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Author: admin | 27.12.2013 | Category: Tinnitus Hearing Loss

A new trend in tinnitus treatment is the use of veryhigh- frequency maskers, including ultrasound, delivered by bone conduction [1,2]. Human ultrasonic hearing has been independently "discovered," documented, and abandoned more than a dozen times over the last half century [3]. The dynamic aspect of ultrasonic pitch suggests that the ear may not be directly stimulated but rather that an intermediary structure may be involved. The brain ultrasonic demodulation theory implies that the sound produced by brain resonance will propagate to the ear via fluid channels. The application of ultrasonic noise to the skull by bone conduction should produce cochlear masking in frequencies corresponding specifically to the brain's resonant frequency, raising the question of how brain resonance interacts with conventional hearing.
For more than half a century, ultrasound has been reported to be associated with the pitch of air-conducted sound in the range of 8 to 16 kHz and often has been cited to be directly related to the highest frequency audible by a listener [3].
Deatherage [7] first noted an ultrasonic diplacusis; that is, the pitch associated with ultrasound could be International Tinnitus Journal, Vol. If the ultrasonic frequency does not determine the perceived pitch but rather the resonance of the brain, how is the reported pitch discrimination in the ultrasonic range possible [3,S], or is it absent [24-26]?
The effect of airborne ultrasound on hearing has not been thoroughly studied, but young normally hearing adults seem at greater risk for very-high-frequency hearing loss. The correspondence of the results of brain resonance, ultrasonic masking, and ultrasonic pitch-matching data are summarized in Figure 2.
Alternatively, just the basal tip of the basilar membrane has been proposed as the site of ultrasonic transduction [7,32]. High- and very-high-frequency stimulation were reported recently to be effective in tinnitus masking [1,2]. If speech is modulated on an ultrasonic carrier, speech monitoring and perception with a high degree of comprehension (approximately 80%) is possible [3,47], even in high ambient noise.
Deatherage swam into a 50-kHz beam and first discovered underwater audible ultrasound 50 years ago [7]. Humans can detect ultrasound up to at least 100 kHz, but perception generally requires direct contact of the source with the body.
I gratefully acknowledge the critical but constructive analysis and editorial contributions of Drs. The mechanisms involved in reception and perception of both audio frequencies and ultrasound are identical, with the exception that ultrasound interacts with an intermediary site, the brain. Masking and long-term inhibition may involve inducing plastic changes in the brain at the central level. So outlandish is the concept that humans can have the hearing range of specialized mammals, such as bats and toothed whales, that ultrasonic hearing has generally been relegated to the realm of parlor tricks rather than being considered the subject of scientific inquiry.
Three lines of evidence suggest that the resonance of the brain is critical for an audible ultrasonic experience. Using a 7-cm radius as a representation of the human average, the fundamental resonant frequency is calculated to be 13.4 kHz.
Such channels have been proposed by Ranke [13] and confirmed experimentally by Tonndorf [14,15]. Ultrasonic masking has been reported to suppress audio thresholds in the 8- to 12.5-kHz range by 2- 29 dB [22,23]. Masking was less for frequencies higher and lower than the resonance peak, which is characteristic of a resonance phenomena. Ultrasonic hearing is unique in that even moderate changes in frequency « 10%) are not associated with the dramatic pitch changes as in the conventional audiometric range. Thus, the brain stimulates each ear equally, but the frequency response of each ear contributes to the perception of pitch.
Each subject matched an air-conducted pure tone (variable frequency) with an ultrasonic tone of 26 or 30 kHz delivered at 5 dB SL.
The effects of ultrasound on audio frequency thresholds depicted for the two ultrasonic sources. Note in Figure 1 that a change in the center frequency of the noise, even at a constant intensity (S dB SL), results in a different frequency or place spread of activation.
