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Medical Forum / Diseases and Disorders / Tinnitus / April 2004tinnitus after dive (Newbie)
I was scuba diving on vacation and on my last dive I noticed my left ear was ringing. I had a little problem equalizing and then ascended a few feet to try again. I never felt any pain, but my left ear has been ringing ever since I got out of the water on that friday afternoon dive. It's been ringing constantly for 4 days now. I don't feel any pressure in my ears and I am able to "pop" (equalize) them. Yesterday, I went to see my regular doctor and he has put me on Pseudoephedrine/Guaifenesin (a decongestant) and Amoxicillin (a antibiotic) Aside from the tinnitus I haven't experienced any other problems (vertigo, etc) The doctor looked at my eardrums and said they both look fine, but since I was suspecting inner ear barotrauma I didn't necessarily expect the eardrum to look abnormal I thought that I may have ruptured one of the round/oval windows, but I haven't experienced any loss of balance or vertigo which I would expect if this was the case. Any advice would be greatly appreciated. Anyone have a similar experience? Thanks. Are you a new diver? What is your normal rate of ascent. Do you make any decompression/safety stops? R. > I was scuba diving on vacation and on my last dive I noticed my left ear was > ringing. I had a little problem equalizing and then ascended a few feet to [quoted text clipped - 16 lines] > > Thanks. Yes, I am a new diver -- we just got open water certification before our vacation. The dive after which my tinnitus began was a 30 foot dive with a shore entry. We didn't make a typical safety stop, like we did during our boat dives, but we did asend very slowly. Perhaps not slow enough? I was with my wife the entire time and she hasn't experienced any problems... but different people different bodies, consumption rates etc. I'm certainly not trying to cover any possible rookie mistakes I may have made as more than anything I want to figure out what to do about this ringing. If I ascended too rapidly could this cause the ringing? Also, I never felt fatigued or any other symptom of DCS -- but as I mentioned I'm new to scuba and I'm not a doctor... Thanks. > Are you a new diver? > [quoted text clipped - 30 lines] > > > > Thanks. Trevor I'm interested in what you said - Youre one of the few people I've met that maybe has a similar scientific approach to myself. Do you have a biology/neuro background, or did you pick this knowledge up after getting tinnitus? you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs or do a google groups search on 'groups:alt.support.tinnitus author:tonyjeffs fistula' or 'author:tonyjeffs oval window' I'm in Liverpool Uk. If you are interested in a telephone chat, email me on my REAL email address which is 9 at tonyjeffs dot com & I'll phone you.(but I wont stay on too long if you're in USA!) Tony http://www.tonyjeffs.com/tinnitus I am in the U.S. and I have no background in medicine. I am a computer programmer with a strong interest in science... My thoughts, concerns and tests were primarily based on things I learned during my scuba class and after as I researched Tinnitus. I had actually read Dr. Murray Grossan's article before he even mentioned it, but went and read it again after he mentioned it in a post. His article helped me decide to seek out an ENT as soon as I could. (Thanks Dr. Grossan.) Unfortunately, it took me a week to see an ENT because my general practitioner didn't seem to think I had anything to worry about and hesitated to refer me to an ENT. When I finally saw an ENT she told me it was serous otitis media (fluid in the middle ear without infection). That is probably what my general practitioner thought as well, but he never gave it a name and I felt I should see an ENT anyway. Further research shows that serous otitis media is fairly common in congested young children because their Eustachian Tubes are less developed and more horizontal. Although it doesn't sound like children experience tinnitus with this, it seemds to occur in adults with fluid in the middle ear. Another effect of havng fluid in the middle ear is a loss of hearing in the effected ear of about 30dB... which fits my case. So even though I am still experiencing the same problems (tinnitus with loss of and 30+/- dB loss of hearing in frequencies greater than 5500 Hz. My current plan is to do more aerobic excerise and drink lots of hot tea to help open my ET's and get the fluid drained as soon as possible. The exercise bit is based on my past experience of aerobic exercise clearing up any congestion for the duration of the exercise when I had a cold or allergies... So far this exercise seems to be rather productive in cleaning out my ears. Yesterday I went rollerblading and was able to get some mucous and blood from my left nostril -- which was clearly coming from my ear. I later went for a run and it produced a little more. I was really hoping that my hearing loss and tinnitus would be improved immediately upon these discharges, but so far there has little/no change -- even after a night of sleep. Another issue for me which I find worth mentioning is that I had bad allergies growing up and it turned my into a "chronic mouth breather" -- which means I breath through my mouth almost all the time... Having just learned that the ET's are connected to the throat behind the nasal cavity, I decided to inhale through my nose as much as I could while I was exercising -- just taking natural breaths. In my mind the idea was to create a slight suction on the ET's -- sort of like a reverse valsava maneuver, but not at all forceful. This helped tremendously in getting the fluid from my ear to come down the eustachian tubes and finally out. (This idea is probably entirely natural to most people, but being a "chronic mouth breather" I had to think about it.) My theory to the tinnitus and hearing loss, should there be inner ear damage, is that it is cochlear damage and not damage to the round or oval windows and that is why I haven't experienced vertigo or other such symptoms. For the most part I am trying to be optimistic and believe that it just takes time to heal and that the tinnitus will go away and a large part of my hearing will return. Though the longer this goes on without improvement the more difficult it becomes to remain optimistic, but for the meantime I'm trying to fight it as well as I can... In the scuba world it looks like I have experienced a "middle ear squeeze" which can be anywhere from mild to severe... with the most severe causing inner ear damage to the oval window, round window, or the cochlea. > Trevor > I'm interested in what you said - Youre one of the few people I've met [quoted text clipped - 3 lines] > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > or do a google groups search on 'groups:alt.support.tinnitus > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 9 lines] > Tony > http://www.tonyjeffs.com/tinnitus This often can happen on ascent. You mentioned allergies, this should have been caught on the medical questionnaire you signed before taking the scuba course. Its not necessarily the end of the diving. There are options that may allow you to continue to dive. > In the scuba world it looks like I have experienced a "middle ear squeeze" > which can be anywhere from mild to severe... with the most severe causing [quoted text clipped - 7 lines] > > > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > > or do a google groups search on 'groups:alt.support.tinnitus > > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 9 lines] > > Tony > > http://www.tonyjeffs.com/tinnitus I was aware that allergies could be a problem, but I was not having any allergy problems at the time. My allergies have improved much since my childhood. (We had cats - a lot of them on the farm... and they were allowed in the house... I loved them, but was allergic to them) I also had hay fever, and now I get hay fever from time to time, but it only acts up for a month or two throughout the year (in MN) -- some years I haven't been effected hardly at all. Though allergies could certainly cause major problems, I was not congested at all and wasn't feeling any allergy problems whatsoever at the time I was diving so I don't think allergies were a factor. On vacation we did a total of 3 dives after our course and we also did a lot of snorkeling. I mentioned that the ringing started after I had difficulty clearing in my last dive, but I think the problem may have started (or been compounded) by earlier breath hold dives while snorkeling when I would dive down head first. Then I had no pain and no after effects. I wasn't breath hold diving to extreme depths, but problems can occur in relative shallow depths as well and when diving head first it is more difficult to equalize. Perhaps I experienced some ear squeeze that put some fluid in my ear, but I experienced no symptoms. I am pretty sure that my problems occured while descending because of equalization problems whether breath hold diving had a factor in it or not I don't know, but I'm certainly not ruling out out completely. I'm still trying to put all the pieces together and I appreciate comments and feedback. I have already learned some valuable lessons (unfortunately the hard way) Though I don't think allergies had any play in this, I certainly will not go diving if I am at all congested. I will also be extra, extra, extra cautious to be sure that I am equalizing well. I thought I was doing a good job already, but clearly I was clearing well enough. I know that some people feel pain when they have problems equalizing. The problem for me is that I didn't feel pain. I just felt pressure, but probably not until the pressure was too great. Pain is generally an indicator telling you to react to the cause. So the theory I have is that since I felt no pain, my reaction was delayed until I felt a lot of pressure (possibly beyond that of what would normally be indicated earlier by pain in other) which put me in greater trouble. -- Or possibly the pain and pressure are synonymous and some people refer to the pressure as pain, but I don't think that is the case... > This often can happen on ascent. You mentioned allergies, this should have > been caught on the medical questionnaire you signed before taking the scuba [quoted text clipped - 12 lines] > > > > > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > > > or do a google groups search on 'groups:alt.support.tinnitus > > > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 9 lines] > > > Tony > > > http://www.tonyjeffs.com/tinnitus Pain is not an indicator that you should equalize, pain indicates that you went too far before equalizing. You need to stay ahead of the problem, not create a problem that needs solving. > I was aware that allergies could be a problem, but I was not having any > allergy problems at the time. My allergies have improved much since my [quoted text clipped - 57 lines] > > > > > > > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > > > > or do a google groups search on 'groups:alt.support.tinnitus > > > > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 9 lines] > > > > Tony > > > > http://www.tonyjeffs.com/tinnitus Exactly! I knew it and thought I was doing well, but apparently I wasn't. Equalize early and often -- those are words that I don't think I'll ever forget again! As a new diver I may have got too distracted by the many fascinating wonders of the underwater world so along with the equalizing mantra I'll add an additional one for descending -- Descend consciously and cautiously. > Pain is not an indicator that you should equalize, pain indicates that you > went too far before equalizing. You need to stay ahead of the problem, not [quoted text clipped - 79 lines] > > > > > > > > > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > > > > > or do a google groups search on 'groups:alt.support.tinnitus > > > > > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 10 lines] > > > > > Tony > > > > > http://www.tonyjeffs.com/tinnitus You begin equalizing AT THE SURFACE before you begin descending.. Try to keep the pressure on the inner ear slightly higher than the water column. Then every couple of feet. As you get deeper, you will find you need to equalize less often. Try to control your rate of decent. Use an anchor line or a mooring line or do a shore descent. Learn to descend in a head up position, knees bent. Watch your rate of ascent, NO FASTER than 30 feet per minute, not 60 feet per minute as some folks do. As you get closer to the surface, even slower. Do that safety stop. Do several safety stops if you can. Very very slow from 15 feet up. If you are congested, be very careful for the reverse block. Very bad. DO NOT DIVE IF CONGESTED. Use saline spray before a dive to clean up the sinuses. It is common to have a lot of nasal discharge after the first dive (Gorilla Snot). Discreetly cleanup your face and mask before getting back on the boat. It is considered un-cool to climb aboard with this stuff hanging from your chin. Be cool. Sudafed is commonly found in experienced diver's kits. This does not mean you can dive when congested, it is to make things even clearer in the sinuses. As you gain experience, it will become intuitive. Be exceedingly gentle with the ears. If you can find an experienced diver to dive with, even better. > Exactly! I knew it and thought I was doing well, but apparently I wasn't. > Equalize early and often -- those are words that I don't think I'll ever [quoted text clipped - 98 lines] > > > > > > > > > > > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > > > > > > or do a google groups search on 'groups:alt.support.tinnitus > > > > > > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 10 lines] > > > > > > Tony > > > > > > http://www.tonyjeffs.com/tinnitus You might consider posting your question to rec.scuba. You need to be somewhat flame-proof as some of the folks are a tad 'sensitive', but if you can ignore the flies, you will find lots of good advice as well. Many of the regulars have very extensive dive histories. > I was aware that allergies could be a problem, but I was not having any > allergy problems at the time. My allergies have improved much since my [quoted text clipped - 57 lines] > > > > > > > > you can look at my previous postings on this topic on http://groups.google.co.uk/groups?hl=en&lr=&ie=UTF-8&oe=UTF-8&q=+fistula+author% 3Atonyjeffs > > > > or do a google groups search on 'groups:alt.support.tinnitus > > > > author:tonyjeffs fistula' or 'author:tonyjeffs oval window' [quoted text clipped - 9 lines] > > > > Tony > > > > http://www.tonyjeffs.com/tinnitus Actually diving is good for allergy - you breathe clean filtered air, clean ocean air, etc. Unless the asthma is bad, I don't rewstrict nasal alllergy from diving. Murray Grossan, M.D. http://www.ent-consult.com Did you have an audiogram? It is one thing to have fluid in the middle ear, but you can still have changes in the inner ear. By having an air and bone audiogram you can determine if the inner ear needs treatment. Murray Grossan, M.D. http://www.ent-consult.com Yes, I had a pure tone audiogram. The hearing in my left ear is fine until somewhere between 4000-6000Hz, from which my hearing then drops to the point that it needs an additional 40dB to hear those frequencies... I'm not familiar enough to know if there are other types of audiograms. Your reference to a "air and bone audiogram" maybe something else. If so then I don't think I had one. On top of the antibiotic and decongestant I was then prescribed 5 days worth of the steroid prednisone. Which, from my understanding may help if there is some inner ear damage. > Did you have an audiogram? > It is one thing to have fluid in the middle ear, but you can still have changes > in the inner ear. By having an air and bone audiogram you can determine if the > inner ear needs treatment. > Murray Grossan, M.D. > http://www.ent-consult.com Hi Trevor, A lot of people put tinnitus down to neuronal damage in the inner ear, but what puzzles me is how this could be caused by a slow pressure change as in scuba, so I think in my case anyway that it has to be something more simple than that such as damage to a larger structure changing resonances, or damage to a blood vessel, so this is why I think damage to one of those windows is directly relevant. Do you have any view as to how inner ear damage may be caused? I may be wrong, but what always frustrated me is that no-one has really researched the simpler options. Cheers Tony I'm still pretty green on my education of the workings of the inner ear. Certainly since it contains the three smallest bones in the human body and many tiny hairs inside the cochlea it is quite evident that the inner workings of the ear are quite fragile. How fragile they are and how great an impact would a slow pressure change have on damaging the inner ear? I don't know. I suppose there are many factors that could come into play that could effect the extent of the damage done. If a slow