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  • Dr. Rohe | Tinnitus and Hearing Center of Arizona shared a video in group.
    3 months ago

    Dr. Allen Rohe of The Tinnitus and Hearing Center of Arizona in Tempe, Arizona was interviewed on radio station 93.3 KDKB to discuss tinnitus with Jennifer Born, Director of Advocacy with the Ame is now being featured in the community.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    9 months ago

    The dorsal cochlear nucleus (DCN) is the most important brainstem region for relaying auditory signals to the brain. It receives signals from the hair cells in the cochlea as well as signals related to eye movements mediated by the vestibular system. It also receives signals from muscle position sensors in the face, neck, head, trunk, arms, tongue, and temporomandibular joint (TMJ). The DCN acts as a relay and forwards all signals to their appropriate places in the auditory cortex and elsewhere in the brain. Sensory data from muscles and acoustic data from the ears are both relayed to the brain at very nearly the same point in the brainstem.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    9 months ago

    In sensorineural tinnitus, the dorsal cochlear nucleus tries to adapt to the injury to the ear but in doing so creates phantom sounds.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Hyperacusis
    10 months ago

    Categories of Hyperacusis

    Category 1
    Patients are significantly affected by tinnitus, but do not have hyperacusis or subjective hearing loss.

    Category 2
    Patients are affected by tinnitus and have significant hearing loss, but no hyperacusis.

    Category 3
    Patients have hyperacusis, but no prolonged ear discomfort or exacerbation of tinnitus when exposed to noise. Exacerbation of ear discomfort and/or tinnitus is usually brief, and, if present, resets itself by the next morning. Hearing loss, if present, is irrelevant because hyperacusis must be addressed first. Amplification may be considered after the hyperacusis problem is resolved.

    Category 4
    Patients have tinnitus and hyperacusis, but have prolonged (day or weeks) worsening of ear discomfort and/or exacerbation of tinnitus after being exposed to noise. This category must be treated very cautiously and requires careful monitoring.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Misophonia
    10 months ago

    Part 3

    Edelstein, who was not involved in this study, comments “There was a huge gap in the literature until recently. I think this study was a triumphant effort towards gleaning neurophysiological insights on misophonia and its findings fit nicely into the narrative emerging from behavioral research on misophonia.”

    It has also been proposed that altered brain connectivity underlying misophonia may be similar to that occurring in synesthesia, a condition in which one sensory stimulus evokes sensation in a different modality (e.g., the letter “A” is associated with the color red). Faulty enhanced neural connections could theoretically lead to abnormal associations amongst sensory and emotional brain regions in misophonia, although this hypothesis remains untested.

    Pacifying sound distress

    Given the novelty of misophonia, effective therapies have been inadequately assessed. However, there is some support for the use of cognitive behavioral therapy and conditioning retraining. Hopefully, with further research into both its psychological profile and neurobiological underpinnings, misophonia will gain both greater social acceptance and effective treatment options.

    PLOS “The Brain Basis Of “Hatred of Sound”: Misophonia.” NeuroscienceNews. NeuroscienceNews, 24 September 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Misophonia
    10 months ago

    Part 2

    The misophonic brain

    Despite an advancing understanding of the psychological and behavioral manifestations of misophonia, little research has attempted to clarify its neurobiological bases. Researchers suspect that misophonia is not a primary auditory disorder, but rather stems from aberrant attentional or emotional processing later in the brain’s auditory system. There is preliminary support for this explanation from one small EEG study. In an oddball auditory paradigm, misophonic participants showed a smaller N1 evoked potential than controls elicited by unexpected auditory tones, whereas the “pre-attentive” P1 component showed no group difference. The N1 is involved in early attention and detecting sensory changes, suggesting that abnormal attentional signaling early in the auditory processing stream may contribute to misophonia. Interestingly, an altered N1 peak has also been associated with impulsivity, drug abuse and bipolar disorder.

