Tinnitus: Hyperacusis

Hyperacusis occurs when a person is hypersensitive to certain noises that would typically not bother someone else (e.g. gunfire, sirens, automobile brakes, movie theater sounds, engine noises, laser printers, MRI, etc.).

Tinnitus occurs when a person hears a constant sound that is generated by the brain to signal auditory system damage. The damage is real. The sound is an indicator that damage exists. Most people with tinnitus have damage inside of the cochlea. It is typically either bent or broken cilia. Bent cilia will likely recover. Broken cilia does not regenerate.

Some people with tinnitus also have hyperacusis. I'm one of those people. The conditions are so unpredictable that every day is different.

I've had the tinnitus for a long time. It started getting louder in recent years and in 2007 I began to notice that I was hypersensitive to the noise of a shared laser printer on my desk at work. To make matters worse, the city rerouted a bus station to right below my office window. The hydraulic brakes would trigger my hyperacusis which would aggravate my tinnitus. I began losing sleep, isolating myself, and even started slurring my words because of sheer exhaustion.

I'm sharing this information with you so that you can get ahead of the issue if you suspect that you may have both conditions. You may find that you need to educate your providers about your conditions. Some medical providers just don't know about hyperacusis or tinnitus (much less both). Print this out. Show it to your medical providers. It may help you to explain what I couldn't when I first noticed the symptoms of hyperacusis.

Also, if you have hyperacusis with your tinnitus, you may not be able to use certain treatments for your tinnitus because these treatments may activate your hyperacusis which can make your tinnitus sound louder and more annoying. For example, some treatments use music to pull the brains focus away from the tinnitus sound. The problem is that the music sometimes involves sounds that trigger the hyperacusis  (e.g. wind chimes, horns, violins, etc.) You can try it out but if you notice a reaction I recommend you stop the treatment. Consult your provider before you stop.

Tinnitus: Transcranial Magnetic Stimulation (TMS)

TMS, an experimental treatment, is showing some positive effects as a possible future cure for tinnitus. I tried to enroll in a research study but was disqualified because my tinnitus is so loud that the doctor performing the research did not want to risk making it worse. My tinnitus flares up during MRI's. He explained that the field strength of the magnets that he uses are similar to an MRI and are too large to pinpoint exactly where the auditory system damage is located. However, he and I had a great conversation.

He told me that he is finding various levels of sensitivity to the magnetic fields. I asked him if he had ever heard of EHS (Electromagnetic Hypersensitivity Syndrome). He said no. I explained it to him. He was pretty receptive. 

Here is the bottom line. I think that TMS, when the magnetic field strengths reach pinpoint accuracy will cure tinnitus that is caused by TBI. It is my belief that once the auditory control panel in the brain that is responsible for the internal sound is identified it can be switched off. The trick is being able to switch it off without doing other damage. We don't want to be cured of tinnitus only to find that the side effects of the treatment are worse than the tinnitus. For example, I'd like to have my ringing ears quiet down but not at the expense of never being able to blink my eyelids again.

I'm hopeful that a cure will be here by 2018. I'm counting on it!

Tinnitus: Redefining the Condition

Medical practitioners often refer to tinnitus as "perceived" sound that has no external source. This definition of tinnitus causes the condition to be taken less seriously than it should be. Why? Because some people wrongly equate the word "perceived" with the word "imaginary."

People who don't have tinnitus have a hard time understanding the difference. This mindset leads to all kinds of problems and misconceptions by the people who know the tinnitus sufferer (including the treatment professionals). The mindset creates a gap.

Here is a classic case of the gap in action:
Tinnitus treatment professional: "Just ignore your tinnitus."
Tinnitus patient: "I can't. It has become too loud. It is affecting my work, my relationships, and my sleep."
Tinnitus treatment professional: "It is all in your head. Trust me. Just ignore it and it will go away."
Tinnitus patient: "You don't understand. It is just too loud to ignore any longer. Help me."
Tinnitus treatment professional: "Listen, it is a perceived sound. I've treated patients just like you and they just ignore the internal sound and it goes away."

