Tinnitus, hearing aids, and the ear/brain system

[cvanc]

Hi all-

Can we talk about tinnitus and related issues?  I bet I'm not the only one here who deals with this.  For me it's 24/7/365.  I've had a recent hearing test and my high frequency rolloff is very significant (down 65dB above 3-4KHz... yes, you read that right, sixty-five dB of treble loss).

The audiologist flatly said the only available treatment was hearing aids.  I have to say the idea of drowning out this continuous sound with some even louder sound does not make sense to me.  I just don't see how that would constitute an improvement.  But I suspect this viewpoint might be an oversimplification and want to kick an idea around with you.

Imagine the ear/brain system has, for lack of a better term, automatic gain control.  Also, perhaps this AGC is more than a simple wideband thing, boosting the entire spectrum when it acts.  It might be frequency-dependent, able to operate over small portions of the spectrum if needed.  Because my 'input transducer' has significant treble loss, this AGC system is really cranking up the high frequency gain in an effort to compensate.  And, in so doing, brings up the noise floor by exactly the same amount, just like an analog gain stage would with a similar change.  And this amplified noise floor is what tinnitus sufferers are hearing.

What do you think?  Thanks.

[Nusa]

I'd say the primary function of the hearing aid is simply to allow you to hear things you need to hear. You can evaluate your own requirements in that regard...are you having trouble hearing things you NEED to hear?

With regard to tinnitus, I gather the idea is to distract the brain with sufficient input that the tinnitus becomes a background sound rather than the primary sound.

You may want to get examined by an appropriate specialist doctor, rather than a mere audiologist. It's possible the underlying cause of the tinnitus is a curable medical problem.

[mtdoc]

Because my 'input transducer' has significant treble loss, this AGC system is really cranking up the high frequency gain in an effort to compensate.  And, in so doing, brings up the noise floor by exactly the same amount, just like an analog gain stage would with a similar change.  And this amplified noise floor is what tinnitus sufferers are hearing.

What do you think?  Thanks.

I think that is very close to current theory on the mechanism for tinnitus - that it is due to increased  gain in higher order CNS auditory neurons that occurs to compensate for the reduced input from lost hair cells in the cochlea.   High frequency tuned hair cells along the organ of Corti are more susceptible to damage than lower frequency hair cells.

[rbm]

I can't contribute to the discussion but can understand cvanc's problem, as I also suffer from tinnitus.  It is distracting at times.  I find though the distraction is much less when I concentrate on something like study or reading.  I also wish for a cure that avoids hearing aids.

[rs20]

Even if the brain had a plain, flat, wideband AGC, then hearing aids would help by increasing the amplitude of the real signal above that of the tinnitus signal; with the AGC therefore attenuating the real signal to a comfortable level and the tinnitus down to a relatively quieter level.

[JXL]

I don't think there is an AGC in our ear/brain system.  I would love to turn AGC off and set gain to minimum, because for me tinnitus is 24/7/365.25 (yes, I don't get that 1 day break every 4 years  ). 
I think hearing aids may make it worse for me, because the perceived ringing gets worse after I'm exposed to loud sounds.
Over the years I have just learned to live it.  When it bothers me it's only when it's when I'm in a very silent environment.

[marshallh]

Go find a practitioner who will give you a DMSA-provoked heavy metal urine test. The test itself returns numbers without a solid reference range but it'll tell you of major problems. I am battling a widespread neurological issue and random tinnitus is one of the things - exacerbated by high lead levels. Mercury buildup especially from amalgam fillings will get into the CNS and interfere with nerve endings. Some people are more tolerant to higher levels of mercury accumulation than others.

Be warned that by dipping into the wild west outside conventional doctors you will have to use your brain and gut sense to find someone who knows their stuff.


Some hearing loss is unavoidable and environmental, but a lot of it will be affected by overall health and other stuff going on in the body. You are somewhat justified to question the audiologist who insists there is only 1 way to go about fixing the problem.

[nanofrog]

I can't contribute to the discussion but can understand cvanc's problem, as I also suffer from tinnitus.  It is distracting at times.  I find though the distraction is much less when I concentrate on something like study or reading.  I also wish for a cure that avoids hearing aids.

I have it as well, and has been the case for as long as I can remember.

