Brief Answer:
Greetings once again!

Detailed Answer:
I wish I felt as facile answering neuro-otology questions as other types of neurological phenomenon, however, I do have at least a score if not many more of patients with tinnitus which is very debilitating to them. Unfortunately, definitive treatments are not universal amongst all and what this tells me is that our understanding of the mechanism behind tinnitus remains poor.

However, the concept of a "gain" control or circuit in the brain makes sense to me and if the journal article you read refers to it in this way then, that's good enough for me.

But let me cut to the chase on how I handle debilitating tinnitus in my patients so I don't appear to be foolish try to expound on theory which is unfamiliar to me....there are ways to "gate" the brain or dampen its inputs through habituation and training. That is certainly one way to "turn down" the volume so to speak. The parietal lobe of the brain seems to be the locus for ATTENTION and ATTENTIVENESS along with circuitry tied to the reticular activating system which is in the brainstem. Now, just coincidentally (as if that were really true? Nature is better than that!....Ha!) a pathway dedicated to cochlear nerve transmissions on their way to the temporal lobes for processing exists.

Now, I'm not entirely sure of the anatomy in this case in terms of where the recognition of tinnitus occurs....is it in the end organ (the cochlea), the brainstem, or the audiotry processing centers in the temporal lobes? But no matter, the pathway is there and so whatever the intervention it needs to DAMPEN that circuit.....Many medications could be tried with this concept of nerve action potential dampening....the problem is we lack SPECIFICITY in such medications and the tendency would be not only to dampen the 8th nerve and its inbound routes to the brain.....but ALL nerves could potentially be affected.

Something on the order of hypnotherapy could work at the level of trying to truncate attentiveness at the higher levels of processing.

Or....and this is what I do for many of my patients.....we can insert a device called a White noise generator and set its frequency of operation to one which exactly CANCELS out the sound wave of the frequency being HEARD by the patient. Tinnitus frequency can be meausured. In other words, if you ask a person to describe the frequency of their ringing.....they may even be able to sing it for you....and if their good....ON PITCH! LOL......

This can be determined by a well capacitated and trained audiometry and hearing center. Once the frequency of the tinnitus is known then, a WHITE NOISE CANCELLATION generator can be fitted to the patient so that the sound it emanates and places into the patient's ear canal...depending upon WHICH ear is experiencing the problem (another issue sometimes altogether...but usually not hard to find by a good lab) which will completely cancel the sound waves out of the offending noise. This would be based upon the physical principle of sounc wave negation....almost like a JAMMING device if you will.

When down correctly the results can be literally miraculous to the patient and though the cause may not be treatable....in this particular case the consequence is.....

Again, my apologies if I could not be as fluent in my response to your question as in other instances but I can only offer experiential knowledge from patients I've sent for this procedure and analysis. Neuro-otology is a world unto its own and a fascinating one....just like any system of the body....when it's working....beautiful.....when it's not......BAD! LOL......

A good hearing center can actually document and assess disability severities according to standardized scales of measure and by inventory questions so you may ask your friend if they've run across any such evaluation tools so far that they've been treated. This can give the doctor a more objective way of determining how well certain treatments or approaches may be working.

As always I wish you the best and hope that your friend also finds some utility to some of this information. I can tell you that in the U.S. not all centers offer such services and the cost of white noise generators can be prohibitive for some individuals especially if they are uninsured. Perhaps, in those instances more conservative things such as hynotherapy, biofeedback, meditation, and yoga would be good places to start....while the quest for the underlying problem continues since treating THAT issue would literally be "the best of all worlds!"

Cheers to you young lady and thank you for your confidence in my service once again. I hope it was of some value.

This query has utilized a total of 30 minutes of professional time in research, review, and synthesis for the purpose of formulating a return statement.

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