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Measuring Tinnitus- detecting an invisible condition

Tinnitus is the experience of ringing, buzzing, whirring or other noises in one or both ears. The sounds heard by people with tinnitus don’t exist externally.

Up to 1 in 8 Australians have tinnitus that severely affects their quality of life [1]. It has many causes and can lead to anxiety, depression and sleep issues.

Currently there is no cure for tinnitus and treatment tends to treat distress symptoms or provide ways to mask the noises, but they are not always effective.

Tinnitus is described differently by everyone who experiences it, and reliance on self-reported symptoms makes diagnosis and monitoring of this condition difficult.

Finding a way to measure the presence and severity of tinnitus will inform diagnosis, treatment selection and could lead to the development of new treatments.

Learn more about our tinnitus research here

Professor James Fallon: Chief Technology Officer and Head of Research Operations at the Bionics Institute

Dr Mehrnaz Shoushtarian: Research Fellow at the Bionics Institute

Dr Sol Marghzar: Doctor of audiology and clinical director of ‘The Hearing Doctor’ in California

Ms Victoria Didenko: Patient who shares her experience of being diagnosed and living with tinnitus.

Ann Fazakerley [00:00:05] Good afternoon, everyone, and thank you very much for joining us today. My name is Ann Fazakerley and I’m the head of philanthropy at the Bionics Institute in Melbourne, Australia. It’s my great pleasure to welcome you to our event today as part of Hearing Awareness Week. Measuring tinnitus. Detecting an invisible condition. So I’d like to begin by acknowledging the traditional custodians of countries throughout Australia and their continued connections to land, sea and culture. I pay my respects to the elders past, present and emerging, and I extend that respect to all Aboriginal and Torres Strait Islander people in Australia and indeed to all First Nations people, as we have several people today from overseas. Before we begin, I just have two housekeeping items. Please keep your microphones mute muted throughout the session. And if you have any questions and we do hope that you have questions, please type them into the Q&A function that you’ll see at the bottom of your screen, and then we’ll aim to answer questions after the presentation. And also at this point like to acknowledge and say thank you to all our donors, many of whom have been extremely loyal to us over the years, back from when we began as pioneers of the cochlear implant or the bionic. Yeah, I know that some of these donors are here today, and we’d like to thank you for your generosity and support as we continue our groundbreaking work into new and very exciting areas of medicine. We would simply not be able to carry out all research without the generosity of our funders. So thank you. So in our discussion on senators today, we are going to give you the latest information on tinnitus, including how many people are affected. We’d like to update you on the primary research that we’re undertaking here at the Bionics Institute. We’d like to demonstrate the incredible impact the research will have on the development of new potential treatments. And we’d like to show you and share with you perspectives from both patients and clinicians point of view. So today you’ll hear from Dr. Mehrnaz Shoushtarian, who leads tinnitus receptor at the Bionics Institute from Victoria de Denko, a tinnitus patient, and from Dr. Sol Marks, a doctor of audiology and clinical director of the hearing doctor in California in the States. So first, let me introduce Professor James Fallon. So tell us more about the Bionics Institute and a long and successful history in hearing research. James holds a Bachelor of Engineering and a Ph.D. in biomedical engineering from Monash University, and he began his research career at the Bionics Institute in the Auditory Neuroscience Program. He has been our research director since 2017, is the leader and mentor to our team of researchers and he is the holder of several patents. James. Professor James Fallon [00:03:33] Thank you and welcome everyone to that virtually to the Bionics Institute today. It’s some 30 years ago. Graham Clark founded by Institute in his quest to develop a cochlear implant to treat deafness. One of the really unique things Graham was able to do and realize is that no one person could develop such a device. So he brought together clinicians, scientists and engineers. And that’s why, as an engineer, I can talk to you now as research director at the Bionics Institute. And he really realized that you need all those different facets working together and in concert to tackle these big, difficult problems. One of the other things he was also very clear about it was the need to measure how well he was doing. So it was always going to be pretty simple to tell whether a cochlear implant participant could hear or not, but how well, with a hearing, he didn’t just want to bring some sound, he wanted to bring in improvements and to be able to measure how much they improved. And so those are the two two key things that the institute continues to do to do today, work across a range of disciplines and measure how well we’re going as well as we can. Fast forward over 30 years. Half the time I’ve been at the institute where we have taken those same philosophies as we work through bionic eye implants, we measure how well we go in those bionic eyes out deep brain stimulation for things like Parkinson’s disease, we develop measures to tell how well estimation is doing so we can titrate that those very specifically and more recently, pure measurement when we’re trying to measure epileptic seizures in patients. So measurement has always been a real key of the institute. And we have also not forgotten about hearing while we’ve done all those new things I’ve just been talking about, hearing is what remained core to what we do and also to my research. One of the things we continue doing is trying to improve upon that cochlear implant. While it’s been around for 30 years, there are still more improvements we can do, trying to get high fidelity and hearing better listening. We’re also trying to repair hearing loss. So one day you never know how to put cochlear implants out of business by having repaired hearing. It’s a long way off, but that’s certainly our hope. But we know we’re not going to do it all at once. I’m measuring how we’re going along the way becomes critical. One of the real challenges, a cochlear implants, is that lots of the standard measurement techniques we typically use just don’t work very well with cochlear implants. It’s we’ve had to invent and develop and co-opt new measurement techniques along the way. And as well tell you about one of those that we’re using in a bit more detail as we go. And so as we do that, we actually find new novel uses for some of these measurement techniques, how we took this measurement technique and started looking at assessing hearing in newborn infants, telling how well their devices were attuned to them to program. You may have heard about potty Janey where we’re really trying to tease apart in very young babies how well the hearing theory man has had a great insight to take that same hearing technology and apply it to a completely different field. Curious again, trying to tell how how bad, adjusting this so we can help develop a treatment for getting this. So with that, I’m going to stop talking about all the things that we have done and come back to and let you get on and hear about all that at. Ann Fazakerley [00:06:36] Okay. Thanks, friends. I’d now like to introduce Dr. Mehrna Shoushtarian, our lead researcher on tinnitus at the Bionics Institute. She’s an alumna of Monash University, holds a Ph.D. in biomedical engineering, and she’s worked in both medical research and industry. A research focus is on the measurement and processing of physiological signals using conventional and novel recording techniques and the development and commercialization of medical devices. She’s been at the Bionics Institute for five years with a focus on tinnitus. For the last three and a half years, someone else will explain to us about tinnitus and the current unmet treatment needs. Unless.

