TINNITUS P A TH O PH Y S I O L O G Y

Author

RAMIRO M. VERGARA
Otolaryngologist. Master in Neuroscience and Biology of Behavior. Psychoanalyst.
Master in Neurolinguistic Programming
Fundacin Ciencia y Tecnologa
Bogota - Colombia
E-mail: ramiro.m.vergara@gmail.com


ABSTRACT.-


In the present chapter it is been proposed a new way to address the
issue of Tinnitus (T), so it is intended to put the reader into context.
Three are cornerstones to this innovative proposal: First, to deal with
the person instead of just the body; Second, to focus your attention on
the noise factor, instead of going directly to the auditory system and
Third, by doing this we realize that T is not produced by the ear or the
auditory system, which only accounts for hearing the noise, but is
actually produced by anatomical elements located around the ear. With
regard to that, it is proposed that the T pathophysiology has two stages:
the first happens at an unconscious mind level, a psychological level
stage and the second, at a neurophysiological and anatomical level, a
physical stage.


This chapter is divided into the following sections:

A. Introduction
B. Literature Review
C. Unconscious mind level step.
D. Neurophysiological and Anatomical level step, which includes:

1. Noise and sound source
2. Demonstrating T as a true sound signal
3. Accomplishing the previous steps so that T will have a sound
source like any other noise
4. If T is a true sound signal we must be able to hear it in some way
5. Intensity and Duration of T.- We must also be able to explain
some particularities of T, such as its long duration and its low intensity

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 6. Treatment - This subject will be discussed in a different chapter,
but it is relevant that it be mentioned here hence, if we are
successful in solving the previous mystery, we should be able to
propose an effective treatment.

E. Conclusion
F. References

A. INTRODUCTION.- We are used to seeing medical science deal
primarily with the physical human body. The mind has not been
considered a factor, to be studied on this matter. Even psychiatry treats
psychopathology with medication for the body. In the same way, T has
usually been treated as a condition generated only by the body, but
psychoanalysis - the science of the unconscious mind - teaches us
transcendence of the mind in human pathophysiology, so that working
with the information derived from neuroscience, psychoanalysis and
Neurolinguistic programming, we are then dealing with persons instead
of just bodies. In the present chapter, we will be applying this same
programming to T.

Apparently the scientific community is turning the corner on this issue
as it can be seen in one of the most famous neuroscience treaties, The
Principles of Neural Science, edited by Kandel and Associates, Fifth
edition, Chapter VII, 2007, that refers to Sigmund Freud, the author
quoting we experience emotional states not only consciously but also
unconsciously; and continued by saying Many of these emotional
states, particularly those involving fear, depend on the amygdala, a
subcortical region of the limbic system.

The first assertion is correct but the concept is incomplete, because

emotions are always experienced in the conscious level but are always
generated from, and relayed as, an order from the unconscious mind
level; and the second part of the reference implies to having been
attributed to Freud, which is untrue and clearly shows the confusion of
the person who wrote it, because the amygdala is not an independent
nucleus in the brain, it belongs to the caudate nucleus, which is made
up of only GABAergic, inhibitory nerve cells, which cannot be
functionally separated from each hemisphere. The caudate nucleus runs
along the size and shape of the hemisphere like in a mirror and it is
used by the brain as a necessary hardware component, to generate
binary codes in the contralateral hemisphere synapsis, that contains the
information going from one hemisphere to the opposite one. Amygdala
cannot contain information on its own. (See Figure N 1).

Figure N 1.- Graphic taken and modified, with permission, from Jairo Bustamantes
Neuroanatomia Funcional y Clnica, Third edition, Editorial Mdica Celsus, Bogot,
2001. It shows the way caudate nucleus runs all along the size and shape of the
cerebral hemisphere, which shows that the amygdala is not an independent nucleus,
so it is made of GABAergic nerve cells only, so it is part of the hardware needed for the
brain to generate binary codes in the contralateral brain hemisphere.

By adding neuroscience, psychoanalysis and Neuro-linguistic
programming, it has emerged the New Scientific Clinical Applied
Research (NSCAR), as a tool to approach T, where the mind is thus
considered a component of the human person as well as the body. The
mind is actually information, which psychoanalysts say is formed from
three different sources, the real (true memories), the imaginary and the
symbolic, information which is not floating around in the air or in a
vacuum, but is physically stored in the brain, in terms of binary codes
generated by nerve cells in every synaptic station.

B. MEDICAL LITERATURE ABOUT T PATHOPHYSIOLOGY REVIEW.-

Meyerhoff and Cooper assert in their T chapter written in Paparella and
Shumrick (1980) that: The lack of a deep understanding of the T is
made evident by these confusing factors and also by the multiple and
varied explanations given. Literature first deals with T on the basis of
clinical and theoretical impressions, but with an unrealistic basis. Many

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therapeutic methods that have been proposed and which are in use at
present are based, at least partly, on one or more of these explanations.
The lack of scientific foundation for these concepts could give rise to
some confusion and could be explained by the fact that the T is, above
all, subjective discomfort for which an objective indicator is in general,
very scarce, and also because there is no animal model for the T, (page
1862). The above statement, made by knowledgeable authors, gives us
an idea of how advanced the T research is at present. Although it dates
back to 1980, things have not changed much from then until now, 2015.

Lothrop, cited by Appaix (1972), proposes the interesting hypothesis
that the ossicular chain is normally kept in stable equilibrium through
the action of the hammer and the stirrup muscles and that T would be
the result of the loss of equilibrium due to the involuntary contraction of
these muscles, which would imply a vibration of the labyrinth liquids.
Although Appaix (1972) notes that Lothrop does not provide any proof,
nor does he argue in favor of his hypothesis, in my opinion, it does
indeed have several merits: first, the problem is well posed; two, it
mentions the anatomical elements involved in a correct, verisimilar
sequence. It is true that the middle ear muscles may involuntarily
contract and that their contraction implies an ossicular chain movement;
and that any ossicular chain movement also moves the labyrinth liquids.
As a whole, these phenomena constitute the hearing phenomenon
mechanical stage and therefore gives rise to a hearing sensation. In the
present chapter this hypothesis is considered as being the preceding to
our proposal.

