustic emissions are a
13 change that occurs in that sound when other sound enters
14 into the equation and that's called a distortion product
15 for otoacoustic emissions.
16 The point that I am trying to convey to you is
17 that the signal that goes into your brain is a mixture
18 of that inside sound and the outside sounds that gets
19 processed in your subconscious. When the separation is
20 complete, you're not aware of it. When the separation
21 is incomplete, then you're aware of it.
22 The quality of the signal, so-called signal to
23 noise ratio, is important in your subconscious's ability
24 to do that separation. If the outside sound signal is
25 strong compared to the inside sound signal, it's easier

1 for your nervous system to do that separation.
2 Hearing loss disrupts that balance. It makes
3 it harder for your nervous system to do that separation.
4 It kind of is a default. It does an incomplete
5 separation. It's almost as if your brain says I don't
6 want to lose all of the signal so I will put some of the
7 tinnitus in there. So hearing loss is an important
8 factor in your nervous system's ability to do that
9 separation.
10 Interestingly, silence is a form of hearing
11 loss. It's just an adverse balancing and very
12 frequently people will complain about their tinnitus
13 being a lot louder and more annoying when it's quiet
14 because that's an adverse signal. It takes energy to do
15 that and people who are low on energy tend to do a less
16 complete separation.
17 It takes time to do this separation. We call
18 that auditory processing time. And when people shorten
19 their auditory processing time they do a less complete
20 separation.
21 One of the circumstances that results in
22 shortened auditory processing time is being threatened.
23 It's almost as if your nervous system says if somebody
24 is going to kill me, who the hell cares whether I do
25 complete separation. So it's kind of a safety factor.

1 And some people have a personality that opts
2 for less time spent. One of my patients shared with me
3 that they thought that that was because they have an
4 alert personality.
5 So there's lots of factors that go into the
6 fact that you are doing an incomplete separation but one
7 of them is hearing loss. And Ms. ******* has a
8 hearing loss so I would put that at the top of my list,
9 but there are probably other things going on too.
10 MR. F***: Q. You mentioned -- that was good.
11 So you mentioned earlier that stress and anxiety can
12 shorten the auditory processing time and therefore
13 increase tinnitus?
14 A. Correct.
15 Q. Explain please. How is that?
16 A. If you spend less time doing the separation,
17 you do a less complete separation so you have more
18 tinnitus.
19 Q. So are you saying that a person who is under a
20 great deal of stress and anxiety --
21 A. Is more likely to complain of tinnitus.
22 Q. If a patient has PTSD, for example,
23 post-traumatic stress disorder, which is like one of the
24 classic signs of ongoing anxiety, would such a person be
25 more likely to suffer tinnitus?

1 A. I don't have a lot of experience with that but
2 my expectation would be yes.
3 Q. How about depression? You know, a person who
4 has a major depression with anxiety features, would that
5 person be more likely to suffer tinnitus?
6 A. Yes.
7 Q. So if I can restate it in a way that I seem to
8 understand it, tell me if I am way off, but you are
9 saying that normally the body is going to -- it's a
10 noisy place and your ear inside your head is going to be
11 hearing those things in addition to the sounds outside
12 the body, but in order to process these and discriminate
13 what is coming from outside versus what is inside, that
14 the brain will remove the inner sounds and separate them
15 out so that the brain can hear what's going on outside.
16 Am I close?
17 A. I suppose that's reasonably close.
18 Q. So maybe this is a goofy question but would
19 every person then have tinnitus if they lacked the
20 ability to completely separate the inner ear, inner body
21 noises from what's outside the body?
22 A. That's presuming that the person has a signal.
23 I mean there are hearing losses where there's a total
24 loss. There's a total absence of the hair cells so
25 there's no signal going into your brain.

1 Now I have simplified things quite a bit
2 because there are central things can happen that
3 aggravate and cause tinnitus. Interestingly, very
4 frequently if you cut the auditory nerve, which is
5 sometimes done for dizziness, 80 percent of people will
6 have absolute silence, 20 percent complain about an
7 increase in tinnitus.
8 And there was some work done over at U.C.S.F.
9 where they actually put some electrodes into the brain
10 stem. I don't want to get into research that may
11 irritate you, but they put the electrodes in and cut the
12 nerve and in 20 percent of the animals, there was a
13 hyperactivity in the cochlear nucleus. The nerves were
14 hyperactive in there.
15 Q. So you're saying that for most --
16 A. It can be central. Generally speaking, if
17 people have no hearing, they don't complain of tinnitus
18 but that's not 100 percent true.

[JazzGuitarGimp]

When I got my custom plugs (many years ago), I was only offered -15dB and -25dB. I opted for the 15's, but it's just too much.... Perhaps I should look into 9's.

[Leo_Gnardo]

Generally speaking, if
17 people have no hearing, they don't complain of tinnitus
18 but that's not 100 percent true.

Very interesting post drew, thanks.