    Recently, researchers used fMRI to examine brain activity in misophonic individuals while they listened to sounds that were neutral, unpleasant or characteristic misophonia triggers. The misophonics rated the trigger sounds as more distressing than the unpleasant or neutral sounds, whereas normal controls rated trigger and unpleasant sounds as similarly annoying, confirming a selective intolerance for triggers by misophonics.

    Critically, the misophonics showed greater activation in the insula than controls during trigger sounds, and this activity increased with greater reported distress. Furthermore, functional connectivity between the insula and other brain regions involved in attention and emotion was altered in misophonics when listening to trigger sounds. Although the insula has been promiscuously implicated in a plethora of cognitive processes, its proposed functions include internal awareness of one’s body and emotional states. Though preliminary, these findings suggest that misophonia is associated with pathological activation of a brain network supporting interception.

    PLOS “The Brain Basis Of “Hatred of Sound”: Misophonia.” NeuroscienceNews. NeuroscienceNews, 24 September 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Misophonia
    10 months ago

    Part 1

    Characterizing the “hatred of sound”

    Since “misophonia” was first coined in the early 2000’s, efforts have been made to characterize its symptoms through patient interview. Although its prevalence remains uncertain due to its still relative obscurity, studies suggest that it typically strikes in adolescence, affects men and women equally, and may occur in much as 20% of the population. The most commonly reported trigger sounds include eating, breathing or repetitive behaviors like typing or pen clicking. Hearing such sounds often evokes uncontrollable irritation, disgust or anger, which the individual recognizes as socially inappropriate. Therefore, the misophonic may try to suppress any outward reaction, with few acting upon their urges with verbal or physical aggression. These aversive responses in fact manifest as measurable physiological arousal. Compared to healthy controls, misophonic individuals have excessive skin conductance responses to auditory stimuli, and the magnitude of these skin responses correlates with how distressing the participants perceive the sounds.

    An undiagnosed disorder?

    The symptoms of misophonia largely overlap with other clinically accepted psychiatric disorders, including obsessive compulsive disorder (OCD), post-traumatic stress disorder, and various phobias. Some individuals reporting misophonic symptoms also have comorbid psychiatric conditions such as attention-deficit hyperactivity disorder, hypochondria, OCD, or eating disorders. Although some experts advise that misophonia be identified as a unique psychiatric disorder, it has yet to be included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

    Miren Edelstein, a graduate student at the University of California San Diego who researches misophonia, explains that “The uncertainty surrounding the official status of misophonia as a discrete disorder stems from the fact that it does indeed have some similarities with other existing conditions. However, while some misophonics definitely do suffer from some of these other existing conditions, many do not and report no other ailments whatsoever. Because of this variation, I don’t believe another existing disorder can completely account for the specific constellation of symptoms present in misophonia.”

    PLOS “The Brain Basis Of “Hatred of Sound”: Misophonia.” NeuroscienceNews. NeuroscienceNews, 24 September 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    10 months ago

    Part 3

    Study details

    Shore and her colleagues are based in U-M's Kresge Hearing Research Institute, which is part of the Department of Otolaryngology at Michigan Medicine, U-M's academic medical center. Co-first authors Kendra Marks, David Martel and Calvin Wu are members of the Shore laboratory.

    They recruited a particular kind of tinnitus sufferer for their study: those who can temporarily alter their symptoms if they clench their jaws, stick out their tongues, or turn or flex their necks. These maneuvers, Shore says, appear to be self-discovered ways of changing the activity of fusiform cells -- providing an external somatosensory signal to modulate their tinnitus.

    The U-M device delivers sounds matched to the loudness and pitch of the phantom sounds that each patient hears. It also delivers mild electrical impulses applied to the area of the head involved in the patients' own tinnitus-altering maneuvers.

    The crucial timing of the auditory and electrical stimulation came directly from tests in guinea pigs that had noise-induced tinnitus, reported in the new study. Those tests showed that specific timing between delivery of the two kinds of stimuli was necessary to suppress the hyperactive fusiform cells.

