[dasb]

I've been following tinnitus research and the most promising treatment is FX-322 [1]. It's a drug that will treat hearing loss, but it could also help diminish tinnitus.

It's currently in phase 2a [2] and results come out next year [3].

[1] https://hear2tell.com/2020/09/29/frequency-therapeutics-fx-3...

[2] https://clinicaltrials.gov/ct2/show/NCT04120116

[3] https://www.hearinglosstreatmentreport.com/estimated-fx-322-...

[meowface]

>The researchers found that some body tissues regenerate much better than others. They studied the lining of the small intestine, which turns over roughly every four days, because it’s designed to absorb and distribute nutrients to other parts of the body. Drs. Karp and Langer saw the molecular pathways that signal the lining’s cells to turn over quickly and form new tissues.

>Around the same time, another scientific group found very similar cells in the cochlea – but with one big difference: in the cochlea, these cells weren’t active. They saw that the cochlea’s cells didn’t regenerate and form new sensory hair cells. “So that was the formation of Frequency,” LeBel explains. “And Frequency was asking, why is that the case? Why is it that the cochlea isn’t regenerating cells and the small intestine is?”

>This led to the discovery of two small molecules that make up FX-322, which targets these cells, called progenitor cells. Essentially, this process is meant to drive hair cell regeneration: The drug targets pathways to those cochlear cells, and when activated, they divide and form a new cell of themselves, called daughter cells. “And then most importantly, they form a new sensory hair cell,” LeBel says.

That sounds incredible. If it really can reliably do what they claim with no significant negative side effects, that'd seem like one of the most "miraculous" treatments I've heard of in a while, both in terms of the technique and what it could accomplish.

[lr4444lr]

Yep. Frequency Therapeutics could make a tremendous medical breakthrough here. But some caution is warranted, even in light of their promising human trials: cochlear cell regeneration and subsequent hearing restoration is observed in reptiles and birds, so there is reason to believe that they can coax mammalian ears to do the same thing, but it may not be as generalizable a result across the human body. But damn will people start trying mightily if it succeeds in the ears. That said, even simply finding a cure for sensorineural hearing loss is nothing short of perhaps one of the top 10 medical breakthroughs in the last 50 years if you look at the cost to society and prevalence of it.

[meowface]

My baseless armchair speculative fear, with absolutely zero knowledge of this field or technology, is if some of the new hair cells could maybe somehow not fully "sync with" or complement the existing set and perhaps just make you hear "differently" but not necessarily better, and perhaps even worse in some contexts, depending on what % of your existing hair cells were healthy.

I have no clue if that has any remote basis in reality, though. And perhaps your brain would eventually learn to sort it all out, so maybe any increased sensory sensitivity would generally be a net plus either way, once enough time passes.

[fouc]

The cochlea is like a snail-shell shaped organ, lined with hairs. When the sound wave - or more specifically the vibration - reaches a bunch of hairs, they in turn fire a bunch of neurons.

The distance the sound wave travels into the organ is related to whether it is a high pitched or low pitched sound. The hairs are essentially "dumb", they only trigger the neuron firings when they detect the vibration.

So regenerating the hairs in the cochlea definitely won't change one's "natural" hearing, but for those that have had missing or damaged hairs for a long time, there'll definitely be an adjustment period where the brain has to re-learn how to interpret the new input. (About 2 weeks or so)

[meowface]

If I'm not mistaken, though, hair cells aren't really "fungible" / identical, right?

>Auditory hair cells are specialized along the length of the cochlea to respond to specific sound frequencies. ... Each of our roughly 16,000 hair cells is dedicated to a narrow frequency range. These cells are ordered along the basilar membrane according to the frequencies they detect. [1]

In that sense, they're dumb in terms of just encoding oscillation patterns, kind of like an electric guitar pickup, but even though a pickup is "dumb", you can get different results depending on the placement and type.

I'm just wondering if and how the newly generated hair cells somehow fit in where they're needed, and how general or controllable the process is.