FWIW, I usually have music playing in the background so I pay less attention to the ringing. Mine sounds like a CRT fly back transformer whine, and it makes falling asleep difficult if the room is silent or nearly so. The fact I'm also an insomniac doesn't help matters either.   

[cdev]

A great many toxicants deplete our body's store of glutathione..

There may be a connection between glutathione status and tinnitus. N-acetylcysteine which is the best value rate limiting precursor of Glutathione also may be useful in reducing the body's burden of some metals (its a thiol like succimer, but not such a strong binder of metals.) Another thiol that may be useful is alpha lipoic acid. (an older name for it is thioctic acid)

I also know that taurine, a sulfur containing amino acid,  is useful in protecting the body from metal intoxication.

But first things first. Have you ever tried supplementing with n-acetylcysteine? Older people should take it daily because the older we get the more glutathione is used up by processes within the body that increase as we age. So you need more to protect your cells angainst innumerable toxic chemicals in the environment, sunburn/radiation, a great many things.  If your cells dont have it available at the specific moment its needed, they have to commit suicide and that uses up your body's ability to produce new cells to replace them. https://en.wikipedia.org/wiki/Hayflick_limit

Cell division is a finite resource that people should try to conserve - especially because of global warming which will mean lots of additional exposures, mercury, and mold are two obvious ones .



 N-acetylcysteine also improves your hearing's resistance to insults (Including loud sounds). Its protective of hearing and the reason is almost certainly the improvement caused by improved intracellular stores of glutathione.

I would also do some reading on inosine.

I would not be surprised if inosine helped restore partial hearing. Inosine is a purine and is useful in cases of partial nerve damage. But in order to work it has to be taken multiple times a day over a period of time. Companies have tried to commercialize it by figuring out various ways to deliver it in a time released manner .

I credit inosine as helping restore my sense of smell (which was completely gone) that I lost due to a heavy mold exposure.
The mold also caused really savage tinnitus, splitting headaches and numerous other problems.

[cdev]

Here!


A randomised, double blind trial of N-Acetylcysteine for hearing protection during stapes surgery.

Bagger-Sjöbäck D, Strömbäck K, Hakizimana P, Plue J, Larsson C, Hultcrantz M, Papatziamos G, Smeds H, Danckwardt-Lillieström N, Hellström S, Johansson A, Tideholm B, Fridberger A.
PLoS One. 2015 Mar 12;10(3):e0115657. doi: 10.1371/journal.pone.0115657. eCollection 2015.PMID:25763866
Free PMC Article
Similar articles

Select item 247086402.

Using prophylactic antioxidants to prevent noise-induced hearing damage in young adults: a protocol for a double-blind, randomized controlled trial.

Gilles A, Ihtijarevic B, Wouters K, Van de Heyning P.
Trials. 2014 Apr 5;15:110. doi: 10.1186/1745-6215-15-110.PMID:24708640
Free PMC Article
Similar articles

Select item 240515613.

Deserves a hearing? A case report of remitting tinnitus with N-acetyl cysteine.

Dean OM, Jeavons S, Malhi GS, Cotton SM, Tanious M, Kohlmann K, Hewitt K, Moss K, Allwang C, Schapkaitz I, Robbins J, Cobb H, Dodd S, Bush A, Berk M.
Afr J Psychiatry (Johannesbg). 2013 Jul;16(4):238, 240. doi:

http://dx.doi.org/10.4314/ajpsy.v16i4.31.

No abstract available. PMID:24051561

Similar articles Select item 246538824.

Mechanisms and treatment of blast induced hearing loss.Choi CH.
Korean J Audiol. 2012 Dec;16(3):103-7. doi: 10.7874/kja.2012.16.3.103. Epub 2012 Dec 18. Review.PMID:24653882
Free PMC Article
Similar articles Select item 91839505.

[Acute paracetamol and aspirin poisoning].Garnier R.
Rev Prat. 1997 Apr 1;47(7):736-41. French. PMID:9183950
Similar articles

[cdev]

There may be some value for tinnitus sufferers in a number of other antioxidants and phytonutrients.

Its definitely worth looking into. Because pro-oxidant substances often cause programmed cell death antioxidants are valuable for neuroprotection generally.

