[bryans]

Tinnitus is usually only described as a high-pitched ringing, but I think it gets far worse when it's on the lower end of the frequency spectrum. It's much more noticeable and can make discerning speech very difficult at times. But while the higher frequencies can be somewhat easily tuned out using white noise (like a fan), the lower frequencies are just always there, even when you're listening to music -- there is a weird "warble" to everything, and it's often not easy to tell whether it's the tinnitus or the bassist holding out a note or the last syllable of a word in the vocal.

As a musician and amateur sound engineer, the higher tinnitus was fairly manageable, but developing the lower tinnitus was pretty devastating and has largely ruined my ability to hear and mix properly. I've needed to read lips for several years now, as a double-check against what I'm hearing. Phone calls are very difficult, but the increase in video calling has helped.

Don't be me. Take care of your ears. Also, remember that noise-cancelling is NOT hearing protection. Buy some musician-quality earplugs (you still hear everything, it's just quieter) and have them with you at all times. Use them even when you think it makes you look dorky at the club or concert or sporting event. It's not worth the psychological torture that is tinnitus, I assure you.

[BossingAround]

> remember that noise-cancelling is NOT hearing protection

I fell for this one as well. I wouldn't be to surprised if noise-cancelling could actually cause tinnitus, or make an onset of it worse (though I haven nothing but biased anecdata to argue the opinion).

[chakintosh]

One thing is sure is that Noise-cancellinng makes tinnitus more noticeable as it's not being drown out by the environment sounds. And It also allows you to listen to music on a much lower volume, which is actually better for your ears.

[rhino369]

I didn't even realize I had tinnitus until I used noise-canceling headphones.

[chakintosh]

same. visited the doc and he said your ears are perfect. No reason you have tinnitus but i'd swear I have it.

[flyinghamster]

The key is to remember that noise cancellation allows you to turn the music _down_.

[jerf]

Noise cancelling headphones have always hurt my ears after a relatively short time using them. One of the ways they work is to shove some of their inevitable distortion up into the high frequencies, above what anyone can hear. I've never heard anything, but they definitely hurt my ears. I don't trust them. This is data. It isn't very solid data, because I can't give you sound pressure levels or anything, and it isn't a lot of data. But normal headphones simply don't make my ears hurt, even after hours and hours of usage in a day, which is most every work day for me now.

(I mean active, "true" noise cancellation generating "anti-sound" for your eardrums, not the passive things labelled as "noise cancelling" because there's apparently no legal definition of the term and anyone can call anything "noise cancelling".)

[Nursie]

That is interesting, I was using noise cancelling headphones a lot when mine came started.

Of course the morning it came on I was also recovering from being riotously drunk the night before, and I'm more inclined to believe something about that triggered it

[gompertz]

Long term sufferer here.. One specific metal concert 15 years ago did me in (unfortunately). I too found that noise cancelling headphones actually flared up my tinnitus more; and resorted to selling my headphones.

[tux3]

I have the same vague suspicion. Nothing credible to support it, but it'd be an interesting data point to collect among the affected population

[philliphaydon]

Oh I have tinnitus. Noise cancelling headphones make my head hurt as it feels like it amplifies the ringing.

[The_rationalist]

https://www.jstage.jst.go.jp/article/jibirin1925/82/1/82_1_1...

[FollowingTheDao]

Yes, klonopin helps reduce my tinnitus. And Tofisopam drug is a different type of benzodiazepine (not for sale in the U.S. or Canada) which blocks the glutamate AMPA receptor.

Glutamate excitotoxicity is at the core of tinnitus, and this is why diet also effects the strength and appearance of my tinnitus.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6458046/

https://www.sciencedirect.com/science/article/abs/pii/S03785...

[tptacek]

As I understand it, diet has not all that much to do with glutamate levels. Your body very rapidly metabolizes it (they do studies where they stuff people full of glutamate while repeatedly checking their blood, and it takes a nauseating amount to see a plasma glutamate spike), and the blood-brain barrier is impermeable to glutamate.

[The_rationalist]

intermitent fasting can reduce base metabolic rate which can in theory downregulate glut. moreover diet alter many signaling pathways, including reduced oxidative stress, which are beneficial to some extent for tinnitus.

[tptacek]

I've been IF for several years now (for whatever good it's done me!), sometimes very strictly and sometimes casually, and I've noticed no correlation whatsoever to my tinnitus. I do buy that anything that really reduces inflammation or anything like that could help, because my tinnitus is definitely correlated to ear congestion and sinus inflammation (but it's always there at some level no matter what).

Basically, my understanding is that the human body is, for basic evolutionary reasons, really efficient at dealing with glutamate.

[FollowingTheDao]

intermittent fasting lowers glutamate because it changes where the TCA cycle gets its energy, not because it reduces the metabolic rate.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1940242/figure/...