Several authors, such as Schneider, Lempert and Rosen, cited by Appaix
(1972), have proposed separately, that the T is caused by damage to
the middle ear innervation. Lempert attributes the absence of T in
chronic otorrheas to the destruction of the tympanic plexus. Although,
these authors are not in favor of his theory, one can take advantage of
Lemperts remarks as indeed being true that T does not appear very
frequently in chronic otorrheas.

If the question was asked as to what happens in otorrheas, the answer
would be that damage was done to the impedance adaptor, which is the
transmission of noise from the ear canal towards the inner ear, e.g. A
patient may produce noise in the ear but the presence of an otorrheas
produced by an injury prevents it from being heard. At this point, it
might be useful to refer to the clinical history of one patient.
G. Q., who had a 50% eardrum perforation of the right ear, with an
average of 35 dB conductive hearing loss, while his left ear was normal,
indicated that at one time when he was at a fireworks celebration, the

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explosions produced a T in his left ear, although not in the right one.
The explanation for this case was that there were different reactions in
both ears of the same patient, even though both ears had been
subjected to the same noise. This is based on the already existing
difference described between both ears, e.g., that the right ear, with its
impedance adaptor and transmitter system having been injured, did not
perceive the T, because the sound signal of T usually appears in the
external ear canal, where the normal hearing ear hears from, and not
from the one that has tympanic membrane perforation.

In this work deemed it highly important to give sufficient attention to
the so-called T psychoacoustic and neurophysiological models. For many
years, a considerable number of the most outstanding T researchers
have been working in this direction. In the Fifth International T Seminar,
in Portland, USA, 1995, Professor Powel Jastreboff, an engineer,
submitted a study entitled The Processing of the T Signal in the Brain,
where he states that the available information suggested about the T is
a prevailing way of thinking, according to which the T is the result of an
injury in the cochlea, that produces a hypothetical abnormal activity in
the auditory nerve then transmitted in a very passive way through the
auditory system up to the auditory cortex, where it is perceived as a
sound. This according to Jastreboff, is called the psychoacoustic model
of T, but he cannot explain the mystery or some other characteristics of
T, such as the different degrees of severity it presents in people, making
an identical description of their T.

Jastreboff himself later announced that as a result of the research
Works, a new model called neurophysiological was created. This model
or mechanism proposes that a number of systems within the brain are
actively involved and are essential in the generation of the T, where the
auditory system performs just a partial role, not necessarily a decisive
one. Each of these systems has some kind of a role, but the clinically
important T arises as a result of their interaction.

Jastreboff specifically proposes: The T signal is generated within the
cochlear nucleus or another brainstem nucleus, as a result of an
unbalance of the activity that comes through nervous fibers of type I
and type II. This unbalance is the result of typically observed patterns of
cochlear damage, after manipulation of almost all of the ototoxic, which
produces an injury in outer hair cells, proportionately larger than that of
the inner hair cells. Thus, the signal originating in inner hair cells and
transmitted through type I fibers, would not be significantly affected,
while type II fibers innervating the absence in outer hair cells, could
degenerate themselves or might show a stable activity, not related to a

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sound stimulus. This hypothesis is a generalization of Tondorfs theory of
pain and might explain many of the T characteristics. This theory also
proposes that the tone of the T should be in the lower part of the
hearing loss curve, in the area of the basilar membrane, where the
largest contrast between outer and inner hair cell damage takes place.

To support his theory, Jastreboff mentions that there has been an
increase in the sensibility of neural cells of the hearing pathway
documented in animals, after temporary or permanent hearing loss.
That the experiments for direct registration of the activity of individual
neural cell in the inferior colliculus and in the dorsal cochlear nucleus,
after an acoustic trauma, revealed that one third of these cells
presented a sensibility increase in the presence of auditory stimulation
and some cells presented an increase in their spontaneous activity. He
also mentioned some other findings that as a whole prove that
subcortical neural cell activity exists in this phenomenon. But in the end,
he adds that it does not prove this activity is related to the T, since it
has never been shown that animals could suffer from T.

In addition to the aforementioned theory, Jastreboff brings forth more
documentation to support his hypothesis, but until now we have heard
enough to reach an acceptable understanding of it. Despite it being well
documented and Jastreboff being an acknowledged authority on the
subject, it must be indicated that the neurophysiological model proposal,
falls into the error of accepting Wegel's (1931) initial classification of T,
not as a proposal, but rather as a biological law, which it is not. When
Wegel (1931) calls a T group non-vibratory that is to say no sound,
what he means is it could not be heard by the naked ear, but he did not
use every available resource at that time, to increase the ability of the
ear to perceive low intensity sounds, but as it will be seen later on in
this chapter, thorough clinical studies of patients clearly show that the
so-called non-vibratory T is in fact a real sound, and what the ear, the
auditory pathway and auditory cortex do, is to hear the T as any other
sound stimulus. It will also show how modern technology has made it
possible to hear the T.

Obviously the central nervous system performs a prevailing role in this
illness, as will be seen later on, when I will be supporting the hypothesis
of a neural cell circuit in any T base. As for the rest of the theories
described, I would like to mention, that hearing and its disorders, are a
different and independent nosological entities from the T illness itself
and therefore the changes in the neural cells behavior in the auditory
pathway, due to noise induced hypoacusis or by neurotoxins, have no
relationship to the T mechanism. One thing is the hearing and the

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hypoacusis, and another is the T, which is quite different, as it has been
observed in the T patients clinical study.

C. UNCONSCIOUS MIND LEVEL STEP.-

The mind is the information stored in the brain, actuates the brain and
the brain governs the body in a stringent and painstaking manner, so
any manifestation like clinical signs and symptoms, are actually
messages coming from the unconscious mind, which drives the brain,
which transmits messages to the body, the territory where it governs.
Keeping in mind the previous point of view, T is actually a message,
which is originated in the unconscious mind that drives the brain to
transmit a message to the body, a process named by Freud as an
innervation.

The unconscious mind which is the information stored in the brain, in
the association cortex, that have reached these deposits through
perception in the primary sensorial cortex areas, previously captured
from the environment by the peripheral sensory organs, must be
considered a fundamental piece in the generation of pathology and in
the treatment approach. So we must begin approaching the T by
interrogating the T patient with an appropriate technique, to capture
more information that could be perceived and then associated with the
information previously stored in the unconscious mind (association
cortex), which is about beliefs, principles and values which generates
the persons reaction to the received information (stimulus). This
response in the first term is a high intensity feeling that prevents it from
being consciously perceived, thus, the unconscious mind must repress
impulses, but the physical excitation (brain) has to be eliminated to the
periphery through a mechanism called innervation by Freud, which puts
into action some groups of muscles, which are the effectors used by the
brain to remove the excess of excitation.

