I am having a problem and hoping someone here can help...

[AudioDoctor]

9 hours ago, Audiophile Neuroscience said:

 

Assuming the tinnitus is related to the TMJ inflammation I would confirm with a bone scan with SPECT to see if it does light up. If so I would consider a guided steroid injection as an option but with caveats TMJ injection for tinnitus

 

I use SPECT to help identify which cervical facet joints to inject under CT guidance and possibly radiofrequency neurotomy.

 

My next trip will be to the Dental specialist to decide next steps. I saw my CT scan and the joint looks rough.

 

Thanks for the link, I'll read it completely later.

[LoryWiv]

On 5/19/2020 at 9:12 PM, Audiophile Neuroscience said:

More to the point, you would not even know it was 6dB higher, as in higher than what. So yes, it is hard to know what the authors meant by this.

 

As I mentioned my intuitive but non verified concern is that in-ear transducers transform the ear canal into a sealed piston and may couple sharp changes in SPL more aggressively to the tympanic membrane although overall SPLs may be the same.The authors quote losing protective air space but do not provide any explanation or evidence.

 

Notwithstanding any speculation on the mechanism, their objective findings of greater hearing impairment at 4k stands but unsure whether such results have been reproducible.

I believe reduction in this effect is the intent of ADEL modules (now APEX) used in 64Audio IEM's. As for efficiacy, I won't speculate.

[Audiophile Neuroscience]

5 hours ago, AudioDoctor said:

 

My next trip will be to the Dental specialist to decide next steps. I saw my CT scan and the joint looks rough.

 

As you know imaging investigations like Xray or CT or MRI may show structural changes like roughness but may have a poor correlation with symptoms and function. Something like a Bone scan with SPECT-CT combines precision imaging with a physiological test of function. If the joint is inflamed it should show "hot" on the scan ie it is metabolically active. It's those sort of joints that tend to benefit more readily from targeted anti-inflammatory steroid injections.

 

Taking prednisone or prednisilone systemically may be less efficacious than a targeted injection but obviously more of a shotgun approach, possibly helping in other ways than reducing inflammation, if any, of the TMJ.

 

Dentists I am guessing will offer things like occlusal splint devices

 

Good luck

[AudioDoctor]

3 hours ago, Audiophile Neuroscience said:

 

As you know imaging investigations like Xray or CT or MRI may show structural changes like roughness but may have a poor correlation with symptoms and function. Something like a Bone scan with SPECT-CT combines precision imaging with a physiological test of function. If the joint is inflamed it should show "hot" on the scan ie it is metabolically active. It's those sort of joints that tend to benefit more readily from targeted anti-inflammatory steroid injections.

 

Taking prednisone or prednisilone systemically may be less efficacious than a targeted injection but obviously more of a shotgun approach, possibly helping in other ways than reducing inflammation, if any, of the TMJ.

 

Dentists I am guessing will offer things like occlusal splint devices

 

Good luck

 

As I am sure you aware, one debate is with the Drs, the other is with the insurance company.