    After patients had the device calibrated to their own tinnitus symptoms, they learned to apply its earphones and electrodes for a 30-minute session each day. Half the group received the bimodal sound-and-electricity treatment for the first four weeks, while the other half received just sounds. Then, they all took a four-week break, and started the next four weeks receiving the opposite of what they'd received before. None of them knew which option they got first.

    Every week, the patients took a survey about how much their tinnitus was affecting their lives, and a test of how loud their tinnitus sounds were.

    Results in human participants

    Overall, the loudness of phantom sounds decreased only after the actual, or bimodal, treatment, but not the sham treatment of sound only. For some the decrease was around 12 decibels, about the magnitude of an electric light bulb's hum. Two participants said their tinnitus disappeared completely.

    Michigan Medicine - University of Michigan. "Specially timed signals ease tinnitus symptoms in first test aimed at the condition’s root cause." ScienceDaily. ScienceDaily, 3 January 2018

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    10 months ago

    Part 2

    A dual-stimulus approach to treating tinnitus

    The approach, called targeted bimodal auditory-somatosensory stimulation, involves two senses. The device plays a sound into the ears, alternating it with precisely timed, mild electrical pulses delivered to the cheek or neck.

    This sets off a process called stimulus-timing dependent plasticity, or STDP, which was first explored in animals and led to long-term changes in the rate at which the nerves fire. The approach aims to reset the activity of fusiform cells, which normally help our brains receive and process both sounds and sensations such as touch or vibration -- what scientists call somatosensory inputs.

    Under normal conditions, fusiform cells help our brains focus on where sounds are coming from, and help us tune out sensations that result from the movement of our own head and neck.

    But the U-M team's previous work in animals showed that loud noise can trigger a change in the nerve cells' activity -- altering its timing so that they fire off synchronized signals spontaneously instead of waiting for an actual sound in the environment.

    The toll of tinnitus

    These events in animals parallel what happens in humans. After exposure to such things as loud noises, head or neck trauma, or other triggering events, some people develop a persistent sensation that they're hearing sounds like ringing or a grinding noise.

    Approximately 15 percent of Americans have some level of tinnitus, but the worst symptoms occur in about 10 percent of sufferers, according to estimates based on interviews with nationally representative samples of Americans. Many of those with more severe tinnitus also have hearing loss.

    Some cases are severe. As many as 2 million people can't work or carry out other daily activities because of the tinnitus itself, or the psychological distress it causes them. Tinnitus is the most common cause of service-connected disability among veterans of the U.S. military.

    Current approaches to tinnitus treatment focus include efforts to address the psychological distress it causes, for instance through cognitive behavioral therapy. Other approaches use sound to mask the phantom sounds or attempt to modulate the brain response.

    Michigan Medicine - University of Michigan. "Specially timed signals ease tinnitus symptoms in first test aimed at the condition’s root cause." ScienceDaily. ScienceDaily, 3 January 2018

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    10 months ago

    Part 1

    Millions of Americans hear ringing in their ears -- a condition called tinnitus -- and new research shows an experimental device could help quiet the phantom sounds by targeting unruly nerve activity in the brain.

    In a new study in Science Translational Medicine, a team from the University of Michigan reports the results of the first animal tests and clinical trial of the approach, including data from 20 human tinnitus patients.

    Based on years of scientific research into the root causes of the condition, the device uses precisely timed sounds and weak electrical pulses that activate touch-sensitive nerves, both aimed at steering damaged nerve cells back to normal activity.

    Human participants reported that after four weeks of daily use of the device, the loudness of phantom sounds decreased, and their tinnitus-related quality of life improved. A sham "treatment" using just sounds did not produce such effects.

    Results from tests in guinea pigs and a double-blind human study funded by the Coulter Foundation validate years of preclinical research funded by the National Institutes of Health, including previous tests in guinea pigs.

    The U-M team has new NIH funding for an additional clinical trial to further refine the approach. U-M holds a patent on the concept behind the device and is developing it for potential commercialization.