In accordance with T etiology described in etiology chapter, the symbolic
meaning of things and events that take place in our environment, are
the efficient cause of T and discovered through the appropriate
anamnesis (psychoanalysis). There are three main groups of events that
always generate fear, these are: Loud blasts which produce the fear of
dying; life events that trigger symbolic meanings of masturbation that
generate the fear of not being able to control ourselves and provoking
an activity which was very censured by adults; and Fear, chemically
generated through the administration of neurotoxic drugs like
antibiotics, salicylates, analgesics and others.

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When effective information is perceived, it enters into a relationship with
the information previously stored that contains the censorship,
(masturbation) on unconscious level and the result is the generation of
fear, which is so intense it cannot be tolerated in the conscious level. For
that reason, fear is re-sent to the unconscious level where it remains
but not immobilized, it is always trying to push its way into the
conscious level. Therefore, the excitation level of the brain is always
moving upwards and according to Fechners law, the brain has to
maintain a constant level of excitation, while at the same time trying to
block this upward push.

In a situation such as this, the brain usually uses two different kinds of
mechanisms to remove the excess. The first, are the effectors, the most
suitable of which are the different groups of muscles, and the other is
the unconscious associative elaboration of meanings, both working
permanently, but in this case these mechanisms fail and are not enough
to return the excitation level of the brain to normal. In such a situation,
the brain does not invent a new mechanism, but returns through its own
phylogenetic history to find a group of muscles that render the needed
help.

The group of muscles located around the ear is very suitable for this
purpose, because they can be contracted without producing an apparent
movement; nevertheless they generate a sonorous message, T, which is
addressed simultaneously to its own person and to other people as well,
as happens with other unconscious mind messages like snoring. This is
to say, the unconscious mind produces the noise to be heard by itself
and by the environment. This is why residual inhibition can be produced,
when the unconscious mind perceives a similar noise coming from
outside, it stops producing its own noise, because now it is listening to
the noise (message) it needs to listen to.

When an informative content belonging to the unconscious mind,
actuates the brain to produce a message, in this case a noise, which is
to be heard by it, the feeling that constitutes the fear needs to hear
something, but the message is also directed to other people as well, but
with controlled intensity.

But when the brain discovers the way to eliminate the excess excitation,
it finds out it is easier than other actions and also produces the message
it wants to hear, it prefers this method, it protects it and it doesnt want
to lose it. That means T has become a brain protection tool, thats why
the brain in turn protects T, so for this information to be effective the
treatment of T must be acknowledged.

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It is well known that some professionals and even researchers are not
familiar with psychoanalysis information, but if we were to think about
things, psychoanalysis is a very important part of neuroscience. The
most knowledgeable and cleverest of scientists with the best attitudes
are expected to have the most amount of information about the person
called the patient, not to exclude any information at all. So it is not
acceptable to reject information simply because it comes from
psychoanalysis, a science we are not familiar with. When dealing with
persons we have the obligation to acquire any information and skills
needed to carry out our mission in the best way.

D. NEUROPHYSIOLOGIC AND ANATOMIC LEVEL STEP.-

In this chapter the intention is to demonstrate how T is a true sound
signal, also how some parts of the human body can act as a sound
source as well as how this sound source has an energy source; my
construction will also explain how some particularities of T, like how it
does not stop ringing for years, but keeping in mind how the
environmental stimulus and symbolic meaning, reaches the unconscious
mind stored in the brain, is the efficient cause of how the brain
mechanism is put into action to explain the excess of excitation through
physical symptoms, that is to say, the sound signal of T.

All this information is new knowledge generated through research work
conducted with the most scientific rigor using the tool The New
Scientific Clinical Applied Research (NSCAR) for about 30 years up until
now, 2015.

To achieve the above promised goal, NSCAR has made me think about T
in a new and different way. This began by focusing my attention on
what T patients said they were hearing. Now, imagine yourself in an
office with a T patient sitting in front of you saying: I have a noise in
my ears and your thoughts are automatically concentrated on the
noise, instead of focusing directly on the auditory system. Then you
begin to search for the origin of the noise, along with all of the clinical
data collected from the T patient.

We must focus strongly on the noise factor because neither the ear nor
the hearing system have anything to do with the generation of T, the
ear only captures the sound signal of T and sends it to the brain. The
patient believes he hears T from the ears because he can only hear
noise from his ears, but in reality the noise is being produced in the
anatomical region around the ear.

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If we think of the definition of T as based on these three ideas: the
patients sonorous sensation, the inability of the examiner to hear the
same beep sound that the T patient says he or she is hearing and the
lack of a sound source, then we can see that medical science has not
been able to answer any of these questions correctly.

To answer the first of the three T definition questions that is to say, T is
a true sound signal; I have followed three strategies from the literature
review, for assistance from some basic sciences along with the data
taken from T patients using a special technique. So lets begin by
studying noise through basic sciences.

1.- Noise and Sound Source.- Maintaining strict, scientific
conventionalism, what comes next, is sound definition or noise, by
saying it is a physical phenomenon composed of two kinds of
movements, vibratory and ondulatory, being generated throughout the
universe as a code that contains and transports information; the
vibratory movement is called the simple harmonic motion, the
ondulatory movement is the elastic wave which travels through a
medium full of molecular size particles.

The simple harmonic motion is the transit of molecular size particles,
meaning that the particle begins its journey from a rest position in one
direction and returns in the opposite direction, passes through the rest
position and travels at an equal distance from where it started the first
time and then returns to the rest position again. The definition of sound
according to physics includes one interesting feature. It states that, the
displacement of an elastic wave that generates vibration in any core
even it cannot be heard.

But we need to pose the question: Not be heard by whom? And the
answer is: By a normal hearing human being. I call on the assistance of
physics, which says, in accordance with the sound intensity spectrum,
there is a fragment of this spectrum, which means, a group of sounds,
ranked as infra sounds, which cant be heard by normal hearing people,
but this group of sounds really exist and appropriate technology is
needed to capture and record them. T belongs to this group of
infrasounds.