Dr Mehrnaz Shoushtarian [00:07:27] And to very much. And. I would spring. And to everyone for attending today’s event. I’m going to talk briefly about our Tinnitus Research Institute. Tinnitus, as you may know, is a condition which involves hearing sounds which aren’t present externally. Different people explain the sound differently. So it can be a ringing, humming, buzzing, but it’s always there and it’s quite a prevalent condition. So one in ten adults are known to have tinnitus, and that’s a conservative estimate. And in 3% of adults that’s just under a million people. In Australia, tinnitus is demonstrated in a severe form, so accompanied by symptoms such as anxiety and depression and people being unable to sleep, unable to work. The number of people with tinnitus is predicted to rise, mainly because of the increased noise exposure that we all have. So we are wearing earphones and listening to the radio on our phones and music, which could lead to hearing loss and a more prevalent tinnitus. Since this also has a significant economic impact. So in the UK, it’s been estimated that the cost of tennis management is about £750 million or 1.4 million AUD per year. In the US in a single year. In 2012, it was estimated that disability compensation to US veterans was about $1.2 billion or 1.7 Australia. So a huge hit on. For a health condition to be managed well. Basically what’s needed is an objective clinical test that can give clinicians a diagnosis and a path to treatments for that. But in tinnitus, there are several gaps. There are no reliable treatments at the moment. And one main reason for that is that there’s no objective clinical test to indicate that a person has success or how severe that it seems. So clinicians can only rely on patient reports which are not always enough to base treatments on the treatments for tinnitus at the moment, mostly focus on the symptoms. So the treatments are around counseling and psychological support. And but this is mostly and sound enrichment, but this is mostly done through trial and error. And patients are often told that they have to learn. So. And would you?

Ann Fazakerley [00:11:00] Might as well now hear from Victoria Didenko. Victoria has been a sufferer from tinnitus for almost ten years. She works as a major advocate for people living with this condition. Victoria is keen to share her experience of living with the condition and will explain the difference that the research where I’m taking up the Bionics Institute but met the people like her. Victoria. Thank you and thank you.