The Occupational Safety and Health Administration (OSHA) has adopted ultrasonic hearing protection working standards [29]. These data clearly support the hypothesis of physical demodulation of ultrasound by brain resonance and the detection of this resonance in the base of the basilar membrane. One-dimensional modeling of the cochlea, incorrectly assuming both scales have equal volumes, results in the prediction that ultrasound activates the first few millimeters (0-7) of the cochlear base. Substantial agreement supports the theory that ultrasound, regardless of its frequency, stimulates an area on the basilar membrane that codes the fundamental resonant frequency on the brain. Summary of the data from modeling, spherical measurement, masking, and pitch match, supporting the theory of ultrasound brain demodulation in the high audio frequencies.
Plastic changes in the auditory neural axis in severe tinnitus, particularly in the auditory cortex, may playa role in the continued perception of tinnitus by adding salience to the experience [34,35]. Calibration procedures are based in part on bone-anchored measurements (in the high audio frequencies of 8-20 kHz) [3].
This result opens the possibility of using ultrasonic speech for communication under poor listening conditions and in situations wherein traditional amplification is ineffective. It seems reasonable to expect that any mammal can detect underwater ultrasound by brain ultrasound demodulation.
Ultrasound sets the brain into forced vibration, and it is the brain oscillation that is detected on the base of the cochlea in normally hearing individuals.
Barbara Goldstein and Abraham Shulman at the Martha Entenmann Tinnitus Research Center in the preparation of this manuscript. Occupational Safety and Health Administration Technical Manual, Section III, Chapter 5, subchapter V: Ultrasonics.

Reference Equivalent Threshold Force Levels for Audiometric Bone Vibrators (ANSI S3.26, 1981).
We proposed brain ultrasonic demodulation as the means of place-mapping ultrasound on the first few millimeters of the basilar membrane.
The application of high audio frequencies (10-20 kHz), which stimulate the base of the cochlea through bone conduction, is a conventional auditory technique.
More recently, the primary auditory cortex has been implicated, using magnetoencephalography, in processing ultrasound tonotopically, consistent with veryhigh- frequency hearing [5]. Support for a brain ultrasound demodulation theory stems from spherical models of brain and psychoacoustic metrics of masking audio frequencies by ultrasonic noise and by matching the pitch of audible ultrasound with conventional air conduction sound. Direct vibration of the brain, but not skull, is sufficient to record auditory evoked potentials [16-18], thus verifying the brain-ear mechanism.
This experiment was repeated using seven normal hearing listeners with no history of otological disease.
Note also that the masker with noise centered at 39 kHz was less effective, as it is almost two octaves above the fundamental brain frequency (see Table 2).
Further, pitch generally asymptotes approximately at the air-conduction match of some 16 kHz, rendering judgments difficult [3,24,25].
The change in the area activated and the subsequent neural coding likely contributed to crude detection of pitch change. Ultrasonic cleaners and related technology (ultrasonic welders, etc.) are an industrial source of high audio and ultrasound of sufficient energy to induce hearing loss. Although some overlap is seen with the brain ultrasound demodulation place of transduction in the cochlea, the mechanism is assumed to be direct stimulation via bone conduction.
The psychoacoustical findings, despite the methodological differences, are also consistent with the brain ultrasound demodulation theory.
Plastic changes reflecting neural reorganization secondary to peripheral hearing loss have also been well documented [36]. Presumably, the increased ultrasonic energy increases the displacement spread on the basilar membrane toward the apex, thus accounting for the observation that the ultrasonic pitch is related to the highest frequency detectable by air conduction. Echolocation is also possible by direct listening to the reflected ultrasonic echoes in the high audio range, after brain ultrasonic demodulation, which, owing to its frequency separation, will not interfere with speech communication. With hearing loss, greater ultrasonic energy is needed to spread the displacement on the basilar membrane toward the region of intact hair cells. Theoretical analysis of acoustic signal generation in materials irradiated with microwave energy.
Auditory perception of radio frequency electromagnetic fields J Acoust Soc Am 71 : 1321- 1334, 1982. Oscillations of the internal ear basilar membrane in the sonic and ultrasonic range from the data of mathematical analysis of the hydrodynamic model of the cochlea.
The functional anatomy of tinnitus: Evidence for limbic system links and neural plasticity.