Sound source - For any one element in the universe to be able to
operate as a sound source, it needs an element to be able to move it. A
sound source is any element that can move on its own ability or by

10
external forces to communicate this movement to the surrounding
fluids, where sound signals travel.

The physics of sound describe three different kinds of sound source,
which are: first, a vibrating object, like a tuning fork which when tapped
on another object begins to vibrate, which means it vibrates because of
an external force and the tuning fork transmits vibration to the
surrounding fluid, in this case the air.

The second kind of sound source is an element that produces changes in
air flux, like the human larynx, in which the vocal cords open and close,
the glottis that changes the quantity of air it flows out of, this produces
a sound wave. Another example is wind music instruments like the oboe
and saxophone. The third kind of sound source is the heat source, which
produces a sudden temperature change that generates a speedy
expansion of the surrounding air like thunder.

According to the above information, the T sound source is similar to the
first mentioned class of sound sources, meaning, muscular fibers get
into motion by the changes in the length of the tendon, which is the way
muscular fibers vibrate and then communicate these movements to the
surrounding fluid where it travels through and can be captured from the
external ear canal with the appropriate technology, which means to say,
through this methodology we hear the same noise the T patient is
hearing.

Also, as stated by physics, in order to introduce changes in the
properties of a sound, such as intensity and frequency, we can do that
by introducing changes in the sound source or in the medium the sound
wave is travelling through.

By using these physics of sound laws, we are able to demonstrate that T
is a true sound signal; this is what can be achieved by performing the
Sound Active Maneuvers (SAM). On performing a physical examination
of the T patient, we introduce physical changes in the peri-auricular
anatomical elements, and through such changes it is possible to
introduce changes in the intensity, the frequency and the location of the
sound source; in one of them or in all three. This demonstrates that T
behaves in accordance with the laws of the physics of sound, so we can
conclude that it would be very strange if T were not a sound signal.

Some T patients have said that their T is located outside their ears and
head, about one foot in distance, this behavior is produced because,
more than one sound source is operating simultaneously and produce

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reinforcement interference, which is known as sound signal behavior
when coming from two known sound sources located at an appropriate
distance. When that happens in the T patient, it is because there are
two different sound sources, two different groups of muscles acting as
sound sources.

In accordance with the definition of sound source by physics, the human
body or its parts can operate as a sound source. This is a fact that
everybody knows; some parts of the human body generate different
kinds of noises, which have been used as diagnoses and treatment
references. Different parts of the human body generate noise when in
motion, like the heart, bowels, lungs when they expand and when they
compress, in all these cases it is all about muscles contraction.

Several centuries ago, medical science had been using any kind of
device to amplify the ear capacity to listen and examine the different
human body sounds and several accurate techniques have been
developed as diagnosis and prognosis of a particular organs health
condition.

2. Demonstrating How T Is a True Sound Signal.- To achieve this
goal, information has been taken from three different sources, medical
literature reviews, basic sciences, such as: anatomy, physiology,
physics, mathematics and so on and third is the clinical study, which
includes interrogation using the psychoanalysis technique and the
physical examination performed on the T patient, taking into account
the SAM and clinical tests based on electronic and computerized devices.

About the T patient interview, it is relevant to say a few words about the
methodology that uses a clinical study with a written questionnaire,
where the professional obtains the information about T behavior, even
though the questionnaire has many questions, it does not leave enough
space for the personal history of every T patient. This methodology
imposes a limitation to the information the professional may obtain from
his patient; clinical knowledge about T is not concluded, we still have
many things to learn, Tinnitology has almost reached its source and
needs to obtain much more information through an appropriate
methodology for it to grow.

Literature reviewed has produced countless data that supports and even
demonstrates the onerous nature of T. The first data found, included in
several publications that give an account of some T patients whose T
could be heard by the naked ear, by the examiner or any other normal
hearing person. Looking at T through its physical characteristics,

12
intensity, frequency and sound source location are equal to those
described by T patients, whom until now have said it was impossible for
it to be heard.

The above assertion means those T sounds are similar to pure tones or
narrow band sounds, often similar to natures sounds; similar in their
pitch to those described by T patients with in the non-vibratory T
group. They are always located in the ear or in the peri-auricular region.
When the T patient comes for consultation their relatives have already
heard the T.

Among these publications we mention Huizing and Spoor from Leiden,
Holland, 1973, who reported the case of two sisters that used to play
the piano with four hands and one of them noticed the right ear of her
sister, was producing a continuous high frequency tone, which could be
heard by any normal hearing person at a distance of 20 centimeters.

Other cases informed: Lobell (1962) reported the case of a three and a
half year old child who had high frequency T in both ears. Cytron (1969)
reported the case of a girl with T in both ears and he measured their
frequency located between 7.500 and 8.000 Hz. Kumpf and Hoke (1970)
reported the case of a lady with T in her right ear and they were able to
measure a 4.200 Hz tone with an intensity between 5 and 10 dB; they
also informed that changes in the body and head position or venous
congestion produced changes in the persons T perception.

Glanville et al (1971) reported the case of a 33-year-old man with a
high pitch T in one of his ears, while two of his three sons had T in both
ears that could be heard by the naked ear. This case is not enough proof
to be considered inherited; the mechanism is probably an imitation.

Zurek, an ENT from St. Louis, USA (1981) found on testing a hearing
aid, that his own right ear was producing a noise he could measure as
1.910 Hz and 7 dB intensity. In 2005, Cristina Feres, from Brazil, during
the VIII International Tinnitus Seminar, Pau, France, informed the case
of a 20-month-old child who presented T that could be heard by the
naked ear, located in the right temporal muscle region.

If we pay attention to the above-mentioned cases, you will notice that
almost all of the cases are with children, so the difference between
children and adults must be considered, and the major difference is in
behavior. Adults are subjected to the social control ethical rules that
prevent them to produce a sound signal that could be heard by others.
Imagine a social meeting like a cocktail party, where 20% of the

13
attendees are sounding in an intensity that can be heard by the other
attendees, it would be an amazing spectacle. Children are not subjected
to the social control ethical rules in the same way as adults.

2.- The Discovery.-

The psychoanalytic technique performed in a T patient consultation,
made it possible to discover in his clinical history, which is believed to be
memorable, T described by the patient consisted of a true sound signal,
even though it could not be heard by the examiners naked ear. (Clinical
history elaborated in 1987).