    "The brain, and specifically the region of the brainstem called the dorsal cochlear nucleus, is the root of tinnitus," said Susan Shore, the U-M Medical School professor who leads the research team. "When the main neurons in this region, called fusiform cells, become hyperactive and synchronize with one another, the phantom signal is transmitted into other centers where perception occurs.

    "If we can stop these signals, we can stop tinnitus. That is what our approach attempts to do, and we're encouraged by these initial parallel results in animals and humans."

    Michigan Medicine - University of Michigan. "Specially timed signals ease tinnitus symptoms in first test aimed at the condition’s root cause." ScienceDaily. ScienceDaily, 3 January 2018

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Musicians Clinic
    10 months ago


    Using his model Wenmaekers calculated the effect of the most commonly used sound-reducing measures, like screens and higher plateaus for the different sections in the orchestra. Those effects appeared to be very small since the main source of the sound was the player's own instrument. The same cause lies behind the relatively small impact (around 3 d of the sound-intensifying effect of small orchestra playing areas like covered orchestra pits. According to Wenmaekers it is still advisable to avoid such small orchestra playing areas but then again, the sound levels are still too high in other areas.

    The only thing that really helps is to play more quietly or to use earplugs. Musicians have long been advised to play using earplugs but now it has been proven that there is no other feasible measure that can be taken.

    Too late

    Wenmaekers, himself a musician, realizes that this is not really what the doctor ordered. "A musician with poor hearing risks losing his job. So to avoid this, earplugs are inevitable. At the same time, you want to perform as well as possible, so earplugs may hinder this. Musicians will have to get used to playing with earplugs from a young age because once you have a hearing problem you are too late."

    Getting away with it

    There is, however, one part of the orchestra that can get away with it in part, the cello and the bass sections. These instruments produce a relatively soft sound and thus present no risk by themselves. The sound that affects the ears of the cellists and bassists tends to be generally lower and comes mainly from the other orchestra sections. So for this group there may be other interventions that are effective apart from earplugs.

    These results were published this month in the Journal of the Acoustical Society of America.

    Eindhoven University of Technology. "Earplugs unavoidable for musicians in the orchestra and at home: Own instruments are often responsible for excess noise levels." ScienceDaily. ScienceDaily, 22 November 2017

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona Musicians Clinic
    10 months ago

    Many musicians suffer ear damage. Professional orchestras have therefore taken measures in recent years to reduce the sound levels. Studies now reveal that physical measures, like placing screens between sections or creating more space between them, have little effect. This is due to one's own instrument contributing just as much to the sound level that reaches the ear as all the orchestra's instruments together. So experienced musicians that play alone at home -- whether professionals or amateurs -- also produce excessive sound levels. The only solution that really helps is earplugs.

    The eardrums of trumpet players and flute players are the most burdened. During loud passages they are subjected to average decibel levels of 95 to 100 dB(A), just from their own instruments. The violin and viola produce decibel levels in excess of 90 dB(A) for their players. These levels are similar to those of a rock concert. They also well exceed the 85 dB(A) limit that European regulations stipulate for the compulsory wearing of ear protection on the work floor.

    Close to the ears

    Acoustics expert and researcher Remy Wenmaekers got these results using a calculation model he developed to work out the level of sound close to the ears of musicians. Wenmaekers chose to use a calculation model rather than measurements on the spot where musicians play their instruments. The reason is musicians never reproduce exactly the same level of sound, which makes comparison of experiments with 'real' musicians virtually impossible.

    As a foundation for his model he used recordings of orchestra music per instrument made in an anechoic chamber (a room without an echo). The model takes account of the direction of the sound of the instruments, the listening orientation of the receivers, reflection of sound, and blocking by people (the musicians themselves). He compared the results of his model with measurements in a real orchestra and there appeared to be a good correspondence.

    This video shows the sound levels at the ears of musicians as calculated by Wenmaekers' model, for the first two minutes of Mahler first symphony (4th movement). It clearly shows sound levels exceeding 100 dB(A) repeatedly.