[1] https://www.nih.gov/news-events/nih-research-matters/hearing...

[fouc]

they should be identical/fungible, it's the location that corresponds to the sound frequency, the nerves to be triggered are in the walls of the cochlea, underneath the hairs.

[anon73044]

My fear would be that they see this product has a bigger market at targeting make hair loss than hearing loss. That said, I wouldn't hesitate to take it today if it would rid me of this wretched ringing.

[JonathonW]

Cochlear hair cells are fundamentally different types of cells than the hair follicles that produce the hair on your head; the name is more than a little misleading in this respect. Cochlear hair cells get their name from hair-like structures called stereocilia that project from the surface of the cells; they don't produce anything like the protein filaments that make up human hair.

A treatment that happened to have application to both male hair loss and hearing loss due to cochlear damage would be a really weird coincidence.

[therealx]

If that's true, you can almost guarantee a cottage industry of doctors writing off label scripts.

[patorjk]

Carl LeBel (Chief Development Officer of Frequency) revealed on the Tinnitus Talk Podcast that several patients in the Phase I/II study reported "improved" tinnitus to their ENTs. How much improvement wasn't measured, but it's one of the reasons they're testing for tinnitus in the phase 2a study.

Otonomy's OTO-413 drug (to fix the ribbon synapses in the cochlea) also seems really promising (results are due out next month). However, for their phase I/II study they're not testing for tinnitus and are actually excluding patients with "bothersome tinnitus". I'm hoping they see the same thing as Frequency and that some patients report improved tinnitus. These two drugs together (regrowing hair cells and ribbon synapses) seem like they could be a good one-two punch against hearing loss and tinnitus.

[vagrantJin]

I get it when my right ear has way too much earwax. J lose some hearing and the ringing wont stop. Just a bit annoying so Im usually wearing headphones with nice soothing music until I can get that wax out.

[furyofantares]

Are you using cotton swaps in your ears? What might be happening is that you shove wax in, clogging your ears and giving you tinnitus. That used to happen to me - the ear wax wasn't the problem, trying to clean it was.

[modeless]

To clean your ears yourself you need something like this: https://www.japantrendshop.com/coden-ear-scope-13000-standar...

I thought it was ridiculous when I first saw it but I took a chance on it and it is actually a great product. You can clearly see everything and clean without damaging your ear. If you've ever had to go to the doctor to clear a blocked ear, you need one of these. With occasional use (~once/month) your ears will never be blocked again.

[Baeocystin]

Man, I wish I had that a month ago- had a random hair from a haircut rubbing against my eardrum, and could. not. get. it. out. Thankfully have a physician friend who was able to scope my ear and remove the offender in about a minute, but it sure would have been nice to have been able to do so at home. Thanks for posting this.

[modeless]

Yes, I have used it for this exact purpose as well.

[maroonblazer]

Drops seem safer to me. I've had good success with Debrox, but there are a variety of brands.

https://www.debrox.com/products/debrox-earwax-removal-kit

[modeless]

The drops have not been shown to be any more effective than plain water. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD...

I dislike flushing my ear with a syringe or squeeze bulb as it is uncomfortably loud and it seems possible to damage the eardrum with overpressure. It is also difficult to tell if it is working or how long you should continue doing it to ensure a clean ear, especially if the ear is not completely blocked.

The endoscope is faster, easier, more comfortable, and lets you see exactly how clean your ear is so there's no guesswork.

[maroonblazer]

I'd not seen that Cochrane study, that's interesting, thanks for sharing.

Sticking something pointy in your ear seems to carry its own risks. How do you ensure you don't puncture your eardrum?

[beaugunderson]

I've sworn off Debrox after damaging my ear recently. The instructions say to leave it in for "several minutes"; I waited ~10. My hearing was impacted for several days afterward. In the one ear I got high-pitched feedback when watching TV, it sounded like someone was running sound through a guitar distortion pedal. It went back to normal after ~5 days but I was very scared that it would be a permanent effect.