[eyiz]

Holy nad. The unstruck sound. That's what the Buddhists and eastern gurus call it. You can change the pitch of the ringing in your ear through meditation. In the west, it's a pathology, in the east it's a blessing. Go figure. When a person begins to develop spiritually, the sound appears automatically. By concentrating on the sound, you can increase the volume, change the pitch, and use it to alter states of consciousness. Of course, if you're not interested in psychic phenomena and altered states of mind, then its just a problem, and a nuisance. The same with all siddhi powers,  they are completely disturbing to those who just want to lead an ordinary life, like most other people. When the kundalini awakens in the unprepared individual all these unusual manifestations begin to appear. You could research all these things, and develop a liking for the phenomena, or you can adopt the view that it's a problem that needs medical treatment. But, be aware, anything the west doesn't understand, is considered a pathology, something to be fixed with medication or treatments. If you want a balanced view, find a spiritual guru, get some answers on the other side of things, see a different point of view.

[cdev]

Has anybody ever tried to determine the actual frequency of a tinnitus sound and maybe beat (heterodyne) against it?  Can it be determined with a signal generator. I know that sometimes I will hear a perceptible shift in the frequency. I associate higher frequencies with more exposure of whatever it is. There is always a cause if I look for it.

There are slight differences in visual contrast sensitivity which are easy to measure and which can give you a way of evaulating your level of toxic exposure.

[rs20]

I'm confused, are you proposing N-Acetylcysteine as a solution, or disproving its effectiveness? Because the first paper you linked strongly fails to find any link between N-Acetylcysteine and hearing improvement (p = 0.54), then the next is just a protocol for how a study should be performed AFAICT, and the third is just a N=1 case study. Lost interest after that, seemed to no longer be anything to do with N-Acetylcysteine anymore?

Here!


A randomised, double blind trial of N-Acetylcysteine for hearing protection during stapes surgery.
...

[jh15]

cdev,

I was playing with sine generators and trying to get a beat note. Didn't succeed, but googling or youtube, I found someone trying to do the same thing.

I was going to try and pick up anything emitted by the eardrum, (hadn't proved that, but heard it might be possible) sync it and reverse phase it.

This guy was doing the exact plan I had. He didn't succeed so far.

Not sure if I came across it while reading Forrest Mims, and he had a link or what.

Oh, a loud bell clanged, and the guy lost his tinnitus temporarily for a long time.

FYI I waited years on an Indigogo hearing aid, and love them. You get a calibration with special phones, a physician or whatever, can change curves with your laptop, and several settings for environment with a magnet held near them to change while in public.

Called ihearmedical.com.

I only use them in public 'for the other guy'.  I don't like things in my ears, and this:

Sounds above a certain level damage your ears don't they?

If your aid is pumping 100 db of correction, won't that blast the remaining hairs? So I keep use to a minimum.

I do love them though, and it was hundreds, not thousands.

[helius]

Has anybody ever tried to determine the actual frequency of a tinnitus sound and maybe beat (heterodyne) against it?  Can it be determined with a signal generator. I know that sometimes I will hear a perceptible shift in the frequency. I associate higher frequencies with more exposure of whatever it is. There is always a cause if I look for it.

http://www.notchtherapy.com

You cannot "beat" the sound of your tinnitus against a sine wave because it is not a real sound. Beat interference is only applicable to objects that obey the wave equation, and the neuronal impulses that cause tinnitus do not. The only way to find the frequency is to subjectively identify its pitch: if you are completely tone deaf you cannot do this.

[VK5RC]

Tinnitus is a risk factor for the development of hearing loss and often accompanies hearing loss but hearing loss is by no means a certainty following tinnitus . I have it, for me it is definitely a 'pink noise' - not a single tone. 
Antioxidants are not a panacea - in smokers they actually increase the risk of lung cancer.
If hearing loss really bad - cochlear implants can help a bit.

[tggzzz]

Only 65dB down? Lucky you

Be aware that the ear-brain system is highly non-linear in any dimension you can think of.  Hence applying "electronic engineering" reasoning to it is of limited value.

There are many many manifestations of tinnitus; what works for one person may or may not work for other people. In very rare cases the inner ear can actually generate sounds that can be heard by external equipment.

If you need two hearing aids, get them. If you only have one then firstly your hearing won't be improved as much as possible. Secondly there is a phenomenon where, if the ear-brain doesn't hear for a while, then it "forgets" how to hear and it isn't possible to reinstate it with a hearing aid.