Some people, who do not have tinnitus, can't seem to understand why a tinnitus sufferer cannot just distract his or her brain away from the perceived sound and be healed. In milder tinnitus, it is possible to distract the brain. In some severe chronic cases it may not be. Every tinnitus sufferer is unique. For example, maskers do not work for everyone. Sometimes a person's tinnitus sound is louder than the masker. In fact, the internal sound may be louder than workplace regulations would even allow. It can be downright maddening.

So, how should we redefine tinnitus? Well, let's take a look at how the brain and the central nervous system work together to communicate. Let's imagine that you go in for acupuncture and a needle is pushed into the bottom of your foot, right in the middle of the arch. Your foot's pain transmitter cells would send a signal to the brain, where pain is produced, and you would experience foot pain.

Imagine that a brain surgeon blocks the area in the brain that is responsible for that particular part of your foot and you experience no pain. Or imagine that you are in the brain surgeons office and he or she stimulates that area of the brain so that you feel pain as though a needle is entering your arch, yet there is no needle. Either way, the pain would be identical. One has an external source and the other does not. In the later situation, the needle is perceived but not the pain. Pain is pain. Sound is sound.

The sound that the brain produces to indicate cell damage in the auditory system is identical to sound from an annoying external noise producing object. There is no difference. Therefore, the word "perceived" should be dropped from the definition. It should be assumed that all pain and sound is "perceived" in the brain, whether the source is external or internal, which makes the need for the word "perceived" irrelevant in the definition of tinnitus.

Tinnitus should therefore be redefined as a sound that is generated by the brain to indicate auditory system cell damage. 

Why is this important? Because, the quicker medical practitioners get past the "perceived" notion that the internal sound is somehow different than an externally noise generated sound, the quicker we will gain traction for research and ultimately a cure. As long as people believe that chronic severe tinnitus is imaginary or somehow easily treated or curable (which it is not) then there is less of a drive for a cure. Those with severe chronic tinnitus want a cure. For now, we have to learn to manage it.

Let's try the treatment scenario under the new mindset:

Tinnitus treatment professional: "You say that you are experiencing tinnitus. Let's figure out what type of tinnitus that you have and work on some ways to manage your tinnitus. We have to prevent it from getting worse. We may have to experiment with diet, exercise, and medications to minimize it. It may take awhile to figure out the right combination necessary to minimize your specific tinnitus. Each person's tinnitus is unique. If your tinnitus is chronic and severe, there is no cure yet. But, researchers are working on a cure."

Tinnitus patient: "I understand. I'm willing to try anything at this point, the tinnitus is affecting my work, my relationships, and my sleep."

Tinnitus treatment professional: "I understand. The sound that you hear is your brain telling you that there is something wrong with your auditory system. It is very similar to pain. We have to figure out what is wrong first. Let's run some tests."

Tinnitus patient: "Thank you."

Tinnitus treatment professional: "You are welcome."

Tinnitus: Ice Vest Test Result

I tried the ice vest and it did not relieve my tinnitus at all. However, it was worth a try. The ice vest certainly did not make my tinnitus worse. As I've often mentioned on this site, everyone's tinnitus is unique to that person because the cell damage causing the tinnitus is unique for each person. It is like two pianos that are out of tune, each one needs to be uniquely tuned up. Although an ice vest did not work for me, it may work for you. Conversely, although Scuba diving temporarily relieves my tinnitus for a few hours, it may not work for you.

rTMS treatment looks promising. I'm keeping an eye on that technology.

Tinnitus: Ice Vests

Update: I tried an ice vest as a possible temporary relief source. It didn't work. But it was worth a try. The following post was written before the test. I do still believe that core temperature has something to do with the temporary relief (not cure) that I experience when I scuba dive. 

The role of the hypothalamus, in the brain, is to keep the body in a state of homeostasis. It is my theory that the hypothalamus may be the primary suspect in regulating the high-pitched ringing sound that people hear when their cochlear cells are broken or damaged. Think of it as an internal alarm.

I further theorize that it is possible to deliver relief from the ringing by cooling the body's core temperature down which causes the hypothalamus to react by arresting the internal ringing. To what temperature the cooling needs to take place to shut down the ringing, I do not know.

I do know that when I scuba dive I do experience relief when my core temperature drops and when my core temperature comes back up, after a dive, the ringing suddenly starts again (like a light switch has been turned off and then on again).

