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andrews65

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 #1 
Hi Dr. Nagler, 

I've been reading about notch therapy (which from a previous post I know you are dubious about). In my research I've seen some opinion that it is possible for tinnitus to be caused by abnormal neuronal activity in the auditory cortex; this is the basis for claims that notch therapy can be beneficial. However this seems counter to what I'd previously understood, which is that tinnitus is caused by inner ear and/or neuronal network generated signals, which an "innocent" auditory cortex then receives. Any "abnormality" is in the inner ear and/or neuronal networks, not in the auditory cortex.  

Do you have a view on the above? If it is possible for tinnitus to be caused by some oddity in how the auditory cortex neurons are working, I can't see how habituation is possible in this circumstance, since my understanding is that habituation happens as the neuronal networks between ear and cortex gradually stop amplifying and start blocking the problem signals.  thanks, Andrew.
Dr. Nagler

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Originally Posted by andrews65
I've been reading about notch therapy (which from a previous post I know you are dubious about).

For those who might not be familiar with my thinking in the above regard, I am dubious because it would be incredibly easy to perform a reliable and independently verifiable double-blind randomized prospective study on notch therapy - yet to the best of my knowledge the proponents of notch therapy have yet to offer anything even close in support of their claims.

Quote:
In my research I've seen some opinion that it is possible for tinnitus to be caused by abnormal neuronal activity in the auditory cortex; this is the basis for claims that notch therapy can be beneficial.

And that would be my second concern. Namely, I know of no studies that support the idea that tinnitus is caused by some sort of abnormal neuronal activity in the auditory cortex.

Quote:
However this seems counter to what I'd previously understood, which is that tinnitus is caused by inner ear and/or neuronal network generated signals, which an "innocent" auditory cortex then receives. Any "abnormality" is in the inner ear and/or neuronal networks, not in the auditory cortex.

Well, that would open a huge can of worms that for the purpose of this board I would like to keep closed. Suffice it to say that having given this subject considerable thought over more than two decades now, I have come to the conclusion that in tinnitus the brain is doing exactly what it is supposed to do; the problem is that the brain is doing its job too well.
  

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Do you have a view on the above?

Other than what I have written above, no. I would only add that if notched therapy could predictably and lastingly accomplish what it purports to accomplish, then I could shut down my clinic as well as this board with a huge smile on my face and endless appreciation.

Quote:
If it is possible for tinnitus to be caused by some oddity in how the auditory cortex neurons are working, I can't see how habituation is possible in this circumstance, since my understanding is that habituation happens as the neuronal networks between ear and cortex gradually stop amplifying and start blocking the problem signals.

Even were I to agree with your premise, which I do not, that does not rule out habituation as an effective approach. Just because there might be - as you suggest - "some oddity", that does not mean the auditory system ceases to function effectively altogether.

Quote:
thanks, Andrew.

You are most welcome. I hope my response clarifies more than frustrates.

All the best -

Stephen M. Nagler, M.D.
Atlanta Tinnitus Consultants, LLC

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The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi
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