Tinnitus Poll : Making a distinction of subtypes

[mariovitali]

Dear All,

There has been a poll previously about Tinnitus. Interestingly i read that some people made the connection that tinnitus relates to their symptom severity. Looking more into this symptom i found that there are two types of tinnitus : The one that occurs in both ears and a second type where it occurs in one ear,named SBUTT (Sudden, Brief, Unilateral, Tapering Tinnitus).

It is critical that we understand more about this symptom according to my research and i would be grateful if you can submit your response.

Thank you.

 

[Forbin]

I've had both c) and d), so I'm not sure which to vote for.

 

[mariovitali]

I've had both c) and d), so I'm not sure which to vote for.

Thanks i will change the poll to account for many responses.

 

[Jonathan Edwards]

My understanding from my ENT professor friend is that pretty much everyone experiences SBUTT at times. I certainly do and have done most of my life. I have also had high frequency constant tinnitus in my right ear since I was a teenager - maybe related to a major ear infection as a child. And I have had continuous bilateral tinnitus since going deaf about ten years ago, although it disappears when I have my hearing aids in and I am in an environment with some noise.

And I don't have ME!

 

[mariovitali]

My understanding from my ENT professor friend is that pretty much everyone experiences SBUTT at times. I certainly do and have done most of my life. I have also had high frequency constant tinnitus in my right ear since I was a teenager - maybe related to a major ear infection as a child. And I have had continuous bilateral tinnitus since going deaf about ten years ago, although it disappears when I have my hearing aids in and I am in an environment with some noise.

And I don't have ME!

Thank you Professor Edwards,

If you recall, i kept a log for 434 days for my symptoms and then these entries were analysed to extract any possible associations. Tinnitus (SBUTT type) was identified as a key symptom that would signal further issues. Neck pain to a specific point was associated with POTS.

Of course we must keep in mind that these are observations of one person. I would like to identify the subtypes and the next question will be the frequency of these manifestations (EDIT : I believe that this may be an important differentiating factor). As discussed in my first post in this thread, there are ME patients that may have found a connection of tinnitus with their symptoms.

I believe that we must investigate this fact further.

 

[DokaGirl]

My unilateral tinnitus started in early March of this year. I have not had it before. I've had ME for 34 years.

Thank you @mariovitali for your research.

 

[Andy]

I've had constant bilateral tinnitus for as long as I can remember. I have the impression that it gets louder the less energy I have but that might be a function of reducing the amount of input from other sources to reduce my cognitive load - so I might move to a quiet room and then my tinnitus seems louder, but it's likely it's at the same level and I just have nothing else distracting me from it.

 

[adambeyoncelowe]

It's mostly just one ear, but I think I get it in both ears from time to time.

 

[Lisa108]

Constant bilateral tinnitus here. Loudness increases with onset of PEM, like a (more than usual) sore throat.

 

[chrisb]

I am going to opt out of the poll. I have fairly constant, probably mild, tinnitus in both ears, but have no particular reason to think it associated with ME. It seemsprobably milder than that suffered by other family members.

 

[Ravn]

Constant bilateral tinnitus of mosquito pitch for the last few years, never stops. Possibly started around the time I relapsed from very mild to severe but couldn't be sure.

Seems to be worse when I'm more exhausted but I've been wondering whether it's actually the same but I'm noticing it more because either I'm doing less distracting activity then or because my brain is too tired to filter it out.

Bizarrely it also gets worse while digesting a larger meal.

I also have occasional SBUTT, higher-pitched and louder than the constant bilateral, but I haven't noticed any connection with other symptoms, it seems to be random so I disregarded it for the poll and only voted a).

 

[lansbergen]

As discussed in my first post in this thread, there are ME patients that may have found a connection of tinnitus with their symptoms.

I did and with overall improvement it slowly became less and now is disappeared.

There is still something wrong in my ears that fluctates with other symptoms but no tinnitis anymore.

 

[mariovitali]

I am going to opt out of the poll. I have fairly constant, probably mild, tinnitus in both ears, but have no particular reason to think it associated with ME. It seemsprobably milder than that suffered by other family members.

I do understand but IMHO, tinnitus may not be that easily dismissable. Some thoughts below :


1) Regarding myself, whenever i would supplement with L-Glutamine i would get severe tinnitus (SBUTT). Also the log i kept identified Parmesan cheese as a problem and apparently Parmesan is loaded with Glutamate :

https://www.sciencedirect.com/science/article/pii/B9780123748454000138

I believe the worst part is when i decided to stop eating meat for a month (large amounts of protein also induced SBUTTs to me) : For that period there were no SBUTTs but when i introduced meat again, i had a scary incident of SSHL (Sensorineural Hearing Loss). This is documented to one of my posts on Phoenix Rising

2) Interestingly, my research suggests (as a hypothesis) that excitotoxicity might be the missing piece of the puzzle in the vicious cycle of ME/CFS (if such thing exists).

3) I find several interesting associations of Kynurenine (more specifically Quinolinic acid) with the NMDA receptor (which is part of the machinery of excitotoxic events).