Ms Victoria Didenko [00:11:31] Hello everyone again. Thank you for inviting me to speak today on my tinnitus experience. I’ve struggled with this auditory torment for almost ten years and it’s been a real emotional rollercoaster of a ride. Now. What caused my tinnitus? Well, I had attended a few parties, held in very noisy venues at the time of my tinnitus onset, and I’d had a fall whilst walking my dog and I’d arrived at middle age. So what caused my tinnitus. One of the about some of the about none of the above. Who’s to know exactly? Because there’s so little research done on tinnitus, the tinnitus symptom that it continues to be a medical conundrum to this day. Hopefully, with the work being done by managers at the Bionics Institute will soon change this. Daily life has its challenges for us all. Life with tinnitus is doubly challenging and hard work. It’s exhausting. It’s not an easy gig living with constant heat noise. 24 seven. This is what my auditory world sounds like. Okay. During the first few months of my tinnitus onset, I experienced a downward spiral into depression. I was experiencing panic attacks. I visited my GP and was given prescriptions for drugs. I didn’t fill these scripts. I don’t take drugs. I don’t take Panadol. I wasn’t sleeping. I couldn’t break the cycle I was in. I’ve never felt so isolated, so traumatized and so very low in my life. I experienced suicide ideation and that frightened me. What to do and where to go. I’d already been to a doctor and his nose and throat surgeon and an audiologist. I felt lost and alone in my despair because no one could help me other than to say that I would hope in time people learn to live with tinnitus. And you will too. I was told by my doctor that I wasn’t given the tools or the information to know how to. I wasn’t doing well. Now I’m a robust person physically and emotionally. And this new me, this falling apart me was an unfamiliar and disappointing stranger. Is there an elephant in the room? Is there an elephant in this room? Room? Well, I believe so. Get a grip. A stone can put things into perspective. Tinnitus patient who isn’t coping. There are people worse off than you. There are worse conditions than tinnitus. Well, doctors might not exactly say this. Exactly. But many do think it. And I too thought this. But I couldn’t get a grip. I didn’t know what was happening to me. And it has taken too long, too many years to learn how to live within it. Support to become manageable. It’s often said that there’s no cure or very little funding for tinnitus research because it is a medical symptom that won’t kill you. People manage. So where’s the drama? Well, my teenagers didn’t kill me. I was dead whilst alive. I was going through the motions, which might pass, but inside I was falling apart. The AI who had existed prior to my tinnitus on set had died and I had become a vessel of noise. I was only noise. The noise was closing in on me. It was wearing me down and I had nowhere to go to escape that noise because I was the sound. How is it that some people who have tinnitus doesn’t seem to be concerned or don’t seem to be concerned, but some people seem to habituate quickly to the hypnosis noise, move on without any negative impacts, and mild annoyance may be at the worst. And there I am. And millions of other tentative sufferers struggling, despairing. I wonder these people who are okay with it, do they hear a pulsating beat of blood thumping in their air? Do they have a sensation of blocked issues? Do they need to keep talking? Swallowing beer. There is a massaging around the ears. Do they have a piercing sound of a high pitched sonic whistle ringing in their head all the time? Currently, no one knows exactly what people are hearing when they describe their tinnitus symptoms other than the person with the tinnitus. So only research and rigorous scientific inquiry will deliver the answers to these important questions. This is why we need to support the research being undertaken by the NAS and the team at the Bionics Institute. Doctors, as well as people experiencing troublesome tinnitus, need to have an objective measure for tinnitus that all families see. If you can’t see something, then it doesn’t exist. That’s live on. With regard to the tinnitus condition. The research being undertaken at the Bionics Institute is paramount in finding the missing link in the advancement of further work to find a few opportunities, or should I say, a way for the brain to switch off from hidden voice. When a cure or remedy isn’t available, people usually turn to the Internet for help. Claims of cures for tinnitus abound. Herbal supplements called laser therapy performed by doctors but without supported evidence. Agents for New Romantics claim it to be a cure tinnitus but without supported scientific documentation. Acupuncture, massage. The list goes on. There are a lot of people making a lot of money from tinnitus, and this rankles me greatly. Having a way to measure the impacts of these treatments on the brain opportunities, Sufferer will prove once and for all what treatment is effective for tinnitus and what isn’t. Now, I don’t know of any other medical condition where the advice for a medical patient is to suck it up and get on with it. In so many words now, those in crisis with their tinnitus often decide to keep their tinnitus trauma to themselves. We tend to beat ourselves up because we’re not coping and shut up. This might sound like I’m being harsh towards DPS and the nose and throat surgeons. Of course doctors want to help. But how can they if a GP can’t write a script for a pill? As a solution to tinnitus. And if an ear, nose and throat surgeon can’t operate the tinnitus away. What else can they do? This is why the work being done at the Bionics Institute is integral to helping these medical professionals do what they do best and do it successfully to eliminate the pain and the suffering that often goes hand in hand with tinnitus. And tinnitus doesn’t affect the sufferer alone. It affects entire communities, work, colleagues, family members and friends. It affects you, each and every one of you. Engaged in this presentation today will either experience tinnitus at some point in your life if you haven’t already, or you will know someone who is suffering from this auditory torment. You may not even be aware that your loved one or work colleagues have tinnitus because they’re keeping it to themselves. A high percentage of musicians and entertainers experience painful tinnitus. Yet because of the competitive nature of their industries, they want to keep their suffering to themselves. Beat it to employ the oboe player without tinnitus than the oboe player with tinnitus. Children, teenagers and deaf people and also experienced tinnitus. Tinnitus is not exclusively an all persons symptom. Again. This is where the Bionics Institute and the research managers of a team is engaged in is so very important for all of us. It’s crucial that there exists a viable, scientific, objective way to measure tinnitus, to pave that way for a remedy for this conundrum. Then and only then will tinnitus prognosis be constructive, positive and successful in the future. We need this research. We need the scientific research. We needed it yesterday. Together. Let’s help silence tinnitus once and. Thank you. Thank you, Victoria, for sharing your very personal experience in such an honest and very passionate way.