A 52-year-old male patient whose tonal audiometry showed a slight
sensorineural hearing loss in high frequency tones; said this about his
right ear T: when I put a hard object between my teeth and clench it
forcefully, I hear a noise in my right ear approaching at a great speed
from several kilometers away that gets louder. The patient always
obtained the same result when repeating this clenching maneuver.

This clinical history made me consider the following:
A. When the T patient perceives these changes in his T, we see how it
corresponds to the different speeds at which the sound wave travels
through different kinds of fluids, in the air the speed is 340 meters per
second; in liquids it is 1,050 meters per second and in solids it is 3,150
meters per second. (Approximate values).

Figure N 2.- Graphic to schematize T-patient clinical history.

So when the T patient is in a resting position, T is being transmitted
through a gaseous or similar medium and when he clenches the hard
object between his teeth, T is then transmitted through a solid medium.
This is the way that sound signals behave when coming from a known
sound source, so T behaves in the same way as a true sound signal thus
this patients T is a true sound signal.

B. When the T patient performs this clenching movement, a mechanical
maneuver including the anatomical elements located around the ear

14
introduces changes in his T, equal to those that can be introduced in
real sounds, with a known sound source, so this T is a real sound the
ear can hear. If the patient can perceive changes in the intensity and in
the location of the sound source, it is because the ear is hearing the
sound.

C. The maneuver this patient executes is a masticatory maneuver,
which is completely external to the inner ear, meaning, through such a
maneuver it is impossible to influence the inner ear functions, the
auditory pathway or the primary auditory cortex. So T is a true sound,
which is generated outside the inner ear and the neural auditory
system. (See figure N 3).

A bioelectric or biochemical phenomenon is happening within the neural
auditory tract. As postulated by many researchers, it would be
impossible for the patient to generate the described changes through
these maneuvers, executed with very external anatomical elements. The
ear and the auditory system are busy hearing the sound signal of T.

D. If we carefully consider the maneuver executed by the patient, we
see it consists of clenching a hard solid object between the two dental
arcades, through which the mandible, the upper dental arcade, the face
bones and the skull are converted into one complete solid. What is
happening with such a maneuver, is that by suppressing the gap
between the two dental arcades and the gap between the mandible and
the skull in the temporomandibular joint, so T is transmitted through
one complete solid, in which the speed transmission is ten times higher,
so it is perceived louder.

E. If we consider the executed maneuver again, we are concerned with
the anatomical structures of the jaw, the masticatory muscles, the
upper arch, the face bones and the skull. If we choose between the jaw
and the masticatory muscles we have concluded, that if they intervene
in the described changes it must be because they are related to the
sound source or with the medium through which the sound is
transmitted. In the case of T, the sound source seems to be located in
the region around the ear and the two mentioned structures are located
in this area, so the T sound source maybe one of them or both.

Remember that sound is composed of vibratory and ondulatory
movements. It is clear it would be quite difficult for the jaw to work as a
sound source since it does not have the proper movement, although, it
may, like any other physical body, act as a sound transmitter.
Furthermore, it would be worthwhile mentioning that even if the jaw,

15
the upper jaw, the face and cranium bones cannot move by themselves
to act as a sound source, they do have a natural resonance just like any
other physical body existing in the universe. This natural resonance
could undergo certain modifications such as, if they are submitted to the
pressure of the masticatory muscles, they become higher frequency
sound resonators. Any resonator increases the sound intensity
corresponding to its natural resonance frequency or to that of its
harmonic overtones (Sears, Zemansky, Young 1986).

But there's another element involved, that presents all of the
characteristics suitable to act as a sound source and these are the
masticatory muscles. Muscle fiber works alternatively, shortening and
lengthening itself, thus if this is done at a high frequency, it is very
likely that it will become a sound source. Masticatory muscles have
several characteristics such as a short distance among insertion points,
large muscles mass, great power and a permanent and intense activity,
properties that would make them very fit for vibratory movement,
whose frequency could be within the audible sound spectrum. Taking
the above into consideration, masticatory muscles become a very likely
source of sound for the patient involved. (See figure N 2).

Phylogeny can render us some assistance here. As it is known,
communication between living beings, the transmission of messages
among individuals of the same species, always takes place either by
putting an individual muscle or a muscle group in motion. The upper
class invertebrates, beings with an exoskeleton, particularly the
flightless ones for example (grasshoppers), communicate with other
individuals of their same species through the emission of sounds that
are audible to their hearing organs, the ribbon reel, the Johnston organ
and the tympanic organ. In accordance with the above described, I
propose, that the human brain performs a regression through phylogeny
as a way to find out, an appropriate group of muscles to express an
unconscious mind message. (See figure N 4).

Entomology has fully described the anatomical composition of these

mechanisms (figure N 4), whereby a muscle group puts some elements
in motion that act as a sound source. If you go to the higher-level
vertebrates, such as the birds, you can appreciate that they count on a
vocal organ called syrinx, where the sonorous element is the muscle
itself. And from here we go on to the mammals and to the human
species, where a muscle, when regulating the quantity of the air stream
by contraction, acts as a matchless sound source, which in turn is
helped by a series of other muscles acting in a neurologically regulated,
perfect sequence, to produce the human voice. Here phylogeny comes

16
in reply to the third question posed with regard to the definition of T,
that is, the identification of the sound source. In other words, one has a
real and a perfectly appropriate sound source.

Figure N 3.- Diagram that summarizes how unconscious information stored in BISC
located in association cortex, over stimulate the motor cortex and other unconscious
content permanently inhibits globus pallidus nucleus, to produce brainstem motor
nucleus that only receives excitatory stimulus. The oscillator form BISC when
constructed makes it possible for energy to sustain T working endlessly. These are
neural structures completely separated from the auditory system.

The need to make an orderly exposure, calls for an ample participation

of the hypothesis by proposing, that the T sound source is always
muscular, even if they are not always the masticatory muscles. The first
thing would be to mention, is that a case was found in medical literature
of a patient reported by Bouche, and mentioned by Appaix (1972), who
because of a voluntary and prolonged contracture of his front muscles,
after one or two minutes he would generate a T in one of his ears.
Bouche attributed the T to a probable contracture of the stapedius
muscle.