    Eindhoven University of Technology. "Earplugs unavoidable for musicians in the orchestra and at home: Own instruments are often responsible for excess noise levels." ScienceDaily. ScienceDaily, 22 November 2017.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    12 months ago

    Tinnitus: Ringing in the Brain | Josef Rauschecker | TEDxCharlottesville. Published on Jan 23, 2017,
    In this talk Josef Rauschecker illuminates the science behind tinnitus as well as the current state of treatment options.
    Josef Rauschecker has 35 years of experience in systems and cognitive neuroscience, more than 25 years of experience in animal electrophysiology, and upwards of 15 years of experience with functional magnetic resonance imaging (fMRI). At Georgetown University Medical Center, he helped create the first human fMRI research facility. He has also held visiting appointments at several institutions, including Harvard Medical School, and has been the recipient of a Humboldt Award and a Finland Distinguished Professorship.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    12 months ago

    Approximately one in 10 adults in the U.S. have tinnitus, and durations of occupational and leisure time noise exposures are correlated with rates of tinnitus and are likely targetable risk factors, according to a study published online by JAMA Otolaryngology-Head & Neck Surgery.

    Tinnitus is a symptom characterized by the perception of sound in the absence of an external stimulus. If persistent and intolerable or sufficiently bothersome, tinnitus can cause functional impairment in thought processing, emotions, hearing, sleep, and concentration, all of which can substantially and negatively affect quality of life. Tinnitus is a common problem for millions of people. A large epidemiologic study of tinnitus and its management patterns in the U.S. adult population is lacking.

    Harrison W. Lin, M.D., of the University of California, Irvine, and colleagues conducted an analysis of the representative 2007 National Health Interview Survey (raw data, 75,764 respondents) to identify a weighted national sample of adults (age, ? 18 years) who reported tinnitus in the preceding 12 months to quantify the epidemiologic features and effect of tinnitus and analyze the management of tinnitus in the United States relative to the 2014 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines.

    Among an estimated (SE) 222.1 (3.4) million U.S. adults, 21.4 (3.4) million (9.6 percent) experienced tinnitus in the past 12 months. Among those who reported tinnitus, 27 percent had symptoms for longer than 15 years, and 36 percent had nearly constant symptoms. Higher rates of tinnitus were reported in those with consistent exposure to loud noises at work and during recreational time. Years of work-related noise exposure correlated with increasing prevalence of tinnitus.

    In terms of subjective severity, 7.2 percent reported their tinnitus as a big or a very big problem compared with 42 percent who reported it as a small problem. Only 49 percent had discussed their tinnitus with a physician, and medications were the most frequently discussed recommendation (45 percent). Other interventions, such as hearing aids (9.2 percent), wearable (2.6 percent) and nonwearable (2.3 percent) masking devices, and cognitive behavioral therapy (0.2 percent), were less frequently discussed.

    The JAMA Network Journals. "Prevalence, severity of tinnitus in the US." ScienceDaily. ScienceDaily, 21 July 2016. <www.sciencedaily.com/releases/2016/07/…

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    1 year ago

    In a study published online by JAMA Otolaryngology-Head & Neck Surgery, researchers evaluated the effect of a cognitive training program on tinnitus.

    Individuals with tinnitus have poorer working memory, slower processing speeds and reaction times and deficiencies in selective attention. Neuroplasticity (the brain's ability to reorganize itself by forming new neural connections) has been the foundation for the creation of several cognitive enhancement programs intended to slow normal aging and potentially improve disorders such as attention deficits. Brain Fitness Program-Tinnitus (BFP-T) is a cognitive training program specially designed to exploit neuroplasticity for preservation and expansion of cognitive health in adults with tinnitus.