[asiachick]

The reviews are pretty mixed

https://www.amazon.co.jp/%E3%82%A4%E3%83%A4%E3%83%BC%E3%82%B...

But more interesting all the recommendations listed on Amazon. Tons of them, many 1/2 the price of the one above, but use your phone as the display

[modeless]

I find Amazon reviews fairly useless these days. Most good ratings are just because of fake or paid reviewers or other scams like switching the product while keeping the reviews, combining two products in one listing, and probably others I don't know about. Amazon seems powerless to fix it, or maybe they just don't think they need to care.

I haven't tried any of the phone based endoscopes but I expect the latency and reliability to be bad. When I'm controlling something that's deep in my ear canal I don't want latency or dropped frames.

[CryptoPunk]

How would a camera to smartphone connector add appreciable latency?

[dmoy]

Oh wow that is amazing

I also get mild tinnitus for the last 6 or so years due to earwax (once it got completely blocked and I had to go to the doctor to have them irrigate it back out).

I don't use cotton or any scraping right now, but I do use the same stuff the doctor used to irrigate it every once in awhile, to middling effect.

Maybe I'll try out that ear scope thing.

[jakear]

I've had great success with the ~$20 ear pump devices available at your local drug store. They look like a normal squirt bottle with a tube tip, you fill it up with warm water and just keep squeezing. I'm not sure what the scope would do for me... I can hear the ear is clogged, I don't need a visual confirmation.

[Fezzik]

I have been using these at least twice a month since high-school (20+ years) after having multiple dramatic ear infections that rendered me temporally unable to hear due to clogging. I was just at the ENT doc last week and he confirmed that my ears 1) look and function great and 2) there is no damage, at all, from using these mini turkey baster like devices when they are used correctly. I highly recommend them, but your own experience may differ and you should probably check with an ENT doc just to be sure.

[modeless]

I find that process uncomfortably loud, and I worry about damaging my ear with too much pressure. I also find it difficult to tell if it's working or if it's finished, especially if the ear is not plugged all the way yet, which I want to avoid.

The endoscope is faster, easier, more comfortable, and makes it possible to clean when the ear is not actually plugged and verify that it worked.

[dmoy]

Yea that's pretty similar to what I'm currently using.

[vram22]

In India a common practice is to go to a doctor (G.P.) who uses a foot-long syringe to irrigate your ears with warm water. It is supposed to soften the wax which then either comes out by itself when you tilt your head (lying down) after the syringing, or can be removed easily by earbud etc.

[sumedh]

> In India a common practice is to go to a doctor

The vast majority of poor and lower middle class Indians dont go to a doctor, they just go to an ear cleaner who sit on the streets and will do the job for you in 5 to 10 minutes for a dollar or two.

[galaxyLogic]

I immerse my head and ears in hot bath-tub. When I get out I put my little finger into the wet ear and then fast pull it out which creates some suction in the ear which sucks the water out and I think also some vax.

[ldarby]

That's risking rupturing your ear drum.

[devenblake]

Thank you very much for commenting this because I do the same thing and probably wouldn't have found out.

[galaxyLogic]

Well I think I do it gently enough. Have there been any reported cases of pulling your finger out of your ear breaking the eardrum?

[coupdejarnac]

Yikes. As someone who's had two tympanoplasties, I would NOT do this.

[tstubben]

I'm also following FX-322 and keeping my fingers crossed that the trials result in a real significant effective treatment for my SSHL in my right ear. It would really be amazing!

[pacomerh]

Thanks for the resources. I'm usually following https://www.tinnitustreatmentreport.com/ for all things tinnitus and that's where I saw the FX-322

[urgentresearch]

Tinnitus Treatment Report creator here. Glad you find the site useful and thank you for sharing the link. Appreciated.

[urgentresearch]

Hearing Loss Treatment Report creator here. Thank you for referencing the site, I appreciate it.