pressure increase puts strain on a blood vessel or other structure and it bursts, the pressure could change fairly quickly... As a quick analogy, I'm imagining slowly blowing up a balloon underwater inside an aquarium. As the pressure / volume slowly increase inside the balloon, the water level inside the aquarium slowly rises. Eventually, the balloon can't take any more pressure and bursts -- perhaps like a blood vessel, oval/round window, etc. The pressure that was slowly built up is now quickly released creating a rapid pressure change. The air from the ballon would then quickly surface and the calm surface water in the aquarium quickly produces ripples/waves... As far as neuronal damage from such an incident, I would tend to agree with you -- I don't think that would be the source of the problem. (Again, my education on this matter is quite lacking, but I can certainly come up with theories...) I would expect the damage to be to one of the more immediate areas effected by the pressure change. Perhaps the pressure causes a slight warping of the cochlea which in turn causes a cilia (or several) to be pressed or pushed into a constant (or at least more restrained) position. The restricted celia now sends a constant or fluctuating signal to the nerves which then relay the signal to the brain as a phantom sound (aka - tinnitus) I imagine hearing loss to be possible if the celia is now unable to send the signal because of the same reason... I would be surprised if these simpler ideas have not been researched. It seems to me that a simple and logical explanation is often much more likely to be accurate than a complex reason. I would guess that if people are simply diagnosing the problem as neuronal damage, they are probably doing it because it's an easy explanation and they don't necessarily know what the real problem is -- or they are using "neuronal damage" as a big umbrella that includes damage that could indirectly be described as such. On a separate, but somewhat related note... It seems quite amazing how far we have come with our knowledge and abilities to fix our eyes. My wife had laser eye surgery and now, after 15 or so years of needing corrective lenses, she her eyes work perfectly on their own. Prior to this medical breakthrough, this was the stuff of miracles. I guess the fact that our knowledge and technology has reached this level is pretty miraculous as well... Now, I'm left wondering... How far has our research come with understanding the workings of the ear? And, How far are we from being able to accurately and consistently make such corrections to the ear itself rather than rely on tools like hearing aids, etc? > Hi Trevor, > A lot of people put tinnitus down to neuronal damage in the inner ear, [quoted text clipped - 12 lines] > > Tony > I'm still pretty green on my education of the workings of the inner ear. > Certainly since it contains the three smallest bones in the human body and [quoted text clipped - 45 lines] > to accurately and consistently make such corrections to the ear itself > rather than rely on tools like hearing aids, etc? Hi Trevor, I could be biased - some would say- but heres what I think! There are a lot of young researchers who want a quick successful result, and it's relatively easy achieve this by hiring a day's pet scanner time along with a good technician. I've no first hand experience of PET or MRI research, so I could be wrong, but I think it is relatively easy, produces colorful highly marketable pictures, and doesn't tell us nearly as much as it appears to. There's not enough people want to do difficult research, such as laboriously staining neurons and looking through a microscope, or trying to build working models of the cochlea, like people did in the early 20th century, partly because it isn't glamorous and partly cos its hard. The key research into the the more basic mechanics of hearing was done 50 years ago by people like von Bekesy, but I think its about time it was revisited using modern technoloy. ...so that's my gripe. And scanner research I don't much rate. We know more about the eye because we can see inside it without damaging it, and if we used a cat, we can make a good estimate of what it can see. Much harder to tell if ananimal is deaf. LASIK and the like are amazing, and cataract operations too. And they can even replace the fluid inside the eye. We can't actually see what's going on inside a living ear. The cochlea's about 3mm diameter, which is a single blob on a PET scanner, the limit of PET resolution. The hairs on the haircells, that move in response to sound are really tiny, between 2 & 5 micro-metres long. But there are some people doing good research. Prof Carole Hackney is one I like ......... Hi To Murray Cheers & Thanks for comments. Tony I just said something wrong... the diameter of the cochlea if you look at it all coiled up like a snail is about 1cm. The diameter of the tube varies, but 3mm is middling. The tube when straightened out is about 3.5cm A hair cell is like the body of the neuron, which for the inner hair cells is stationery. The cillia are the 'hairs' at the top, a few uM long, and 1/3 uM wide. The point I wanted to make is that theyre absolutely tiny in comparison to the other parts of the ear Well its too late at night. I need sleep. Tony Hi Tony, Trying to make sense of this makes me sleepy:) - jean >I just said something wrong... the diameter of the cochlea if you look >at it all coiled up like a snail is about 1cm. The diameter of the [quoted text clipped - 9 lines] > >Tony Suppose we could enlarge the cochlea with a space raygun' so it was big enough to fit the Empire State building inside. Imagine a cochlea that big. Then we go inside and look at an inner ear cilia (hair). Proportionally,i t would be just 2 inches long! Tony Gawd I find that hard to believe. Here's the maths (width of cchlea)/(length of cilia) = (Ht of EmpState)/(Hair) 3mm/(.3 um)= 1400ft/0.14ft 0.14ft=2" "Trevor" <jimmypops@hotmail.com> wrote in part: >I would be surprised if these simpler ideas have not been researched. It >seems to me that a simple and logical explanation is often much more likely [quoted text clipped - 3 lines] >real problem is -- or they are using "neuronal damage" as a big umbrella >that includes damage that could indirectly be described as such. There have been quite a few studies done that explore how a pressure change can affect hearing and damage the cochlea. There have also been a number of computer models built that capture the physics involved. I think that the pressure change is thought usually to act via the tiny membrane at the end of the chain of small bones in the middle ear. The membrane can be forced into the fluid-filled inner ear and cause damage via a number of mechanisms that have been identified. I'd say your "theories" are not far off! The damage mechanisms usually do involve injury to the hair cells (usually the outer hair cells). Even when pressure causes a membrane to tear (a fistula), the resulting loss of fluid and derangement of physiology in the inner ear probably results in hair cell death before the fistula can heal.  SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > "Trevor" <jimmypops@hotmail.com> wrote in part: > [quoted text clipped - 20 lines] > the resulting loss of fluid and derangement of physiology in the inner ear > probably results in hair cell death before the fistula can heal. Me & Jim don't see eye to eye about much. I disagree with the slant he puts on data or research which is often out of kilter with the quality or scale of the research he identifies, or sometimes alludes to without identifying. I think it's important to recognise trivial research for what it is, and quality research for what it is. You have to preserve the true perspective. Hi Jim. We disagree here, not over fact, but over emphasis. Tony > "Trevor" <jimmypops@hotmail.com> wrote in part: > [quoted text clipped - 20 lines] > the resulting loss of fluid and derangement of physiology in the inner ear > probably results in hair cell death before the fistula can heal. Jim, you're a clever guy, but sometimes you're a total bulshitter! Tony > "Trevor" <jimmypops@hotmail.com> wrote in part: > [quoted text clipped - 20 lines] > the resulting loss of fluid and derangement of physiology in the inner ear > probably results in hair cell death before the fistula can heal. Jim, you're a clever guy, but sometimes you're a total bulshitter! Tony Actually the concept of a hole in the round window following a dive with hearign loss and the fluid runnning out and the nerves dying is not quite correct. Often we close the hole of the round window and the hearing comes back instantly!. Seems to be more of a concept of opening or closing an electrical circuit, at least in some cases. Murray Grossan, M.D. http://www.ent-consult.com entconsult@aol.comnospam (ENTconsult) wrote in part: >Actually the concept of a hole in the round window following a dive with >hearign loss and the fluid runnning out and the nerves dying is not quite [quoted text clipped - 4 lines] >Murray Grossan, M.D. >http://www.ent-consult.com I think there is a shift in potassium and sodium ion concentrations within the fluid compartments. That can be toxic if severe enough or long-lasting enough. It is also possibly the mechanism for hearing loss, tinnitus and fluctuating hearing in hydrops as well. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > entconsult@aol.comnospam (ENTconsult) wrote in part: > [quoted text clipped - 11 lines] > It is also possibly the mechanism for hearing loss, tinnitus and fluctuating > hearing in hydrops as well. A little knowledge & a lot of speculation jim!! There's a different ratio of ion concs in the different compartments, but there's no evidence that the concentration ratio does (or doesn't) change in response to fistula. And theres no reason why it should. It couldn't reach poisonous levels (But see if you can figure out why for yourself!!). It's more likely to be a larger scale physical thing. Helmholtz' earlier work on inner ear resonance was shown to be somewhat wrong, but it helps to think along the lines of his theory to get the picture. Its not that different to Bekesy. Tony tonyjeffs@aol.com (TonyJeffs) wrote in part: >There's a different ratio of ion concs in the different compartments, >but there's no evidence that the concentration ratio does (or doesn't) >change in response to fistula. It does if a fistula is present between compartments. >And theres no reason why it should. A number of clinicians and researchers have expressed the view that small fistulae may be present between compartments when a fistula occurs into the middle ear space. Also, a long-standing theory about Meniere's attacks is that they involve small fistulae between endolymph and perilymph. (I am actually doubtful about this in the case of Meniere's.) > It >couldn't reach poisonous levels (But see if you can figure out why for >yourself!!). I think your statement is false. Certainly I recall reading of cochlear duct enlargement followed by rupture of Reissner"s membrane and the destruction of hair cells by the potassium-rich endolymph. > It's more likely to be a larger scale physical thing. >Helmholtz' earlier work on inner ear resonance was shown to be >somewhat wrong, but it helps to think along the lines of his theory to >get the picture. That's entirely possible. I think that the reversible effects of a fistula are probably due to some combination of changes in ionic composition of fluids and mechanical effects of missing fluid. Permanent losses may be due to potassium toxicity to the hair cells or may reflect larger structural changes in the cochlea. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > tonyjeffs@aol.com (TonyJeffs) wrote in part: > [quoted text clipped - 31 lines] > of missing fluid. Permanent losses may be due to potassium toxicity to the > hair cells or may reflect larger structural changes in the cochlea. To which definition of "fistula" do you subscribe, Jim? Are you talking about a puncture? If so, might it not make more sense to use that word considering the definitions found here: http://www.google.com/search?q=define:fistula Lot's of us aren't familiar with medical terminology. I do recall my dentist telling me I had a "fistula" on the side of an abscessed tooth once so your use of it here has me confused. "Ball 95" <bushlies@whitehouse.now> wrote in part: >> tonyjeffs@aol.com (TonyJeffs) wrote in part: >> [quoted text clipped - 46 lines] >dentist telling me I had a "fistula" on the side of an abscessed tooth once >so your use of it here has me confused. I thought a fistula was what was being discussed already in the thread. The definitions on your URL seem pretty much the same to me. A fistula is any abnormal opening between two parts of the body. In the case of the inner ear, there is a fluid filled organ resting inside bone. Covering tiny openings in the bone are two membranes known as the round and oval windows. In addition, inside the inner ear are membranes that separate fluids of quite different composition. If a pressure is applied to the eardrum, in some cases the eardrum can move in, say, and push the oval window membrane abnormally far into the inner ear. There is a kind of pressure relief valve provided by the second membrane, but--obviously--if things go too far, one or the other of these membranes will rupture. If that happens, you have a fistula between the inner ear and the middle ear. You may get some other fistulae (fistulas) at the same time in the membranes within the inner ear, allowing the normally separated fluids to mix. The fluid in the main inner compartment is toxic to hair cells (receptor cells) in my understanding, and leakage through such a fistula can thus damage hearing. In some cases, the inner ear membranes do fine, but the eardrum blows. That's a fistula also, but not the type beng addressed. Sorry if I used too much jargon. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > "Ball 95" <bushlies@whitehouse.now> wrote in part: > [quoted text clipped - 75 lines] > > Sorry if I used too much jargon. So then, it is a hole? "Ball 95" <bushlies@whitehouse.now> wrote in part: >So then, it is a hole? Blow up a tire too much and you get a blowout. That's basically it. So, yeah, you get a hole. "Fistula" means it's a hole that connects two parts of the body that shouldn't. If you have a hole partway through the enamel of a tooth, you have a cavity. If it goes all the way through to the next tissue, you have a fistula. Both are holes, just different types. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG Jim Re your comments. First off, a treatable fistula is not a fistula between the internal cochlear membranes. Secondly, a hole between internal membranes would cause an increase in entropy, and the ionic concentrations therein *which isn't poisonous to start with* will become less poisonous. Potassium poisoning is as good as impossible. I suspect that in the back of your mind you were thinking of 'glutamate poisoning' when you suggested this, which could be an issue, although I personally don't think it is. Tony I'm sorry for the agressive comments but you really do annoy the hell out of me, because you seem to string together technical concepts in a scientifically arbitrary, but gramatically impressive manner, and although it makes you 'appear' to have insight, and perhaps makes some people feel reassured that they're apparantly listening to an 'authourity', your technique actually misleads, putting a restraint on true scientific appraisal. You certainly know enough of the background material to perform a true analysis. If you used your brain power to really get an insight into what you're talking about rather than to raise your profile with your verbal dexterity, then you really are clever enough come up with something scientifically useful. As opposed to presenting material that LOOKS scientifically useful. Otherwise, you are in the wrong arena, and your presentation skills would be better directed towards politics. There's a lot of politics in science tho! Tony The real point i was T R Y I N G to make before we got sidetracked is: It is entirely possible that tinnitus in some cases, such as mine, is caused by a resonance related issue that is not neurological in origin and has something to do with a fistula or perforation in the accessible parts of the external surface of the inner ear. In such cases, it may well be possible to cure tinnitus using current technology. Because of that possibility, we should push for quality research in that area. It makes sense Tony tonyjeffs@aol.com (TonyJeffs) wrote in part: >Jim > >Re your comments. >First off, a treatable fistula is not a fistula between the internal >cochlear membranes. That's usually true. There are exceptions, such as with superior canal dehiscence. I don't care if tears in, say, Reissner's membrane are called fistulae or not. My only point was that it is possible that the symptoms of a fistula between the inner and middle ears are partly due to tears or changes in permeability of other