Tinnitus & Migraine: Expert Insight

[Dr. Hamid Djalilian]
Yes. Traditionally, pathophysiology of tinnitus has been explained as, well, you have loss of cells in the inner ear or the loss of the synapses between the hair cells and the auditory nerve. However, that can explain the fact that there is an increase in what's so-called spontaneous firing rate in the central auditory system. Now, when we actually think about this is you think about, well, what's happening in a person who, let's say, was 49 years old, had the same degree of hearing loss as they've had for the last couple of years. Then suddenly they turn 50, let's say, and then their tinnitus becomes either loud or becomes noticeable.

There must be something that's changed. This can't be something that's just the spontaneous firing rate just went from nothing to a whole lot in that span of time. The people who say, I have tinnitus that comes and goes. I have it some days and it's really bad. Then I have somebody that's completely quiet. If that spontaneous firing rate is there, it's probably not coming and going. Then you have this other category of patients who say that I've had this tinnitus for a long time. It was very quiet and I didn't notice it most of the time. It was not bothersome.

Then it just after this sudden event, usually I have some event they'll notice or something, it became very loud and it stayed loud. The traditional pathophysiology really doesn't explain that.