My 94 year old neighbor, totally deef in one ear, can't hear out the other, for real. Has a hi-tech hearing aid, $2300 discounted, and the gain twisted up far as it will go. Tinnitus? His hearing aid whistles so loud, I could hear it across the street 50 yards away. Now he's in the old folks home, the staff can hear him similarly. Distant early warning system: "here comes ol' George." HE doesn't hear the whistle, and it must cover up any audio the HA passes. I brought him to an audiologist for his 5 year check last spring. Flat line, both sides, 55 dB down. Poor old guy, I feel badly for him. Meanwhile he gives anybody nearby an artificially induced temporary tinnitus. OK it's externally generated but HE doesn't complain about the whistle.

[Reeltarded]

Brilliant. You are a genius, Leo. We should develop a bluetooth hearing device that is two parts for obvious reasons.

[Leo_Gnardo]

Brilliant. You are a genius, Leo. We should develop a bluetooth hearing device that is two parts for obvious reasons.

Me? For reporting this? Nah, just slightly smarter than the average bear, on a good day.

Bluetooth, funny you should mention that. First hearing aid I saw @ 1960, an earpiece with separate mic & amp, freshly transistorized in a little plastic box carried in a pocket or clipped to shirt or jacket. (Couple more transistors and you could listen to the ball game or pop music.) Connected by wire back then of course, these days you would use bluetooth for that 2-foot run.

In any case ol' George would be better off without the whole rig. In the last couple years his neighbors, relatives, social workers, therapists, nurses, caretakers, docs, bank manager and I have filled in a small stack of notebooks because we have to write down everything for him, hi tech HA or not. His nieces bought a flat screen for his nursing home room so he can watch his Mets games. They proposed buying headphones too but I said he still couldn't hear if you put a thousand watt amp on them. The phones would catch fire before he heard a thing.

Hope nothing like this happens to any of us.

[M Fowler]

I was trained annually on tinnitus and hearing loss at VA and there has been no treatment for tinnitus by VA all those years I worked there, 33 years.

VA is a leader in research so I sure they would have did something by now especially since tinnitus and hearing loss is the number one service connection claim filed by veterans.

VA awards 10% disability whether it is in one ear, both ears or central.

My tinnitus started in the Marines due to noise exposure from weapons fire and has gotten worse in my old age, just live with it.

[vibratoking]

Oddly enough, a group here at work designed a wireless hearing aid for a company called Phonak. It is not Bluetooth because that protocol is too power hungry. Our chip is a custom protocol that is very low energy and much more battery friendly.

[norburybrook]

My Daughter wears a Phonak bone anchored hearing aid

Marcus

[potatofarmer]

So about 10 years ago I looked into what the risk was and the options to mitigate, and ended up by trying to limit the overall band SPL by using smaller amps and having some good quality, flat response custom ear plugs http://www.etymotic.com/hp/erme.html
I tried the 15dB first, but they were too much, I felt too 'distanced' from the music. However, switching to the 9dB inserts fixed that and has made it possible for me to continue with the band.
Pete

I use a pair of their (cheap!) "HD" plugs for shows and practice: http://www.etymotic.com/hp/er20hd.html

The 15dB seem about right for me, at least compared to normal 30 dB plugs.

I've got mild tinnitus in my right ear. I went through a fairly substantial physical when I got hired at my current job - chest X-ray, EKG, etc. For the hearing test, our medical department has a "silent" room (I'm sure it's still an order of magnitude louder than an anechoic chamber, but still) and turns out I've got a ~30dB notch in my right ear, right at 6 kHz.

I'm also a huge earwax accumulator. I thought I was going deaf sometime in my early 20s and after enough friends badgered me, I finally went to the doctor. They did that irrigation/ syringe squirt gun thing and my god was it an entirely different world when I got out.

[Structo]

Yeah, I've had tinnitus in both ears for years.

Loud music, construction work, etc for 30 years will do it.

I understand the little hairs in the ears can be damaged or broken off, never regrowing.

Hell, after I turned 50, I have all kinds of hairs growing out of my ears.

The latest addition is low frequency (like subwoofer low) in my right ear.
Seems I only hear it when trying to go to asleep.
For weeks I thought it was the neighbor kid playing his gangsta rap.

Most the time I can tune out the high freq stuff but it's always there.

[JazzGuitarGimp]

Hell, after I turned 50, I have all kinds of hairs growing out of my ears.

Thanks for that - I needed a good laugh today, and oh man, can I relate!

[malt]

Have had the ringing for years, and most of my hearing malfunction it´s this set up´s faulty.

[IMG:600:800]http://i141.photobucket.com/albums/r63/malt_photo/IMG_1716_zpsbf461639.jpg[/img]

Got my old marshal back, ben a way fore over a decade.

[Mark]

When I got my custom plugs (many years ago), I was only offered -15dB and -25dB. I opted for the 15's, but it's just too much.... Perhaps I should look into 9's.

I've used the soft rubber type which are -25db and ear muffs to protect my hearing I also use an 18 watt amp too. I rehearse with a Champ too when possible, thus my many posts about getting the Champ to go above and beyond.

The ears still ring, but it's about minimization.