membranes within the inner ear, and that the mechanism might be via changes in electrolytes within the different compartments. It's also possible that the effects are more due to loss of sodium ions just in the leaking compartment (from perilymph). That may influence things that I certainly have no understanding of, beyond the fact that the resonance of the cochlea would obviously change and that itself could disturb hearing. I can certainly see that the basic mechanism of the wave passing along the cochlea no longer works if the membrane beneath the stapes is badly torn! I assume you were arguing for something like that. Certainly Dr. Grossan's comment about hearing returning immediately upon repair of a fistula is somewhat consistent with your view. I just think there are a wider range of possibilities, especially when a fistula does not heal and is not repaired in short order. I don't actually think we disagree on this stuff. >Secondly, a hole between internal membranes would cause an increase in >entropy, and the ionic concentrations therein *which isn't poisonous >to start with* will become less poisonous. Potassium poisoning is as >good as impossible. I suspect that in the back of your mind you were >thinking of 'glutamate poisoning' when you suggested this, which could >be an issue, although I personally don't think it is. No, we disagree here. The endolymph is toxic to hair cells due to the high concentration of potassium ions. >Tony > [quoted text clipped - 10 lines] >clever enough come up with something scientifically useful. >As opposed to presenting material that LOOKS scientifically useful. Apology accepted. :-D >Otherwise, you are in the wrong arena, and your presentation skills >would be better directed towards politics. I'm a terrible politician. You must be kidding! >There's a lot of politics in science tho! Politics is everywhere. Usually causing harm. >Tony So what does all this have to do with the post that started this thread? Do you think the discussion of fistulas and such is useful? Fistulas are a controversial area in otology--there's the politics again. Some ENTs see them in every patient and others think they only exist in patients who have undergone extreme head trauma. Some prescribe rest and restricted activity and others do a surgical repair at the drop of a hat. I don't think any ever do a positive test for perilymph before operating. And a fistula that stays open between the inner and middle ears is a route for infection and can lead to encephalitis and death. Most docs seem to think that the fistula repairs itself--that it is sort of a biological imperative. So why do you think tinnitus and hearing loss can persist after repair? SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > tonyjeffs@aol.com (TonyJeffs) wrote in part: > No, we disagree here. The endolymph is toxic to hair cells due to the high > concentration of potassium ions. Jim I'm itching to explain why you're wrong, but I'd resent telling you. But I'd love to understand why you claim the above. Can you explain your reasoning? Tony tonyjeffs@aol.com (TonyJeffs) wrote in part: >> tonyjeffs@aol.com (TonyJeffs) wrote in part: > [quoted text clipped - 6 lines] >Can you explain your reasoning? >Tony I feel like I'm in a game where the rules haven't been explained. I'm a guy with tinnitus, Tony. I'm not working in a lab studying cochlear fluids. But i read a lot and talk with researchers occasionally. My understanding, which I guess you know is all wrong, is that endolymph can leak through a fistula into the perilymph. Endolymph--though much smaller in volume than perilymph--is incredibly high in potassium. The resulting increase in potassium in the perilymph is toxic to outer hair cells. According to what i've read, and several references I just checked, the increase in potassium in the perilymph of the scala tympani, which surrounds the basal end of the outer hair cells, impairs the function of outer hair cells and causes hair cell destruction. This toxicity is due to the potassium (in the perilymph) causing a toxic agent to be released. (I forget the agent's name, but can find it later.) That's how the endolymph potassium can cause hair cell injury in the case of barotrauma/fistula. I have to work some long days now--big project behind schedule--but I'll be happy to read your explanation here of why I (and the authors of several reference papers I think I can find) are wrong about this. I like to learn! Jim, always happy to provide entertainment in a.s.t. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > tonyjeffs@aol.com (TonyJeffs) wrote in part: > [quoted text clipped - 33 lines] > > Jim, always happy to provide entertainment in a.s.t. > tonyjeffs@aol.com (TonyJeffs) wrote in part: > [quoted text clipped - 58 lines] > > http://oto.wustl.edu/cochlea/intro4.htm Jim Endolymph is NORMALLY high in potassium. Not 'incredibly' high. It is at a potassium concentration that is common throughout the body. Now you've looked at some articles, and you've looked at a video, you must surely recognise that what you have said does not make sense, even if you're too proud to admit it. If you look at your video, you'll see that the leak takes potassium UPWARDS (through Reissners membrane, as you correctly state) into the top section of the inner ear, but this does not bring the weakened potassium closer to the hair cells which are nearer the bottom; it takes it FURTHER AWAY from the hair cells, which are bedded down in the lower section (which you rightly identify as the Scala Tympani). (Now I suspect you'll argue it could seep through via the csf pathways. Please don't make me have to explain why that's dumb!) If you look at the article you cite, and maybe if you do some related background reading, you'll realise that those scientists are describing a genetic mutation that causes a defect in the PRODUCTION and REGULATION of the potassium containing fluids, producing ABNORMALLY HIGH concentrations in the wrong places. These are very abnormally high concentrations which, in turn, produce toxic chemicals. They are NOTHING whatsoever to do with the leakage of normal concentrations through a fistula, and are NOT the sort of reduced concentrations that would be produced by fluid leaking from one compartment to another. See- This is what I mean - you're stringing together two unrelated pieces of scientific information, and making them appear connected. .............. I don't see the point in what you do, your litrerary technique, other than to make yourself look good to non-scientists. You really do have the potential to genuinely understand this stuff. You're someone I could get on with, and have useful conversations with, if you'd talk straight rather than trying to look that bit smarter by bulshitting for the last mile. If you look at science from a scientific point of view rather than as a means to boost your political standing, you could achieve something that really would boost your reputation forever. If you use bullshit, from time to time you're going to get found out. Tony tonyjeffs@aol.com (TonyJeffs) wrote in part: >Endolymph is NORMALLY high in potassium. Not 'incredibly' high. It is >at a potassium concentration that is common throughout the body. It is "incredibly high" for the inner ear and the cerebrospinal system as a whole. >Now you've looked at some articles, and you've looked at a video, you >must surely recognise that what you have said does not make sense, [quoted text clipped - 8 lines] >(Now I suspect you'll argue it could seep through via the csf >pathways. Please don't make me have to explain why that's dumb!) I'll save you the time, Tony. You are absolutely right. The fistula would have to be through the membrane at the bottom of the endolymph compartment rather than the one at the top. But so what? It is exactly those types of leaks that are suspected to cause the symptoms of a Meniere's attack. >If you look at the article you cite, and maybe if you do some related >background reading, you'll realise that those scientists are [quoted text clipped - 6 lines] >reduced concentrations that would be produced by fluid leaking from >one compartment to another. I cited the article because it mentions the mechanism by which increased potassium in the perilymph causes toxicity to the outer hair cells. I did not mean to confuse you with the genetic context of the article. >See- This is what I mean - you're stringing together two unrelated >pieces of scientific information, and making them appear connected. The two pieces of information that I was stringing together are (1) that a tiny opening can (and does) occur in the membranous container of potassium-rich endolymph, and (2) that this potassium can cause toxicity to the hair cells, whose cell bodies normally reside in the almost potassium-free perilymph. I think this process may be an active part of what goes wrong when a perilymph fistula occurs. >.............. > [quoted text clipped - 10 lines] > >Tony My mistakes, Tony. I made two. The first was in citing the upper rather than the lower membrane as an example of where endolymph can leak into perilymph and affect hair cell bodies. You played that for all it was worth, and you deserve a prize. The second mistake was in thinking you might actually be interested in discussions here about science and in trying to combine your and my knowledge about these things to learn together and maybe even address some questions that arise in this newsgroup. I would expect that we each have some relevant training and knowledge that the other lacks. But your interest appears to have been in gamesmanship and in putting me down. You did a good job, though. I make mistakes all the time, Tony. I don't care a bit if you point them out. But it would be better for a.s.t. if you did so in a constructive way. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG >> your interest appears to have been in gamesmanship and in putting me down. Jim, don't try and turn the tables on me. I'm accusing YOU of gamesmanship. So don't try to turn it around. I've said quite clearly that I'd love to be able to have a straight scientific conversation with you, if you'd just lay off with the b-s. I put forward an interesting idea, but rather than help develop it, you tried to demonstrate -or rather to create the illusion - that you knew better by putting forward a series of suggestions that, although affording the impression of scientific cohesion to a person less knowlegable than either of us in this field, really don't make scientific sense. If you want a straight scientific conversation with me,I'd love to do that. There are not too many people know as much as you, as much as me, frequenting these message boards. You have potential to be one of the best, But only if you PLAY IT STRAIGHT, and stop trying to impress people by bluffing with stuff you don't know. It's ok to make mistakes, but it's not ok to get caught out when deliberately blagging. Toxic levels of K+ can, on your own evidence, be caused by a genetic abnormality, but not by diffusion through a perforated membrane. Now, youve suggested perforation of another membrane at the bottom of the middle chamber would cause poisoning of the haircells, without a genetic abnormality. What membrane are you talking about now? Or d'you want that I just give you a hand and pull you out of the hole youve dug for yourself? I'm not doing this to make a prat of you. I'm doing it out of frustration. You appear to me to be talking b-s, purely for effect. And you are knowledgeable enough to not need to do that. Tony I feel cruel now. Maybe this is what you are and are destined to be, and maybe I'm asking you to be something different. tonyjeffs@aol.com (TonyJeffs) wrote in part: >Toxic levels of K+ can, on your own evidence, be caused by a genetic >abnormality, but not by diffusion through a perforated membrane. Why not? This is what I find written by multiple knowledgeable sources. Maybe we should just agree to disagree. No one here cares, anyway, I suspect. >Now, youve suggested perforation of another membrane at the bottom of >the middle chamber would cause poisoning of the haircells, without a >genetic abnormality. What membrane are you talking about now? It doesn't really matter. If there is a perforation of either Reissner's membrane or the basilar membrane, endolymph and perilymph will mix within the entire membranous labyrinth. The hair cells we have been talking about are normally in an essentially potassium-free fluid. So the fluid they are in after the perforation will contain too much potassium and this will cause toxicity, possibly causing hearing loss or tinnitus. The mixing of the fluids (re-establishment of an equilibrium with the perforation would occur rapidly I would think, given that we are talking about potassium ions. The routes would include through the perforated membrane(s) and around the helicotrema. I'm not certain about some of the other possible routes, though they exist. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG Waaal . . . THIS was a sort of amusing drop-in ;-) You know, if you you both didn't have at least SOME interest in a public display of academic plumage, you'd be conducting this internecine exchange via e-mail. But by all means, carry on. It's a far cut above all of the OTHER combat which has taken place in here ;-))))) RHaj shrkatty@aol.com (ShrkAtty) wrote in part: >You know, if you you both didn't have at least SOME interest in a public >display of academic plumage, you'd be conducting this internecine exchange via >e-mail. >RHaj Well, you wouldn't know your helicotrema from a hole in the ground, Mr. Smart-a.s Attorney. ;-) SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG > Well, you wouldn't know your helicotrema from a hole in the ground, Mr. > Smart-a.s Attorney. ;-) Jim, Isn't that (helicotrema) how Kahn got that Earwig into Chekov's head? PaulS (aka Mr. Sulu) "PaulS" <gatorz@bellsouth.net> wrote in part: >Isn't that (helicotrema) how Kahn got that Earwig into Chekov's head? > >PaulS (aka Mr. Sulu) Talk about having an ear bug... SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG >From: jchinnis@SPAMalum.mit.edu (Jim Chinnis) >shrkatty@aol.com (ShrkAtty) wrote in part: > [quoted text clipped - 7 lines] >Well, you wouldn't know your helicotrema from a hole in the ground, Mr. >Smart-a.s Attorney. ;-) True. But I do know my res from a gestae, Mr. Erudite Analyst. ;-) RHaj > > tonyjeffs@aol.com (TonyJeffs) wrote in part: > [quoted text clipped - 6 lines] > Can you explain your reasoning? > Tony -What membrane do you think could theoretically perforate to creast a fistula that would allow potassium ions to poison the hair cells? Do you think it is the concentration of this potassium that would make it poisonous? Or what else is it about potassium that you think would render it poisonous to hair cells? I do suspect you were thinking about glutamate poisoning in the back of your mind, but having started on the wrong foot, have dug yourself a hole that you're too embarrased to climb out of. Am I right? Thanks for accepting my apology for being harsh, but did you recognise the point I was making? Tony tonyjeffs@aol.com (TonyJeffs) wrote in part: >> > tonyjeffs@aol.com (TonyJeffs) wrote in part: >> [quoted text clipped - 9 lines] >-What membrane do you think could theoretically perforate to creast a >fistula that would allow potassium ions to poison the hair cells? How about reissner's membrane, though that's not the only possibility? That would shoot K ions into the perilymphatic space occupied by the hair cell bodies. >Do you think it is the concentration of this potassium that would make >it poisonous? The change in K concentration would immediately affect hearing, but the toxicity appears to be indirect. >Or what else is it about potassium that you think would render it >poisonous to hair cells? Man, you are persistent. Hold on... OK, here is one reference: "Most importantly, the increase in potassium in the perilymph of the scala tympani, which surrounds the basal end of the hair cells, causes a toxic agent to be released, interfering with the normal function of the outer hair cells (McGuirt and Smith, 1999)." The reference is from http://www.shs.ohio-state.edu/Faculty/Fox/BuckEARS_web_site/mutations.htm You can look up McGuirt and Smith. >I do suspect you were thinking about glutamate poisoning in the back >of your mind, but having started on the wrong foot, have dug yourself >a hole that you're too embarrased to climb out of. Am I right? I guess I'm too stupid to be embarassed. I'm still happy to be shown wrong and to learn something. >Thanks for accepting my apology for being harsh, but did you recognise >the point I was making? No. >Tony I came across a nice movie that depicts the rupture of the boundary membranes of the endolymphatic space, BTW. Salt is a great one for producing graphics that make this stuff clear! See: http://oto.wustl.edu/cochlea/intro4.htm SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG Sorry, I think I've gone on one post too long. I just reread the thread, and think my point came across pretty well. Jim, Get yerself a beer and send me the bill Tony. >I just reread the thread, and think my point came across pretty well. ................ Well, I just read the thread for the first time. And I think that what comes across is Tony's insecurity and inability to avoid personal digs when the level of the discussion becomes too much of an intellectual challenge for him. Nothing has changed over seven years in that regard. Jim was putting forth his ideas on a TOPIC and was trying to DISCUSS it. Here are some of Jeffries's comments directed at or referring to Jim in that regard: >Jim, >you're a clever guy, but sometimes you're a total bulshitter! >I disagree with the slant he puts on data or research which is often >out of kilter with the quality or scale of the research he identifies, >or sometimes alludes to without identifying. >you really do annoy the >hell out of me, because you seem to string together technical concepts >in a scientifically arbitrary, but gramatically impressive manner, and >although it makes you 'appear' to have insight, and perhaps makes some >people feel reassured that they're apparantly listening to an >'authourity', your technique actually misleads, >I'm itching to explain why you're wrong, but I'd resent telling you. >I don't see the point in what you do, your litrerary technique, other >than to make yourself look good to non-scientists. [quoted text clipped - 5 lines] >a means to boost your political standing, you could achieve something >that really would boost your reputation forever. >stop trying to >impress people by bluffing with stuff you don't know. >You're FAKING IT. >And its not useful, except in making you look good. smn > >I just reread the thread, and think my point came across pretty well. > [quoted text clipped - 44 lines] > > smn Nagler I think this thread has had its day. Leave it be. Tonyjeffs >I think this thread has had its day. >Leave it be. Well put. And very wise. Susan sufein@aol.comnospam (Susan ) wrote in part: >x-no-archive: yes > [quoted text clipped - 4 lines] > >Susan I think that issues related to tinnitus, such as barotrauma and possible damage mechanisms, ought to be able to be discussed here without personal remarks of any kind at all. I'm happy to continue and am sure that Tony and others have insights that I lack--insights that I (and others) won't benefit from without their participation. I respectfully ask all past participants who may have strayed a bit into personal commentary--including Tony, Stephen, and myself--along with others who still may be interested in the ideas, to keep the discussion going. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG For anyone who might care, what I have been thinking of re potassium toxicity to hair cells that might be associated with membrane leaks within the inner ear is driven by things I have read about endolymphatic hydrops. I will mention one source that cites several classic sources in turn. The most recent source I have is: SN Merchant, SD Rauch, JB Nadol, Jr. Meniere's disease. Eur Arch Otorhinolaryngol (1995) 252:63-75. Quote: "One of the more widely accepted theories is that proposed by Lawrence and McCabe [54] and later refined by Schuknecht et al. [113]. In this scenario, a sudden rupture of the thin distended membranous labyrinth results in flooding of the perilymphatic space with potassium rich neurotoxic endolymph, causing paralysis of sensorineural structures which in turn results in a sudden attack of vertigo and/or hearing loss." As to any ambiguity of the outer hair cells being affected by such "neurotoxic endolymph," I quote from a classic audiology text, Audition, by Pierre Buser and Michel Imbert: Quote:"In this way, the mammalian scala media forms a morphologically enclosed space, an endolymphatic space into which the cilia of the hair cells can extend, while the rest of the receptor cell occupies perilymphatic space." [p 123] I am no expert on the anatomy or chemistry of the inner ear and freely admit that I may somehow be misinterpreting my sources. SignatureJim Chinnis / Warrenton, Virginia, USA Want to discuss Meniere's? See http://groups.yahoo.com/group/MenieresDG >I am no expert on the anatomy or chemistry of the inner ear and freely admit >that I may somehow be misinterpreting my sources. ................. Jim, you have been consistently a respectful and productive participant on this newsgroup for years. You have given of yourself generously and unconditionally. You are a true friend to the tinnitus community. Now, with all due respect (and indeed a whole lot of respect is due you), it is quite apparent from reading this thread why you feel the need to write the words quoted above. Why jump through the hoops that Jeffries is purposely setting up for you? Don't give him the satisfaction - the bastard certainly doesn't deserve it. smn >>I am no expert on the anatomy or chemistry of the inner ear and freely admit >>that I may somehow be misinterpreting my sources. [quoted text clipped - 13 lines] > >smn Nice bedside manner showing through again, doc. Thanks for demonstrating your obvious instability and illustrating once more why folks need to avoid you. Kudos to Jim for ignoring your blatant attempt to start something, by the way. Terri http://pub219.ezboard.com/btinnitusactivismandsupport >Nice bedside manner showing through again, doc. Thanks for >demonstrating your obvious instability and illustrating once more why >folks need to avoid you. When folks demonstrate obvious instability, the best thing to do is understand that they're in trouble and/or pain, and not to antagonize them. That's the only way for a decent person to respond once the other person's decompensation is evident. Susan >x-no-archive: yes > [quoted text clipped - 9 lines] > >Susan ................... OK, Susan. I'll be nice and antagonize you no longer. :-) But why don't you be nice to this newsgroup to show some good faith. OK? Almost everybody here has either killfiled terri231 or deletes her posts unread - me included. Please do not defile our computer monitors by quoting her crap in your posts. I wish you well with your illness, Susan. We strongly disagree on numerous issues - disability included. We have both been unkind to each other. We know where each others' "buttons" lie - and just how to push them. But know beyond any doubt that I wish you health and a long life full of all the good things this world has to offer. smn >>x-no-archive: yes >> [quoted text clipped - 26 lines] > >smn If you delete my posts unread, how do you know what I said? Terri http://pub219.ezboard.com/btinnitusactivismandsupport > If you delete my posts unread, how do you know what I said? Because he doesn't delete Susan's. Let me know when you get to Algebra I. PS >> If you delete my posts unread, how do you know what I said? > >Because he doesn't delete Susan's. Let me know when you get to Algebra I. > >PS .................... I don't delete yours either, Paul! Grrr. :-) Interestingly, this scenario is actually on topic for tinnitus. Why? Because tinnitus is a symptom - not a disease. And with a symptom, you have to be aware of it in order for it to exist. I have written a bit more about tinnitus as a symptom - and the clinical significance of tinnitus's being a symptom - at www.tinn.com/thresholds.html Now to me, since I have killfiled terri, so too she does not exist. Until somebody "gives her life" by copying a post of hers in a response, that is. She can scream as loudly as she wants. She can bitch and moan and groan. She can type her narly little fingers to the bone. SHE DOES NOT EXIST. Unless somebody copies a post of hers. What is terri a symptom of? Depends on your perspective, I guess. I'll leave it at that. smn >>> If you delete my posts unread, how do you know what I said? >> [quoted text clipped - 31 lines] > >smn My perspective is that you are a sad man. You have killfiled me a dozen or more times, or so you said. I consider it a compliment because I know that you can't stand to see the truth right there in black and white. Why anyone would follow your lead after all you have said and done lately and in the past is beyond me. To think you have any influence over others must be part of this vivid fantasy you have about yourself. Please get help Stephen. You are losing it again. Terri http://pub219.ezboard.com/btinnitusactivismandsupport >> If you delete my posts unread, how do you know what I said? > >Because he doesn't delete Susan's. Let me know when you get to Algebra I. > >PS Just like you, Paul, he reads every word