What is Tinnitus?
Tinnitus is a common problem that, in different forms, affects around 20% of the population. It manifests as a perception of a ringing, buzzing, whistling or roaring noise, often of high-pitched or variable quality, in the head, or in one or both ears. It may be fleeting, recurrent or persistent. Symptoms more often persist and those afflicted often describe them as ranging from distracting to annoying to painful. In a few, tinnitus may present as no more than a difficulty concentrating or focusing on actual sounds in the environment. While tinnitus can be a standalone condition in itself and idiopathic, it may be a symptom of several preexisting or underlying conditions, ranging from inner ear damage by viral infection to other neurological conditions like multiple sclerosis (MS). In the majority of those afflicted, however, tinnitus does not point to anything sinister or serious etiology.
Tinnitus can be caused by injuries to the ear or head, recurrent or prolonged exposure to loud sounds (especially those high-pitched), loud percussive noises; or it could be an age-related idiopathic degeneration, referred to as Presbycusis. Tinnitus may even be a disorder of the circulatory system, affecting the small vessels feeding the cochlea, in the inner ear. The latter, of course, is the helical organ, which transduces the mechanical movements of the eardrum (transmitted along the three little ossicles, bridging the middle ear) into electrical signals transmitted along the vestibulocochlear nerve (8th cranial or auditory nerve) to the brain. As the sound waves reach the eardrum via the outer ear canal (the external auditory meatus) they make drum oscillate in a way that reflects the characteristics of the sound. Those oscillations are transmitted to the tiny bone called “hammer” (malleus) that is attached to the drum. The hammer, in turn, communicates the vibrations to the second little bone or ossicle, known as the “anvil” (incus). From the incus, the oscillations travel to last ossicle, the “stirrup” (stapes) that has a little piston, which fits into a corresponding hole in the inner ear. The rapid oscillations of this tiny piston cause compression waves in a body of gelatinous material, contained in a helical structure called cochlea (helix). The nerve endings of the auditory (vestibule-cochlear) nerve that go to the center of the helical cochlea (via the cochlear nerve) connect to tiny hairs or bristles, which protrude into the jelly of the cochlea. Any vibrations in the jelly, caused by the stapedial piston are detected by the bristles which bend and sway with extreme fidelity, generating specific electric signals that travel along the auditory nerve to the brain. The brain is endowed with the power to decipher the information. Any damage or interference with the aforementioned chain of sound transmission and transduction from sound waves in the air at the outer ear to electromagnetic impulses at the brain, can lead to varying degrees of hearing loss and/or tinnitus. To recap, the sound waves at the eardrum transmit along the three ossicles, through the jelly, mechanically moving the bristle to generate electricity in the eighth nerve, ending up as electromagnetic signals at the brain.
As previously noted, tinnitus can either be caused or worsened by a number of different entities. Damage or pathophysiology at the cellular level could be one of them. As the tiny hairs of the cochlea sway and bent with the oscillations of the jelly, excessive strain and bending may damage or even fracture them. Damage to the hairs from excessive oscillations often result from trauma and damage caused by high sound pressure levels (SPL’s) such as those found at construction sites, concert venues, shooting ranges, etc.; and once damaged those bristles are not known to regenerate. The nerve signals from the damaged bristles can “leak” as aberrant signals, eventually being perceived and interpreted by the brain as bizarre noise like tinnitus, that does not match reality.
As mentioned, this sound manifests as a buzzing, ringing or hissing sound, or variations thereof, which can be relentless and continuous. Age-related hearing loss, also known as Presbycusis, is another common cause of tinnitus. Other conditions, a few of which can be more serious or even sinister, may cause tinnitus. Meniere’s disease is one of those serious conditions, which in addition to tinnitus, may include loss of hearing, vertigo, migraines, etc. it is an inner ear disorder of uncertain cause, which has no cure. Acoustic Neuroma is a benign tumor of the auditory nerve, which is serious by virtue of it being in a very hard-to-get-to area of the skull, where the inner ear is located- the “petrous” (rock-hard) bone.