There is a large deal of suck-it-and-see when it comes to reducing hearing problems; this is a problem if each "suck" costs a lot of money. A "try before you buy" scheme is helpful; I'm very grateful for the NHS since they have several options available, all free.

[b_force]

Has anybody ever tried to determine the actual frequency of a tinnitus sound and maybe beat (heterodyne) against it?  Can it be determined with a signal generator. I know that sometimes I will hear a perceptible shift in the frequency. I associate higher frequencies with more exposure of whatever it is. There is always a cause if I look for it.

http://www.notchtherapy.com

You cannot "beat" the sound of your tinnitus against a sine wave because it is not a real sound. Beat interference is only applicable to objects that obey the wave equation, and the neuronal impulses that cause tinnitus do not. The only way to find the frequency is to subjectively identify its pitch: if you are completely tone deaf you cannot do this.

I was actually wondering about this. I do think you can do something with phase shifting/delay.
In the end, ANY type of sound (virtual, real or not) has some sort of phase.
My girlfriend has pretty bad tinnitus. She is pretty musical so therefore we could track down the most important frequencies (yes she has multiple, which makes it so much worse).

I still have to make a test setup to see if we can make it actually more manageble.

There is onlly another side of the story. I don't know if it makes the problem worse if people have hearing damage. Normally those people need to be carfull with any type of extra noise and loud sounds. Does that also works for "out of phase" signals?


Btw, an old friend of my works for a big hearing-aid transducer company. Did you know those things leave their factory for 1-2 bucks, incl profits etc!!!
In the store you pay easily $600-$800 for those bloody things.
Some middle man in between knows how to fills his pockets......

[tggzzz]

Btw, an old friend of my works for a big hearing-aid transducer company. Did you know those things leave their factory for 1-2 bucks, incl profits etc!!!
In the store you pay easily $600-$800 for those bloody things.
Some middle man in between knows how to fills his pockets......

It is always easy to underestimate the costs of "the last mile". As a rule of thumb in non-commodity retail industries, the retailer doubles the cost of the product to them. It will be worse in this industry due to...

I presume there will be significant expenses associated with fabricating custom acrylic/silicone ear inserts, buying audiology equipment, gaining certification, learning about the merits of specific products, dealing with "it doesn't work well" rejections, failures in normal use, home visits for assessment, retail premises, product volumes, ...

Besides, the transducers are the least interesting part of the hearing aid. Making a DSP run on 1V for weeks on a small battery shouldn't be underestimated. Their semiconductor processes are entirely dissimilar to processors/memory/logic etc!

[Gary.M]

Btw, an old friend of my works for a big hearing-aid transducer company. Did you know those things leave their factory for 1-2 bucks, incl profits etc!!!
In the store you pay easily $600-$800 for those bloody things.
Some middle man in between knows how to fills his pockets......

Hearing aids for $600-800? If you're talking AU/NZ$ more like $1000-3000 per ear!



Sent from my x600 using Tapatalk

[b_force]

Btw, an old friend of my works for a big hearing-aid transducer company. Did you know those things leave their factory for 1-2 bucks, incl profits etc!!!
In the store you pay easily $600-$800 for those bloody things.
Some middle man in between knows how to fills his pockets......

It is always easy to underestimate the costs of "the last mile". As a rule of thumb in non-commodity retail industries, the retailer doubles the cost of the product to them. It will be worse in this industry due to...

I presume there will be significant expenses associated with fabricating custom acrylic/silicone ear inserts, buying audiology equipment, gaining certification, learning about the merits of specific products, dealing with "it doesn't work well" rejections, failures in normal use, home visits for assessment, retail premises, product volumes, ...

Besides, the transducers are the least interesting part of the hearing aid. Making a DSP run on 1V for weeks on a small battery shouldn't be underestimated. Their semiconductor processes are entirely dissimilar to processors/memory/logic etc!

That still doesn't explain a factor 800 or more!
Btw, this where the precies a few years ago, without fancy DSPs. Most of them actually use a very simple passive filter.