[The_rationalist]

No, your answer makes sense but your are being fooled. Tofisopam is not a benzodiazepine. It is what we call a 2,3 benzodiazepine. This is an exception that makes it radically different than any other benzo. It does not directly bind at GABA-A like e.g klonopin and is a weaker anxyolitic. It's action mechanisms is very atypical, it acts as a PDE inhibitor, as a GABA PAM and as a dopamine presynaptic antagonist, making it mildly stimulant. The effect on phopshodiesterases give it unique pharmacology including neuroprotective effects.

Therefore this study shows effectiveness that is theoretically higher than regular benzos. I don't think that regular benzos or tofisopam block the AMPA receptors, although their increase in inhibitory GABA has a similar effect. It would make sense to combine benzos with an NMDA antagonist such as e.g memantine in order to reduce excitotoxicity (or weaker ones like magnesium l-threonate)

I advise you to try tofisopam (grandaxin) especially since it is a safe and extensively studied drug. Tofisopam is for sale in the U.S, OTC in practice e.g on rupharma, cosmicnootropics, possibly indiamart, etc You should not take it in combination with klonopin nor any other drug without advice from an expert (spoiler almost no-one is qualified) as interactions are possible. E.g it is a CYP inhibitor like grappefruit juice. note that the dose escalation must be very slow since tofisopam slightly increase heart contractility which can give non-dangerous but scary transient heart palpitations for a limited subset of the population.

There are many interesting neuroprotectants/modulator e.g BPC-157, cerebrolysin, etc However the most promising treatment besides tofisopam, is a drug that is only available in japan: https://www.semanticscholar.org/paper/Effectiveness-of-Celep... It is likely that tinnitus is already a solved problem, but no one knows it yet besides a few retired scientists.

A complete pharmacological response would also look in synaptotrophics and in mitochondria targeted antioxidants, such as SkQ1

[FollowingTheDao]

Tofisopam is a type of benzodiazepine, yes? Benzodiazepines are depressants that enhance the effect of the GABA, and the literature suggests that tofisopam does not act on the GABA-A receptor but it does enhance the binding of other benzodiazepines to their binding sites.

Any increase in GABA will counteract the excitatory transmission of Glutamate. That is all that matters.

But I know klonopin can eliminate my Tinnitus. So if you can explain how that works go right ahead.

[The_rationalist]

> Any increase in GABA will counteract the excitatory transmission of Glutamate. That is all that matters. No that is not all that matters. The main effect of tofizopam is unrelated to GABAergy, the fact it indirectly modulate GABA-A and potentiate benzos is a plus but its main effect come from atypical PDE inhibition. Look if klonopin is viable for you and solve your tinnitus that's great to hear. But for many people regular benzos are not a complete solution. Tinnitus is a multi-factorial condition and some people might get better results that other with a given medication.

> if you can explain how that works go right ahead Tinnitus is an excitatory overload localized in audition related neuron circuits. AKA too much glutamate (mGLURs, AMPA, NMDA, kainate). The brain is mostly a mixture of excitation (GLUT) and inhibition (GABA-A, B). By taking a classical benzo like klonopin you increase your GABA-A level which inhibit the overload of excitation (GLUT). That is why it works. You can also lower you glutamate levels independently of you GABA via an NMDA antagonist such as memantine. Those two mechanisms are the basic treatments to tinnitus. However there are more specific mechanisms (PDE, synaptotophics, calcium blockers, anti oxidants, bioenergetics) that can be complementary. Classical benzos and NMDA antagonists are not enough for some people with tinnitus.

[philliphaydon]

I've never heard of this.. https://en.wikipedia.org/wiki/Fludiazepam

Is this the same? I'm in Taiwan so googling to figure out what i could ask the pharmacist for to try.

[traceroute66]

> Use them even when you think it makes you look dorky at the club or concert or sporting event.

Yeah, but that's the problem, just like the Western world attitude to masks and COVID.

With COVID, all those Western big babies referring to masks as muzzles, nappies etc. and shouting about "muh freedom". All this despite indisputable objective scientific evidence to the contrary that masks work, let alone all the subjective evidence from countries like Japan where masks are the norm during cold/flu season and so nobody complained about wearing them during the COVID era.

Well its the same with hearing protection, people don't wear it because they consider it makes them look dorky and they care more about their perceived image in others eyes than their own personal health.

But equally, I think venues such as clubs, cinemas, theatres and operas have to take their part of the blame. Does it really need to be that loud ? Exactly what "experience" is your audience gaining out of the excess loudness apart from hearing damage ?

[P_I_Staker]

Um, yes it actually does have to be that loud sometimes. Some venues have taken your advice and it's lead to lame events where some people can barely hear the music in certain parts of the venue and there's no punch, even right next to the speakers.