Plastic changes in the auditory cortex induced by intensive frequency discrimination training. Vestibular hypersensitivity to sound (Tullio phenomenon): Structural and functional assessment.
The otolithic organ as a receptor of vestibular hearing revealed by vestibularevoked myogenic potentials in patients with inner ear anomalies. Thresholds of Hearing by Air Conduction and by Bone Conduction Under Different Masking Conditions. The peripheral site of action of low-frequency ultrasound is more problematic but, in this study, we argue that the ultrasonic transduction is also parsimonious with conventional auditory theory, with the exception of its demodulation.
The same authors confirmed ultrasonic hearing and ultrasonic speech perception in approximately one-half their deaf subjects. Taken together, these findings suggest the absence of a specific place of ultrasonic frequency mapping on the cochlea but a dynamic mechanism that is a function of remaining hearing or hair cells and intensity of the ultrasonic stimulation.
Audiometric thresholds were obtained in the conventional audiometric frequencies and extended through the high audio frequencies (10 - 20 kHz) using a Virtual 310 audiometer (Virtual Corporation, Portland, OR). Recall that 26- and 30-kHz center noise maskers were both at an equal SL (5 dB); therefore, the relative energy is not a principle factor but only its relationship to the fundamental frequency of the brain being forced into vibration. Note that the 26-kHz noise resulted in an increase in frequencies as well as masker threshold shift as compared with 39 kHz. Further, the multiple coupled resonances of the brain and skull can yield subtle intensity cues [27,28] but, in any event, changes of perhaps 10% of the frequency are required in the ultrasonic range to be detected as a pitch shift [3]. The model also predicts multi peaked or "slurred" waves higher than 20 kHz, rather than a conventional single traveling wave peak [33].
Characteristically, neurons sensitive to a damaged cochlear region will reprogram their best frequencies either higher or lower, resulting in greater neural representation of frequencies on the "edge" of the damaged peripheral region.
In the case of severe deafness, with ultrasonic thresholds approximately at 30 dB above normal, insufficient surviving hair cells exist in the apex to detect the basilar membrane motion. In fact, what humans experience as ultrasonic perception may have been a necessary precursor in the evolution of echolocation specialization in marine mammal ears and brains. Ultrasonic pitch is not related to the stimulating frequency but rather to the remaining high audio frequency ability of the listener. Paper presented at the Twenty-First Annual Meeting of the Association for Research in Otolaryngology, St. Maass, never credited again for his original discovery, made all the essential observations in regard to ultrasonic hearing phenomenology.
Ultrasound would then be unique as a form of auditory stimulation that any listener with any degree of hearing loss could detect given sufficient ultrasonic energy. Modeling the brain with such a boundary condition, the F is reported to be approximately 70% higher [8].

Monitoring neural vascular function with Doppler ultrasonic imaging provides unexpected support for the brain ultrasound demodulation theory. Thresholds were repeated in the presence of ultrasonic masking noise, with peak energy centered at either 26 or 39 kHz. Note that the masker centered at 1 octave above the brain fundamental (26 kHz) produces more masking and a wider range of masking than does the masker approximately 2 octaves above (39 kHz). Note the close correspondence of the maximal hearing loss and frequencies within the brain's resonance. This model would not predict a peak frequency for masking or pitch matching in the range observed as does the brain ultrasound demodulation theory.
In the only tinnitus-imaging study of neural reprogramming [34], the tinnitus frequency area expanded (more than twice the size) with some hint of lower-frequency expansion below the tinnitus frequency, as expected subsequent to hearing loss. Placing a transducer on the water surface and measuring the pressure output in a small tank can be complicated, even when brain and water impedances are similar [24]. In the case of complete deafness, the increased ultrasonic energy likely displaces the otolith organs, resulting in saccular stimulation.
In contrast, this suggests an apical cochlear site or other noncochlear acoustic site that is activated in the presence of severe deafness.
Ultrasound refinement could lead to new types of audio amplification, auditory orientation (echolocation), and tinnitus treatment, if the mechanism can be clearly elucidated.