    Jay F. Piccirillo, M.D., of the Washington University School of Medicine in St. Louis, and Editor, JAMA Otolaryngology-Head & Neck Surgery and colleagues randomly assigned 40 adults with bothersome tinnitus for more than 6 months and 20 age-matched healthy controls to a BFP-T or non-BFP-T control group. Participants in the intervention group were required to complete the BFP-T online one hour per day, five days per week for eight weeks. The BFP-T contains 11 interactive training exercises (simple acoustic stimuli, continuous speech, and visual stimuli) in an attempt to address the attentional effect of tinnitus.

    Tinnitus assessment, neuroimaging, and cognitive testing were completed at baseline and 8 weeks later. The controls underwent neuroimaging and cognitive assessments.

    The researchers found that patients with tinnitus in the BFP-T group had improvements in tinnitus perception, memory, attention, and concentration compared with patients in the non-BFP-T control group. Neuroimaging changes in brain systems responsible for attention and cognitive control were observed in patients who used the BFP-T. "A possible mechanistic explanation for these changes could be neuroplastic changes in key brain systems involved in cognitive control," the authors write.

    No changes in behavioral measures were observed between the two tinnitus study groups.


  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    1 year ago

    What triggers tinnitus?
    Tinnitus is more common in people with hearing loss, caused by damage to the cochlea or the auditory nerve. Tinnitus can be due to exposure to loud noise (instantly from an explosion or multiples experiences over a long period of time), medications that damage the auditory nerve, middle ear problems (such as infections and vascular tumors) and aging as hearing loss gradually develops.
    Tinnitus can also be a symptom of Meniere's disease, a disorder of the balance mechanism in the inner ear. Some drugs like aspirin, certain antibiotics, antimalarial drugs, anti cancer and anticonvulsants can also trigger tinnitus or worsen its perception. The experience of tinnitus can be bearable for some, and annoying and painful for others.
    Tinnitus induces a temporary period of hearing loss or a "hard-of-hearing" experience, where the whole world appears to have turned down its volume. During this period, cells in the dorsal cochlear nucleus try to compensate for this low surrounding volume by boosting their signal.
    This intervention is successful, but by the time the temporary hearing loss disappears, the signal boost has been stored as a "memory" in the dorsal cochlear nucleus, a memory which is not easily forgotten. The consequences of this scenario is tinnitus, a false signal generation which is perceived in the absence of an external stimulus. Limiting noise exposure or wearing ear protection are the best safeguards.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona
    1 year ago

    Phantom sounds
    The generation and transmission of signals in the brain are subject to constant changes. In particular, signals can be boosted or tuned down in a process known as "plasticity". When signals are boosted, it is referred to as "long-term potentiation", a process which is critical in our ability to learn and store memories.
    Knowing that tinnitus is a phantom sound which does not exist in the outside world but is perceived, suggests that somewhere in the brain there are cells generating a false signal in response to a sound which does not exist. Studies show that auditory signals are transmitted from the cochlea, in the inner ear, to a brain structure called the dorsal cochlear nucleus.
    Cells in the dorsal cochlear nucleus are capable of boosting their signals. Exposure to loud sound prevents the dorsal cochlear nucleus from boosting its incoming signals. What was even more interesting was that loud sound exposure turned up the dials, saturated the signal transmission and left no more room to boost the signal any further. Exposure to loud sound therefore altered brain plasticity, leaving the dorsal cochlear nucleus in a compromised state.

  • Dr. Rohe | Tinnitus and Hearing Center of Arizona shared a video in group.
    2 years ago


    Research has revealed how the hyperactivity behind tinnitus can be observed in the auditory cortex. The auditory cortex is physically organized according to the pitch of sounds that it perceives, from low to high pitch.

    The Desyncra™ proprietary pitch-matching procedure makes use of this to target the therapy to the hyperactive region in the auditory cortex.


    The Desyncra for Tinnitus therapy is delivered using therapeutic tones via an iPod and Desyncra earphones. The therapy takes place over a 36 week treatment period.

    The noninvasive, targeted therapy is tailored to the patient’s tinnitus profile and is adjusted periodically throughout the therapy to ensure it remains optimized.

    For more information please visit www.desyncra.com

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