It's even noticeable, because a lot of venues have this really annoying practice of turning the system way down for the openers, thus hamstringing their set, and making the headliner look that much better. Believe me, artists can look really silly playing quiet elevator music while we wait for the real act. (what a fing rip if you paid $50-100+ on a ticket).

Loudness is a component to musical enjoyment. Very much like the carbonation, acid, and alcohol we add to drinks to make them fun. In those cases too, our bodies can be damaged too. Often times what's fun, hurts us. I do think it's stupid if they don't have hearing protection available.

[ASalazarMX]

> lame events where some people can barely hear the music in certain parts of the venue and there's no punch, even right next to the speakers

Isn't this a good thing? I'd work with the speaker arrangement to improve perception, it might be more expensive to have more, quieter speakers than a few ear popping loud ones. My ideal venue would have the same loudness in every point, just not loud enough that you have to scream to the ears of your companions.

[e7b9]

Yes, it really needs to be that loud.

Above a threshold (about 90-100 decibels (dba or dbc - can't recall)) the vestibular system in the inner ear (the balancy bit) is stimulated, which ?induces dancing? and ?feels good? ...

https://sci-hub.se/https://asa.scitation.org/doi/pdf/10.1121...

[traceroute66]

Meanwhile, in other news .... noise-induced vestibular damage.

[ASalazarMX]

Yes, it really needs to be that damaged.

Well, it technically doesn't need the damage, some people just like it.

[flyinghamster]

> With COVID, all those Western big babies referring to masks as muzzles, nappies etc. and shouting about "muh freedom".

It's that idiotic macho posturing crap, as is all too often the case. There are always muppets pooh-poohing even basic precautions like safety glasses because they're "sissy stuff." Well, you'll cry like a sissy when a metal chip from the grinder flies into your eye. Earplugs fit right into that category.

[bigDinosaur]

Not sure I follow: OH&S rules often require adequate hearing protection be warn in employment, and everyone basically follows those rules without complaint (edit: perhaps I should state 'relatively little complaint', compared to protests about masks).

If you have to wear earplugs or whatever at a venue, the problem is that it's too loud.

[bryans]

> If you have to wear earplugs or whatever at a venue, the problem is that it's too loud.

It's a little more complicated than being "too loud" though. The problem for venue sound is that everything is being projected from a single stereo source at the stage, meaning it generally needs to be at the very least 6dB "louder" at the source to reach the back row, and it usually ends up being more like +12dB for a larger venue -- due to both natural air resistance and bodies soaking up sound. So if it's a high energy gig and people want to dance, they need to be hearing it at a minimum of ~95dB (and we're more accustomed to over 100dB at this point), which means the front row levels may already be upward of 112 or 118, which nobody should be listening to for prolonged periods.

But that's just the average SPL. The bigger problem this all leads to, is when things aren't hard-limited properly and every single snare hit for the entire night is spiking to 130dB and over. It would be nice if it were as easy as slapping a limiter on the master and calling it a day, but it takes some pretty intense math to do it properly, because there may be dozens of speakers even in a small venue, and all of those sound waves are intersecting with each other and bouncing off walls and people. And that's presuming the venue was properly sound treated in the first place -- if it wasn't, then all of those compounding sound wave situations are made so much worse and unpredictable.

Ultimately, the problem is laziness and greed. Venues absolutely need to invest in supplemental systems to provide reasonable SPL at the middle and back, rather than trying to push it all out of two speaker columns on the stage.

[tim333]

>Buy some musician-quality earplugs ...Use them even when you think it makes you look dorky

Or as a mild sufferer myself, use cheap wax ear plugs which is what I do. No one actually notices them and you can vary the sound blocking by how much you squish them in. I use a key ring thing to carry them https://www.ebay.co.uk/itm/131545172517?hash=item1ea0b40a25:...

[sul_tasto]

I wish there was a more stylish version of aviation headphones. I wear headphones because I don’t want to hear what’s going on around me, especially human dialogue.

[flyinghamster]

Good noise-cancelling headphones are amazing. I have a set of Sony WH-1000XM3 cans, and I can play music at a quiet level with them while mowing the lawn. They are a bit more stylish than my Beyerdaymic DT 770 Pros, at least. They've been superseded with an XM4 model at the very least, but I'm happy with mine. I'm normally in the "don't buy Sony" camp, but these are a worthy exception to the rule. Note that this is mostly because I like their sound out of the box and felt no need to fiddle with hidden-behind-an-app controls. I took a look at the legalese when I tried installing the Android app, and noped right out.

That being said, I have had tinnitus all my life, not knowing it even had a name until I was an adult. For me it's a steady ~9 kHz tone. If the 'phones are on and the music isn't playing, I hear nothing but EEEEEEEEEEE, much like how I felt when I walked into an anechoic chamber.