17


Figure N 4.- Taken from Neurobiologa of Shepherd G. first edition, Editorial Labor,
Barcelona, 1985, with permission. This graph shows the way noise is generated in a
grasshopper, an upper invertebrate insect.

Although Bouche did not argue in favor of this hypothesis, it is resumed
here, by saying that the stapedius muscle is innervated by the facial
nerve, which also innervates the front muscles. Here again it is used the
assistance of phylogeny to recall an event that occurred or started
approximately 250 million years ago. At the beginning of the Mesozoic
age, during the Triassic and Jurassic periods, the stirrup bone and the
tympanic membrane used to be superficial, and were then transferred to
the temporomandibular region, where no external listening duct existed.

At that time, the impedance adapted system was just a bone called
columella, which later on gave rise to the appearance of the stirrup bone
and the other two bones that constituted the ossicles chain. All these
complex of structures emigrates from the otic neckline in the cranium,
up to the temporomandibular articulation region (Romer and Parsons
(1977). This shows that the stapedius muscle is indeed a facial muscle
or perhaps cranial, but in any case, during the past ages it was part of
the frontal muscle (figure N 5).

The reader is invited to do a mental exercise along with me, by thinking

about a subject who tries to contract the forehead muscles, where he

18
exerts intense voluntary pressure on the nucleus of the facial nerve
origin, where the motor neurons innervating the said muscles are found,
but also there are those that innervate the stapedius bone muscle and in
all likelihood the pressure could spread to them, although not easily.

Figure N 5.- Diagrams showing the evolution of the middle ear and auditory ossicles.
Diagrammatic sections through the otic region of the head of A, a fish; B, a primitive
amphibian; C, a primitive reptile; D, a mammal (showing the ear region only); E, side
view of the skull of a primitive land vertebrate; F, side view of a mammal-like reptile
showing the shift of the eardrum from the otic notch of the skull to the jaw articulation
region. A, articular; d, dentary; eu, Eustachian ; hm, hyomandibular; i, incus; m,
malleus; me, middle ear cavity; oe, outer ear; q, quadrate; s, stapes; sp, spiracle; tm,
tympanic membrane. Taken from Romer, Man and the vertebrates, University of
Chicago Press.

The above paragraph proposes that different muscles, other than the
masticatory, may become a sound source in T disease. The stapedius
muscle, mentioned above, will again be involved since the proposal is
extended to the hammer muscle. A fact that has widely been mentioned
in medical literature, is that the middle ear muscles have an ear
defensive function regarding very intense sound stimulus and daily
experiences, which show that when perceiving an intense sound as for
e.g. after listening an airplane noise, a whistling remains in the ears for
a few seconds, and then disappears. Bluntly speaking, the whistling
originates in the tonic clonic contraction of one of the middle ear

19
muscles or both, which in turn is the reply of the brain to the airplane
sound stimulus. It is possible to go further to say that the hammer
muscles contraction, produces a whistling and that the stapedius
muscle produces a sound similar to an air exhaust.

It is also relevant to mention here, that the acoustic reflex can be freed
through two forehead maneuvers, first, the examiner blows air in front
of the patients eyes, and second he raises the subjects eyebrows with
his thumbs, Djupsland (1974). Thus the relationship between the frontal
muscles and middle ear muscles is supported.

But there is still more to say about the middle ear muscles. Whenever
an unilateral T appears i.e. present in only one ear, the acoustic reflex
will be present in both ears, but with an increase in the threshold in the
affected ear. In these cases, it is proposed that the middle ear muscles
are involved in the ear experiencing the T, whether generating the T or
transmitting the sound towards the inner ear, like in any other sound
stimulus, there is a higher intensity stimulus required to free the reflex.
Pearson mentions in Appaix (1972), two cases related to the veli
palatini muscle clonus, made evident by salpingoscopy, where muscle
contraction produced a T similar to a pounding. It should be
remembered that the veli palatini muscle belongs to the masticatory
muscles, innervated by the motor branch of the fifth cranial nerve, the
same as for the hammer bone muscle.

According to where the T is located, or the sound source, which is the
same, it could be a matter of two muscular groups located farther away,
such as the pericranial, frontal and occipital muscles, as well as the
facial and cervical ones. The T is also commonly called head noise,
which refers to cases where the sound source comes from the
pericranial muscles. If investigated further, the hypothesis of muscular
sound would receive many more favorable arguments, but it is not my
purpose to tire the reader, rather to make a reasonable claim for the
proposal, which seems to have accumulated enough evidence according
to what has been told so far.

In addition to the information discussed above, it is relevant to present
the clinical history of a 51-year-old male having T in his right ear for the
last 4 years. During the last year he noticed how the T intensity
increased, each time more frequently. Every time that happened, after
two hours he began to feel pain and strain in the right side of the neck,
about six months later the pain and strain extended to the right
shoulder as well.

20
At the beginning, this case states that only a reduced group of muscles
generated the T sound signal and later it states how other muscles
groups are involved, as the patient mentioned. So it is proposed T is
produced by a group of muscles that cannot be very easily identified,
because they do not produce any apparent movement because they are
contracted and do not generate any movement. Both groups of muscles
are innervated by cranial nerve motor nucleus, all of which are relayed
to the same brain structures.

The Cranial nerve motor nucleus is columnar in shape, so the motor
nerve cells in charge of different groups of muscles are located at
different levels within the nucleus, so at the beginning, excitatory
impulses arrive only to the higher nucleus levels, when conflict grows
and enhances the excitation, then it reaches the motor nucleus lower
levels.

According to the theory presented here, noise is produced by over
excitement acting on the motor cortex and an inhibition acting on nerve
cells in globus pallidus nucleus (GP), which contains only GABAergic
neurons, whose axons go to innervate motor nerve cells, in the motor
nucleus of cranial nerves, which are also innervated by the cortico-
pontic bundle, so these motor nerve cells receive only excitatory
impulses coming from motor nerve cells in the motor cortex. (See figure
N 3).

At the beginning, when he only felt T, the exerted inhibition was acting
only in a limited part of the GP nucleus nerve cells, but later when the
conflict grew and occupied larger spaces in the brain, it restricted a
larger number of nerve cells in the GP, that prevented motor nerve cells
in the cranial nerve motor nucleus, to be inhibited every time they
received an excitatory impulse through glutamic acid liberation. (See
figure N 6).