I write. He can't help it. We haven't heard you weigh in on his publically deriding Susan, though, so I guess you think that is "ok" but what I do isn't. Terri http://pub219.ezboard.com/btinnitusactivismandsupport > We haven't heard you weigh in on his publically deriding Susan, > though, so I guess you think that is "ok" but what I do isn't. > > Terri Terri, The issue I have is exactly "what you do" when you chime in on these "pissing matches"......you perpetuate them! Otherwise, your contributions on tinnitus issues are very welcome and often insightful. PaulS >> If you delete my posts unread, how do you know what I said? > >Because he doesn't delete Susan's. Let me know when you get to Algebra I. > >PS I have finally made some sense about why Paul and others won't publically take Stephen to task over his abusive behavior. I have often wondered why seemingly sensible people would keep quiet. Stephen knows who you are, where you live and where you work and you know what will happen if you cross him because it has happened to others. You have my sympathies, folks. Terri http://pub219.ezboard.com/btinnitusactivismandsupport > I have finally made some sense about why Paul and others won't > publically take Stephen to task over his abusive behavior. I have > often wondered why seemingly sensible people would keep quiet. >Stephen knows who you are, where you live and where you work and you >know what will happen if you cross him because it has happened to >others. You have my sympathies, folks. Terri, You have left out a few options that sensible people might well explore......Maybe its not my place to take anyone to task publically. Or, maybe I do so privately. Or maybe I think Susan is tough enough to handle herself. I occasionally take you to task for starting flame threads or perpetuating them. I'd prefer to do that privately but you choose to live here publically and anonymously. PaulS >>I am no expert on the anatomy or chemistry of the inner ear and freely admit >>that I may somehow be misinterpreting my sources. [quoted text clipped - 13 lines] > >smn ........................ To restate lest there be any confusion as to my meaning ... Jim, you have been consistently a respectful and productive participant on this newsgroup for years. You have given of yourself generously and unconditionally. You are a true friend to the tinnitus community. Now, with all due respect (and indeed a whole lot of respect is due you), it is quite apparent from reading this thread why you feel the need to write the words quoted above. And that feeling is *totally unjustified*. Why in the world jump through the hoops that Jeffries is *purposely* setting up for you? Don't give him the satisfaction - the bastard certainly doesn't deserve it. smn >>>I am no expert on the anatomy or chemistry of the inner ear and freely admit >>>that I may somehow be misinterpreting my sources. [quoted text clipped - 31 lines] > >smn The usual cycle following one of your meltdowns is the "try to make amends" stage by offering false platitudes and attempting to butter up those that you previously insulted to make it seem like you didn't say the terrible things that you did. I didn't think it would happen, but I am really starting to feel sorry for you, Stephen, since you are caught in this relentless cycle like Bill Murray's character in "Groundhog Day". How frustrating it must be for you to keep waking up to the same song because you didn't get it right again. Terri http://pub219.ezboard.com/btinnitusactivismandsupport > For anyone who might care, what I have been thinking of re potassium toxicity > to hair cells that might be associated with membrane leaks within the inner [quoted text clipped - 25 lines] > I am no expert on the anatomy or chemistry of the inner ear and freely admit > that I may somehow be misinterpreting my sources. Jim Your references are good. I was of the view that since the tops of the hair cells are in 150mM K+ and since the interior of the hair cells contains 140mm K+, they should be pretty comfortable being swathed in lesser concentrations of potassium ions. But I'll have a rethink. I can see how such might occur in menieres witn an enlargement of the middle chamber, and an increased volume of endolymph, that is sufficient to seriously contaminate the large vol of perilymph, but I don't think it'd be relevant to what I'm looking for, in that:- 1.the normal vol of endolymph is very small in comparison to perilymph, so the dilution would be great. 2. a movement of say 1mm in the oval window, spread over 4mm2 would result in a movement of just .001mm spread out over the much larger surface of any of those membranes, so it wouldn't be enough to cause a rupture.; purely by the hydraulic ratio. (guessing the numbers, but you'll get the point) With scuba, there isn't even a dudden precussive force in barotrauma that could cause a localised shockwave, so I don't myself think a perforation of reissners could occurr. 3. Even if it did, its a long and winding road for the K+ to get to the scala tympani in any quantity. It'd be too dilute by the time it got there. ...So I would think it'd need some other kind of abnromal behaviour for that to be possible. So what I'm looking for is some kind of physical, non-neurological condition, not involving damage to hair cells. (I gathered from an earlier discussion that you don't view the hair cell as a neuron - The camp is split on this - I hadn't realised that before - but it has enough of the traits of a neuron for it to be reasnable to class it as one. It's certainly much more than a mechanical switch. So I would categorise damage to the hair cell or the synapse of the auditory nerve neurological damage, but wouldn't consider anything else in that area to be so) Pehaps damage to the oval window causes a simple, non-neurological change in resonance resulting in tinnitus. That's what I'm interested in, BECAUSE it would be curable: Place a sealed vessel to your ear. No sound Make a hole in it, and do it again and you have the sea shell affect! The immediate response in this technological age is that the idea is way too simple. I accept of course that it could be wrong, but it is interesting purely because if it's right we could deal with it. (in contrast, If we prove tinnitus is due to malfunctioning neuron well its half a victory because we understand the problem but have no solution) A key and obvious flaw is that if there was a hole in the oval or round window big enough to cause this affect, the fluid'd leak out. Maybe it doesn't need a complete opening. Filling a void with helium instead of air, would change the resonance (a la "Micky mouse voice" experiment with withhelium baloon). Maybe filling the middle ear with helium would raise the frequencies of tinnitus by an octave. Maybe Itd be interesting to try. Finally This whole site is really good. I think you may have alrady mentioned it. Anyone interested, it's worth working throuh the pictorial guide. http://oto.wustl.edu/cochlea/ Tony tonyjeffs@aol.com (TonyJeffs) wrote in part: >> For anyone who might care, what I have been thinking of re potassium toxicity >> to hair cells that might be associated with membrane leaks within the inner [quoted text clipped - 94 lines] > >Tony I agree with most of your comments. I think the thread started with some talk about how a barotrauma could cause tinnitus via something related to a fistula. Something like that, anyway. You talked about some kind of damage or change in the round window as an example of a possible thing worth looking at. (I'm writing from memory, which isn't as good as it used to be.) I then suggested that other inner ear membranes might be damaged when a middle ear fistula is produced, and that these effects might lead to hair cell damage. I suggested potassium poisoning from the endolymph getting into perilymphatic spaces as one way that might happen. I think your comments above are very good criticisms of the idea, and they are typical of my own skepticism with regard to it. But I don't think they make it unworthy of being looked into. Neither did I mean to imply that purely mechanical damage to a structure such as the round or oval window might not somehow produce tinnitus. A few comments on some specific things you wrote: >I was of the view that since the tops of the hair cells are in 150mM >K+ >and since the interior of the hair cells contains 140mm K+, they >should be pretty comfortable being swathed in lesser concentrations of >potassium ions. But I' |
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