4) Finally tinnitus may be a sign of excitotoxicity in certain individuals :

One major factor for cochlear neurons pathology is excitotoxicity. This is due to an excess release of glutamate, the IHC neurotransmitter. Excitotoxicity occurs when IHCs are damaged, suffer or die. This is why cochlear neurons are affected by ototoxicity, acoustic trauma, or local ischemia (which may be the main mechanism of neural prebycusis). Recent findings have also involved excitotoxicity in triggering some tinnitus.

http://www.cochlea.eu/en/pathology/surdites-neuro-sensorielles/excitotoxicite

 

[mariovitali]

Regarding Quinolinic acid (QUIN) :

Title : Quinolinic Acid: An Endogenous Neurotoxin with Multiple Targets



Quinolinic acid (QUIN), a neuroactive metabolite of the kynurenine pathway, is normally presented in nanomolar concentrations in human brain and cerebrospinal uid (CSF) and is o en implicated in the pathogenesis of a variety of human neurological diseases. QUIN is an agonist of N-methyl-D-aspartate (NMDA) receptor, and it has a high in vivo potency as an excitotoxin. In fact, although QUIN has an uptake system, its neuronal degradation enzyme is rapidly saturated, and the rest of extracellular QUIN can continue stimulating the NMDA receptor.

<SNIP>

QUIN can potentiate its own toxicity and that of other excitotoxins, like NMDA and glutamate, producing progressive mitochondrial dysfunction

Link : https://www.hindawi.com/journals/omcl/2013/104024/

 

[chrisb]

I do understand but IMHO, tinnitus may not be that easily dismissable.

Don't get me wrong. I do not dismiss tinnitus. It can be a profoundly unpleasant symptom. I do not dismiss the idea that for some it may be related to their ME. It is just that in my case I suspect that genetic factors are a stronger influence.

 

[mariovitali]

Tinnitus and the NMDA Receptor :

EDIT : I confirm that stressful situations would also induce SBUTTs

Endogenous dynorphins, glutamate and N-methyl-d-aspartate (NMDA) receptors may participate in a stress-mediated Type-I auditory neural exacerbation of tinnitus.
Sahley TL1, Hammonds MD, Musiek FE.
Author information

Abstract
Tinnitus is the phantom perception of sounds occurring in the absence of an external auditory stimulus. Tinnitus: [1] effects 50 million individuals, [2] often results from acoustic trauma and, [3] is very often exacerbated under stressful conditions. Tinnitus may result from lesions occurring at any location in the auditory system, but its mechanisms are poorly understood. Evidence is provided supporting an endogenous dynorphin-mediated potentiation of glutamate excitotoxicity at cochlear Type-I auditory dendrites that may well exacerbate chronic subjective neural-generated tinnitus during periods of heightened stress. The proposed mechanism is based on the following: [1] lateral efferent olivocochlear (LEOC) axon terminals contain endogenous dynorphin neuromodulators and are presynaptic to cochlear Type-I auditory dendrites that bear both κ-opioid and N-methyl-d-aspartate (NMDA) receptors/binding sites

https://www.ncbi.nlm.nih.gov/pubmed/23313584

 

[Peter T]

I selected (e) as for most of the time it is not an issue for me, though occasionally I do hear what sounds like a whooshing blood flow with pulsing in both ears at times when I feel I might (or occasionally do) feint. This subjectively feels it is happening at times of low blood sugar (note, I am not diabetic).

Also there are other random auditory symptoms at times when I am at my worse, but I feel it is not consistent or long lasting enough to warrant the label tinnitus.

 

[mariovitali]

I selected (e) as for most of the time it is not an issue for me, though occasionally I do hear what sounds like a whooshing blood flow with pulsing in both ears at times when I feel I might (or occasionally do) feint. This subjectively feels it is happening at times of low blood sugar (note, I am not diabetic).

Also there are other random auditory symptoms at times when I am at my worse, but I feel it is not consistent or long lasting enough to warrant the label tinnitus.

May i ask if one of the "auditory symptoms" you mentioned resembles a brief (1-2 sec) blockage of hearing on one of your ears ?

 

[fossil]

I ticked a) but I get pulsatile tinnitus as well.

though occasionally I do hear what sounds like a whooshing blood flow with pulsing in both ears

@Peter Trewhitt, have you heard of pulsatile tinnitus?

 

[Maria1]

I don’t think I can describe what I have as Tinnitus. However, I do have a feeling of fluid in my ear which seems to increase when I have a spike in other symptoms. There is bubbling, popping and crackling. No wax so not that.

My ME/CFS started 6.5 years ago and I had ear pressure problems on and off way before (I was a smoker for many years and put the ear problem down to that, along with frequent and prolonged throat infections).

My ME/CFS symptoms have changed over the past years or so; all over pain and headache has become more debilitating. It feels as if there is extra fluid in my body which hurts. I say all over but it’s worse down my left side, the side where my ear pops and bubbles, also the side of my migraines. This fluidy pain is so bad lately I’ve been considering a GP visit but I can’t bear the feelings of paranoia that go along with seeing any doctor!

Your research sounds interesting @mariovitali