21


Figure N 6.- This graphic shows the functional unity of the brain. This is the way
nerve cells can suitably located each other, to create binary codes in every synaptic
station and is also the most suitable excitatory channel where inhibitory nerve cells are
located, in order for the brain to be able to increase and decrease the function speed of
any organ in the human body, such as muscles.

Conflict that generates T is an information content, which is formed by a
feeling, which is stored in one or several association cortices in the
brain. This feeling can grow, so as it does, it occupies larger areas in the
brain and then it becomes more powerful. It may inhibit the GP more
intensely and produce more excitation in the motor cortex (Area 4).
(See figure N 3).

It is been possible to demonstrate that the above mentioned feeling is
always about fear, but it is not a non-specific fear. On the contrary, in
accordance with psychoanalysis, it is always related to several fear
generating events in life, fear to die like in blast injuries and more
frequently fear to masturbate, fear of not being able to control ourselves
to abstain from masturbation; but this is because masturbation was a
highly censured activity during childhood. Many patients experience
panic crisis some days or weeks before T starts.

But in these cases fear remains at an unconscious level because of its
high intensity, which prevent the T patient from being aware of any type
of provocation, that generates the excitation level in the brain goes up.
The brain liberates the excess through the innervation of some effector,

22
the most suitable of which are the muscles and regressively the brain
finds the muscles located around the ears to be used to achieve such a
goal, see above phylogeny. This is the unconscious information
transformed in an innervation, described by Freud (1895). This is to
read into the patient as an open book. (See figure N 7).

Figure N 7.- This semi anatomic graph shows the way the brain builds the hardware
needed to make quantitative changes, excess or default, in the human body organs
such as muscles. That is done through the BBFC, the functional unity of brain.

Another illustrative case is, a T patient 33 years old with T onset 45
days before, noise located in left ear and extended to the left side of the
head and backward, acute signal and some times like a saw. Very
anxious patient, very scared, thinking he will never be free of such a
noise. Homosexual, he cried all the time.
At the treatment beginning I prescribed Pyridoxine orally and he was
already taking Alprazolam three times a day 0.5 mg that I approved too,
but noise and intense anxiety remain and appeared insomnia, then I
proposed to associate alprazolam 0.5 mg with half amitriptyline 25 mg
tablet three times a day. With this association he could sleep 6 hours,
anxiety diminished 70% and the noise presented several changes,

23
diminished 60% in intensity, became more like a pure tone, diminished
its extension and was listened more profound, deeper in the left ear.
According with the noise and sound source theory, the described
changes consist in: at first the sound source was formed by a wider
group of muscles and because of the association of alprazolam and
amitriptyline action the external group of muscles became relaxed and
stop vibrating and producing noise, only the most internal group of
muscles, said the middle ear muscles, hammer and stirrup muscles,
remain vibrating.

This happened, because of alprazolam and amitriptyline work in brain,

producing or increasing the Gaba neurotransmitter action and according
to the theory, Gaba was absent in the cranial nerves motor nucleus,
because of an inhibition of the globus pallidus nucleus, where they are
located the GABAergic neural cells that send its axons to the cortico
pontic bundle, in order to conform the brain functional unity
microcircuit. In T pathophysiology an excitation of the motor cortex area
and an inhibition of the globus pallidus nucleus has happened, in a
simultaneous way, such excitation and inhibition have been generated
from the mind information stored in association cortex areas, which are
constituted by brain information storage microcircuits, the storage unity
generated by brain.

At this point it is took the risk of saying, that the described clinical
behavior cannot be produced by the inner ear or auditory pathway or
the auditory cortex, and thats because T is an independent pathological
condition from the hearing and auditory system. That for, all the amount
of resources and time spent on the study of the auditory system in the
investigation of T, it has been a waste of time, as has been shown in the
recent Tinnitus Research Initiative meeting, held in Ann Arbor, Michigan,
USA, June 7 to 10, 2015.

Now, it is considered to be relevant to draw attention to the patients A.
D. clinical history, to mention that it is not the only case where the
patient has discovered something about his T, but just the opposite.
When posing the question to patients, in more than 90% of my
subsequent case experiences, there have been different findings made
on their own initiative, sometimes related to their real T sound
condition, e.g. with intensity and frequency changes and others to the
locality of the sound source, which has already been demonstrated to be
muscular.

The factor has nearly always been an environmental cause or result of
mechanical maneuvers applied to the ear, or to the pre auricular region

24
or carried out by the pre auricular structures or in the neck area. The
changes achieved were also related to sound intensity, T frequency and
the localization of the sound source. It is mentioned here the
observation made by Robert Levine (1999), who presented the so-called
somatic regulation of T, which consists of changes introduced in T
sonorous characteristics, when the patient changes the position of his
body or part of his body, even located far from the ear, like the lower
limbs, but Levine does not know about the symbolic meaning the
unconscious mind works with.

It has been possible to describe by these patient's reports, how
maneuvers that are called sound active, have been designed, along with
the information on the physics of sound, since they produce changes in
the sound signal which patients claim to be hearing. This occurs because
either the sound source or the medium through which the sound signal
is being transmitted has been modified by the maneuvers. The
possibilities of changes are: the sound stops with the applied maneuver;
another is the intensity increases, which could be the most frequent; the
third is intensity decreases; the fourth frequency is modified and the
fifth changes in the localization of the sound source; something that is
very much in agreement with the physics of sound.

The sound active maneuvers (SAM) are: 1. Masticatory, related to: a)
The dental arcs clenching, b) Strongly biting a hard object, c)
Mandibular lateral movements, d) Mandibular back and forth
movements.
2. Swallowing, proper swallowing of saliva or food.
3. Permanent occlusion of the external ear canal, using the fingertip.
4. Alternate occlusion of the external ear canal, using the fingertip.
5. Placing a shell shape hand over outer ear.
6. Alternately drawing the palm of the hand near and away the outer
ear.
7. Pressing the cranium in a lateral or anteroposterior direction.
8. Rotating the head as fast as possible with the neck relaxed laterally.

25


Figure N 8.- This drawing tries to show the different Sound Active Maneuvers (SAM)
professional can perform, to demonstrate that, what the T patient is hearing, coincides
with the physics of sound. (Drawing from J. Ariza)

These are the maneuvers the author has described until now. However
any maneuver changing the ear, head, face or necks natural resonance
properties, may be considered as sound active. I am certain that each
author may describe the maneuvers he or she uses while trying to help
their patients, following the laws of the physics of sound.