But even with DSP these prices are insane.
There is absolutely no technical excuse for it.
(I have been long enough in the audio field to have a good sense for that)

[tszaboo]

I had tinnitus for some time. Maybe years. It wasnt very loud, disturbing me or anything.
I was able to cure it. Basically, I wear ear mufflers, whenever I feel like it. Usually an hour, maybe two in a day. I wear it when I do something loud, power tools, even vacuum cleaning. I wear it, when the noise from the street is annoying me. I wear it when the neighbors do too much noise at 2 AM.
Mine is 3M Peltor X5A, this was claiming to have the best protection from their lineup, -31dB, that is a lot.

You look funny in it, sure. I dont care. Best 30 EUR I've spent in my life. Although, I also clean my ear regularly since, and I've been taking vitamins. Might have been those. In any case, I get annoyed by sounds made by other people (called misophonia*), so the ear protector is still a huge win.

Misophonia:

Misophonia, literally "hatred of sound", was proposed in 2000 as a condition in which negative emotions, thoughts, and physical reactions are triggered by specific sounds.

I hate people walking like a 2 ton cyberman, people hitting things together for no good reason other than to make the noise, smashing doors, leaving their 19 century tractor car standing below my window with running engine, motorcycles.

[tggzzz]

Btw, an old friend of my works for a big hearing-aid transducer company. Did you know those things leave their factory for 1-2 bucks, incl profits etc!!!
In the store you pay easily $600-$800 for those bloody things.
Some middle man in between knows how to fills his pockets......

It is always easy to underestimate the costs of "the last mile". As a rule of thumb in non-commodity retail industries, the retailer doubles the cost of the product to them. It will be worse in this industry due to...

I presume there will be significant expenses associated with fabricating custom acrylic/silicone ear inserts, buying audiology equipment, gaining certification, learning about the merits of specific products, dealing with "it doesn't work well" rejections, failures in normal use, home visits for assessment, retail premises, product volumes, ...

Besides, the transducers are the least interesting part of the hearing aid. Making a DSP run on 1V for weeks on a small battery shouldn't be underestimated. Their semiconductor processes are entirely dissimilar to processors/memory/logic etc!

That still doesn't explain a factor 800 or more!
Btw, this where the precies a few years ago, without fancy DSPs. Most of them actually use a very simple passive filter.

But even with DSP these prices are insane.
There is absolutely no technical excuse for it.
(I have been long enough in the audio field to have a good sense for that)

The issues I alluded to weren't technical; they were the commercial "cost of doing business" - and those cannot be derived from technical considerations.

Since you are "in the audio field", what costs would you assign to:

• NRE costs of developing a new hearing aid, and getting it on the market. Please indicate what you have and haven't included (e.g. catalogues, inventory, regulatory, advertising, accounting, instruction manuals etc etc)
• NRE costs a retailer has when selling the first example of a new hearing aid. Please indicate what you have and haven't included (e.g. audiology equipment, hearing aid programmers, training, advertising, professional fees etc etc)
• costs a retailer has when selling every hearing aid. Please indicate what you have and haven't included (e.g. number sold per year, time taken to test hearing and take moulds, mould manufacture costs, fitting and tweaking time, discuss alternatives with client, secretarial overheads, expected proportion of complaints/breakages etc etc)
• costs associated with buildings, taxation and other "bad stuff"

I think you will find the component and manufacturing costs are a very small fraction of the total costs.

As a small example, in an efficient large busy UK hospital, I (as a client) would expect to take at least three hours of an audiologist's time. Now, as a rule of thumb, assume that the cost of employing a technical professional is 2.5 times their salary. So, picking figures out of thin air, if someone earns £40000/year, the hourly cost of employing them will be ~65/hour => ~£200 per client. On top of that you have to add the "retail" NRE costs, and manufacturing costs; I can't estimate either of them. So, with a traditional retail markup of 100%, you are looking at £400 plus 2*NRE + manufacturing costs. And at that point you aren't so far from £800.

So even a crude back-of-an envelope calculation gives a feel for how the costs quickly mount up.

Of course, if you know that the prices are excessive, there's nothing stopping you entering the market yourself, and becoming very rich!

[cdev]

NAC is the precursor of glutathione.
Many kinds of hearing loss involve pro-oxidant processes. So consuming the most bioavailable direct precursor of glutathione has been shown many times to be helpful as it improves GSH (or redox status). GSH levels decline in all older people due to much of it being used up by physical changes that occur in cells which deplete GSH.

 Inosine is a trophic factor that helps damaged axons heal.