Prevention and Management
Oftentimes, the best method is simple measures to address the risk factors for the condition itself. Over time, as outlined above, exposure to loud noise can damage the delicate structure and physiology of the ear; so, the best preventative method is to protect the fragile mechanism of sound transmission along the ear-complex. Avoiding situations that involve exposure to loud and persistent noise, is always sound advice; and if those situations cannot be avoided, then one should invest in hearing protection. Over the ear noise canceling protective headphones can cut out a lot of the damaging SPL waves and protect the delicate inner ear mechanics from harm.
Long-term exposure to amplified music or listening at a very high volume through earphones can similarly cause hearing loss and tinnitus. Not only do earphones directly funnel high SPL waves into your ear, but long-term earphone use can trap dirt, bacteria, and wax in the ear itself further raising the risk of hearing loss and tinnitus symptoms.
Management of tinnitus once the damage is done comes down to treating any underlying conditions first. Following a hearing test and general symptom assessment, specialists will usually look at the removal of any impacted earwax, treating any underlying blood vessel or vascular conditions, and changing a patient’s medications or life-style if either or both could be a contributing factor. Many patients have had success with noise suppression therapy utilizing white noise machines or masking devices, worn by the patient. These devices produce a specific frequency of white noise to cancel out the internal stimuli caused by tinnitus. Over time, utilizing tinnitus retraining methods, the brain can be programmed to simply “ignore” the signals that result in the tinnitus. Many patients report that their symptoms do not appear to be present unless they specifically focus on them. Certain medications have similarly been proven to reduce the severity of the symptoms. While these medications are helpful, like most medications, they may exhibit side effects such as drowsiness and nausea; so, all medications should be used with caution, through a specialist provider.
As we have pointed out in many of our previous blogs, Autologous Stem Cells have been harvested and put to work with extraordinary results for a wide variety of conditions. The nature of Stem Cells allows them to differentiate into whatever type of tissue the body requires, from blood vessels to muscle fibers to neurons. This ability seems perfectly suited to the challenge presented by tinnitus. When irreplaceable nerve fibers are damaged and misinform the auditory nerve causing literal “noise” in the communication process, it makes sense to employ a biological agent of change that is multipotent enough to help repair the damaged connections. In the cases of hearing-loss-related tinnitus, Stem Cells could possibly repair the damaged tissues and restore better function to the inner ear. In 2013, a patent was granted for this exact application. The utilization of adult Stem Cells from the patient’s own adipose tissue, in the form of Stromal Vascular Fraction (SVF), to treat tinnitus has been explored by various research groups- including our own. One study led by Rutgers University isolated a gene called NEUROG1 to instruct Stem Cells in the inner ear to become auditory neurons. Other studies are taking different routes to achieve positive results, and we expect to see stem cell therapeutics, for a variety of diseases (including tinnitus), change dramatically in the next few years, approaching the issues from different perspectives.
Who We Are
While tinnitus sufferers should understand that research leading to the development of a therapy is a process which naturally takes time, Autologous Stem Cell utilization is becoming increasingly commonplace in experimental studies and research, here in the United States. These perfectly safe procedures are gaining momentum; and more practitioners are becoming aware of the body of evidence, which supports the positive contribution from SVF in reducing or eliminating symptoms through its anti-inflammatory, immuno-modulatory and regenerative functions. We at Gulf Coast Stem Cell Regenerative Center, an affiliate partner of the Cell Surgical Network, conduct patient-funded research with the intention of treating patients with their own Autologous Stem Cells. We aid in the management of autoimmune, degenerative, inflammatory, and ischemic conditions, and our highly skilled team of providers is committed to the goal of alleviating symptoms, enhancing functionality, and improving overall quality-of-life for our patients.
While much of this research is still in the early stages, the Gulf Coast Stem Cell and Regenerative Medicine Center (GCSC) is excited to be at the forefront of medicine’s future. Utilizing state-of-the-art research methods and some of the most dedicated minds in this country, we endeavor to push forward the progress of regenerative medicine while bringing the exciting results and new procedures home to help our local community. Further, Gulf Coast Stem Cell uses a safe and minimally invasive procedure to collect and utilize the patients’ own adipose-derived stem cells for use in the management of various pathologies and health conditions. Interested patients can fill out a confidential candidate application or call (866) 885-4823. A dedicated member of the Gulf Coast Stem Cell and Regenerative Medicine Center team will address any questions or thoughts you may have. For more information, please visit our website.