It is worth mentioning here, that there are other types of maneuvers
that could introduce some changes to the T sound signal, which change
the muscle contraction status. The patient can do these maneuvers with
a reflex action, in the neck, body or limbs.

3. If T is a true sound signal and it has a sound source then we must be
able to hear it in some way.

One of the first classifications of T was made by Wegel (1931), who said
there are two groups of T, one that the naked ear can hear, which is
vibratory T and the other that cannot be heard by the naked ear,
which is non vibratory T. Even though this could have been an
appropriate approach at the time, it was published, but it was not an
unmodifiable biological law and Wegel lacked modern technology. Now,
we are in a different position. Fowler (1944) changed the names of

26
vibratory to objective T and non-vibratory to subjective T; and T is also
known as hearing hallucination.

Sayed Tewfik (1972), was the first who attempted to capture the sound
signal of T, by proposing to use a Phonocephalograph to hear T, but he
failed because this was not appropriate technology. Starting with this
information, it was proposed using modern technology, and along with a
group of engineers, to design and manufacture an electronic and
computerized device it has been called The Objective Accouphenometer
(OA), that is able to capture the sound signal of T, record it and
reproduce it to be listened to by the examiner and then by the patient,
who will tell us how similar the noise we let him hear is to his T noise.
The OA prototype has been tried on more than one hundred T patients
and showed a 62% efficiency rate. Naturally, the OA has to be tested on
a larger number of patients and by other professionals in the future.

4. Intensity and Duration of T.-

T has two special features, which are: low intensity, which prevents T
being heard by a normal hearing person and the duration of the noise,
which lasts continuously for years without stopping.

T intensity should be proportional to the rate of excitatory impulses that
the motor pathway delivers to the group of muscles that are acting as
the sound source. But T is an action or a message that originates from
the unconscious mind and psychoanalysis teaches us that for every
emitted neurophysiological impulse generating an action, there are at
least two confronting forces that the brain executes as a mathematical
interaction between the two forces (neuroscience) so this interaction
indicates the results of the actions produced.

So in the case of T, there are also two confronting impulses where the
mathematical transaction between them is the produced T, that cannot
be heard by normal hearing people, because its intensity is controlled
through two neurophysiologic impulses: one that needs to remove an
excess of excitation and to produce a sound to be heard by itself and
another that discreetly wants to liberate the excess, which goes
unnoticed in the environment, so T remains within the infrasounds
intensity spectrum. This always happens in brain and of course in mind,
every time an individual performs an action that is a mental boost that
has emerged victorious, after defeating at least one more contrary
intention pulse.

27
It should be noticed that the two mentioned impulses and the
mathematical transaction, are two tasks executed by the brain under
the order and regulation of the stored information in the unconscious
mind. The needed hardware of the brain count on, to carry out the
mathematical transaction information on this topic, may be consulted in
The New Paradigms in Neuroscience, by the author.

Note: Another particularity of T is how it lasts for many years without
stopping, is also considered to be a mystery that medical science does
not have an answer to. According to neuroscience information the
following answer was developed. The present chapter has already stated
that the first step in the T generation mechanism takes place in the
unconscious mind level and the unconscious mind information is stored
in the brain.

Figure N 9.- This graph shows the way BBFC locates nerve cells in respect to each
other, to constitute a BISC, which is the storage unit, that constitutes every
association cortex in the brain in accordance to the proposal of Mountcastle
(1968)where the needed insight to understand it can be seen.

28
Neuroscience teaches us that the unconscious mind information is
stored in the brain, in a special hardware it is been called brain
information storage circuit (BISC), which is the hardware generated by
nature, with the needed physical structure to be able to fulfill the task of
storing information, in the conditions needed by individuals to take
advantage of it. (See figure N 9).

One BISC is constituted by a limited number of nerve cells of both kinds,
excitatory and inhibitory, suitably arranged in pairs to create binary
codes in every synaptic union and these pairs are arranged in a circular
shape, so neural impulses can circulate endlessly through the BISC,
where energy never dissipates, because it is renovated in every synaptic
union formed by the pairs of nerve cells that create the binary codes.
One BISC is similar to the oscillators that are used in engineering, where
the mechanical or electronic energy is fed back. (See figure N 9).

Figure N 10.- Semi Anatomic graph tries to show the way the unconscious mind
storage in BISC in association to cortices, overexcited motor cortex and inhibit pallidus
nucleus.

29
The circular shape of the BISC is originated from the description made
by Mountcastle of the cerebral cortex, who said, it is constructed as a
sort of a column called barrels, because they are wider in the middle
and narrower on the ends. This cerebral cortexs shape cannot be
derived from a different phenomenon, other than from nerve cells
circulating this way. This shape makes it very suitable to accomplish two
objectives; first, to store information forever and second to achieve that
by using the least number of nerve cells. It is relevant to say, this kind
of cerebral cortex structure must only be in association cortexes, while
in storage.

So the excitatory neural impulses leave the motor cortex, where they
are initiated, since one BISC is associated to the location of the cortex in
the brain (memory) and inhibitory neural impulses are coming from
another BISC location in some other area of the brain or in the same
association cortex; as BISC energy is endless, so in the same way, T
remains endless. (See figure N 10).

D. CONCLUSION.- From the information presented throughout this

chapter, author hopes to be achieved the aim to demonstrate medical
science must not continue to approach patients as just bodies.
Pathology is responsible for screaming that this is wrong, that is unreal.
Patients are not only physical bodies but also individual persons with
minds that store information in terms of binary codes, generated by
neural impulses in every synaptic junction and not floating through the
air or in a vacuum. Mind is the real power that governs the behavior of
persons and the performance of organs and tissues; so that can cause
the disease and restore health if properly intervened. Professionals
cannot keep refusing to increase their information, if required to
adequately fulfill its mission, as it is happening with the issue of T.

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English language reviewed by:

Pamela Ann Tsolis
Born in New Haven, Connecticut USA
E-mail- silost55@gmail.com

Experience:

English teacher
Simultaneous and written Translations
TOEFL/ IELTS Training

Bogot, July 27, 2015

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