When the imaging beam was focused at the center of the brain, patients reported hearing a high audio sound, much like tinnitus. Thus, ultrasound will map in the high audio frequencies, because the brain is the demodulator regardless of the stimulating ultrasonic frequency. Note the close correspondence of the masking curves for 26- and 39-kHz-centered ultrasonic noise and the noise-induced hearing loss (NIHL) composite audiograms reported for industrial worker exposed to intense ultrasound [30]. The concept of brain ultrasonic demodulation as applied to industrial exposure is unique and begs for further exploration.
This pattern was striking in only four of the subjects, and the mean high-frequency hearing loss for all subjects was just outside the normal range. Indirect high audio frequency stimulation (ultrasound) or direct highfrequency stimulation can be an effective masker in tinnitus and can contribute to long-term tinnitus relief through neural repogramming. Some deaf patients could hear ultrasound, albeit at levels higher than those in normal listeners, and frequency discrimination was possible, although far poorer than in the audio range. The implication is that different sites on the inner ear's basilar membrane are activated, depending only on the proportion of hair cells present.
For all practicality, the exact resonant frequency of a brain with a 7-cm radius is probably a number between the free and boundary states. The higher the ultrasonic frequency is in regard to the brain resonance, the more energy is required to set the brain into forced resonance, accounting for the wider spread of masking for 26 versus 39 kHz (Fig. In addition, the presence of both high audio frequencies and ultrasound in the workplace can increase the ear damage risk, as a place-coding overlap exists on the basilar membrane (see details later). Assuming that maximal displacement of the basilar membrane is at the place corresponding to the brain's fundamental frequency (1.5 mm from the base for 26 kHz), bulk innerear fluid displacement, permitted by compliant oval and round windows at very high intensities (100 SL+), could conceivably create fluid flow in the saccule, not unlike the Tullio effect [39]. Applying a microwave burst to a 7-cm radius sphere containing fluid with properties similar to those of brain results in a measured peak frequency of 11.4 kHz. Setting the brain into resonance resulted in a clear, high-pitch, audible sensation consistent with brain resonance in the 11- and 16-kHz range. The very short cilia of saccular hair cells, not mass-loaded by gel or otoconia [40] in the striola region, are likely fluid velocity-sensitive. Microwave absorption causes a rapid heating that launches a pressure wave within the sphere. The use of imaging ultrasound has had mixed success [20,21], but the critical feature in failure might be not focusing the beam at the brain's center to maximize brain ultrasonic demodulation. High-frequency stimulation (high audio and ultrasound) have been shown to mask tinnitus and produce varying degrees of residual inhibition [1,2]. If the head is exposed to such microwave stimulation, the fundamental brain frequency is proportional to the brain size.
Because ultrasound produces high audio stimulation by virtue of brain resonance, the direct use of high audio stimulation is more economical in power requirements and still stimulates the brain at resonance.
9, No.2, 2003 Stimulating the saccule, an organ having input into the auditory pathways in mammals [37,41,42], may explain ultrasonic detection in the deaf. A human infant would have a resonant frequency between 16 and 22 kHz assuming a 5-cm radius.
Anecdotally, a graduate engineering subject who had no measurable hearing and who was an unsuccessful cochlear implant user described the perception of 26 kHz and an alternating knocking in her head.
The cilia of hair cells have opposite orientation on either side of the saccular striola, which could neurally code the alternating phase of a sine wave as an alternating knocking. A hydrophone implanted in the brain of a cat recorded peak pressure at 39 kHz as a result of microwave pulses [11]. Other subjects reported unsteadiness when rising from a seated position after ultrasonic listening, which also was suggestive of saccular stimulation.
Clearly, more work must be conducted to elucidate the source of nonauditory coding of ultrasound in humans, but complete loss of hearing and balance seems to preclude its detection.
As deduced from the foregoing data, the human brain resonant frequency is likely between 11 and 16 kHz, with the exact value being determined by individual skull geometry. No published reports have cited the use of ultrasound in treating tinnitus in severely deaf individuals in spite of a high incidence of tinnitus in this population [43].

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