Fortunately, I wear hearing aids with maskers built-in and so I keep them close-by. I place the hearing aids in my ears almost immediately after the dive because I know how suddenly the ringing comes back. Recently, after a cold water dive, I exited the water and sat on some stairs looking out at the ocean and I had absolutely no ringing. I enjoyed the quiet. It lasted awhile before it suddenly started again.

Recently, I went diving in 74 degree water and only wore my 5mm sleeveless wetsuit. I was in the water for about an hour and as my body cooled down, at about 10 minutes into the dive I noticed the tinnitus was gone.

I spoke to a fellow diver about this phenomenon and she mentioned that her cousin uses an ice vest to treat MS. Perhaps ice vests may be a possible treatment option for people with tinnitus.  The following is a link to an ice vest. If you decide to try it, please let me know if you experience any results. I just ordered one and I will be sure to post my results on this site.

http://www.amazon.com/Flexi-Freeze-Ice-Vest-Navy/dp/B001P30358/ref=sr_1_1?ie=UTF8&qid=1350339794&sr=8-1&keywords=ice+vests

Tinnitus: Pilates

Many people with chronic severe tinnitus find it very difficult to participate in cardiovascular workouts because the workouts can raise blood pressure and raise AC current levels in the brain which causes the tinnitus to get even louder and then taper down a few hours later. When the tinnitus is louder it can trigger natural brain annoyance responses like depression and mood changes.

If you are doing jumping jacks, running, or bouncing your head in any way as part of your workout you should probably stop doing that because you are creating infrasound waves inside of your cochlea that could be causing more damage to your delicate cilia cells. 

Some medical providers do not know about the infrasound phenomenon and so they generally recommend cardiovascular workouts for tinnitus patients. You have to take control of your health and recognize that you have a choice. You have to know what makes your tinnitus worse and what does not. Avoid what makes it worse regardless of what anyone else recommends. You are the only person in the world who has your unique auditory damage. You are uniquely out of tune (like a piano).

Before my tinnitus became severe, I used to participate in triathlons. I ran, biked, and swam often for training. Now I cannot even imagine participating in a triathlon. But, if I don't exercise then my overall physical health will plummet and the tinnitus will get worse. 

Since I could no longer maintain a triathlete regimen I had to look for an alternative. The best alternative that I've found is Pilates. It does not cure my tinnitus or make me any less aware of the tinnitus. Pilates does keep me from becoming physically unhealthy and possibly prevents my tinnitus from getting worse.

If you live near water, go kayaking once in awhile just to get some fresh air and apply your new Pilates arm strength. Plus, the sound of water is a natural white noise that may mask your tinnitus while you are paddling. Biking is good. Focus on what you can do, not what you can't do.

Occasionally I will attend a stationary bike class but I inform the instructor beforehand that I will not be able to maintain the class pace. They are very understanding. It really is just to get my legs moving. I bring my Bose QuietComfort 15 to class with me. 

What works for me may not work for you. Your tinnitus may be completely different from mine. You may have secondary conditions that might prevent you from certain exercises like Pilates. Your body is made to move. Excessively loud tinnitus is exhausting. It will make you not want to move. You have to compel yourself to do so.  

Tinnitus: Temporary Relief While SCUBA Diving

I've noticed some temporary relief from my tinnitus while SCUBA diving and for a few hours after each dive. When I leave the water and try to listen for the ringing sound it is completely gone. A few hours later, it suddenly returns. I have severe chronic subjective tinnitus.

My theory as to why this happens has to do with temperature. Pressure, at depth, can be ruled out as the source of temporary relief because the cochlea and the brain are fluid filled spaces.

My theory is that as brain temperature cools it causes the AC current, in the brain, to drop causing temporary relief. A few hours later, on land, as the brain returns to its normal temperature the AC current raises back up and the tinnitus suddenly returns. It is like a light switch being turned on and off.

Researchers should be looking at brain temperature control as a possible treatment option. The water that I dive in is typically 52-56 degrees. That is about the same temperature as iced tea. I wear a 3mm hoodie and a 5-7mm wetsuit which keeps me fairly warm but cooler overall than I would be on land. I typically dive in the 25-50ft. depth range.