Ann Fazakerley [00:20:26] Thank you. I’d now like to introduce Dr Sol Marghzar. Dr. Marghzar holds a doctorate in audiology with certification by the American Board of Audiology, and he is clinical director of the hearing. Doctor in California. USA is evaluated and treated over 40,000 patients since 1997 with a special interest in the treatment of tinnitus. Dr. Marghzar was one of the experts invited by the American Academy of Audiology to develop the guidelines for the evaluation and management of tinnitus that was published in 2004. Dr. Marghzar today will speak to us about the difficulties that doctors experience when it comes to diagnosis, diagnosing and treating tinnitus, and the impact that our research could have on both doctors and patients. Dr. Marghzar.

Dr Sol Marghzar [00:21:30] Thank you so much and I appreciate the opportunity. I would like to first, according to the Code of Ethics of American Economy reality to announce that I do not have any of those ciation with by the Institute in a financial or otherwise. I was not paid for this presentation and I will not benefit at all from. Funds for anything that will be given to by this. I’m going to start bearing so that other people would get to ask questions as well. So. So I would like to let everybody know that I am usually the one who sees patients f when people are asking for help. I’m the one who gets before, and there always has been a problem with providing help for the patient for all the reasons that you alluded. Of the one of the biggest problem is that we need to have an objective pool to determine what level of interest this patient suffering from. And we need to categorize any condition that is as enigmatic as tinnitus needs to be characterized at this time. Jasper Bath, who developed the neurophysiological model, has got five different categories from 0 to 4, based on presence or absence of human laws or upright uses, which is sensitivity to loud sounds. As well as a condition called winding up of the team, which is when people get increased tinnitus as a result of exposure to stuff. But these are, again, all subjective. Then it’s interesting, by the way, seeing categorization with an X instead of a Z. This was probably one of the changes that Lucy had to do to my presentation. So there is also that other type of categorization. We want to know what level or severity of entities, patients we’re dealing with. So we using that to try to scan opportunities, handicap inventory or TFI, which is in it as functional index. And these are like papers or forms on the computer that patients fill out, but it’s all affected by many factors. Sometimes wrongfully. So because, as Victoria dutifully wrote, the patient’s psychology gets affected by the. This by itself also hurt us in a way because we don’t know. Is it the loudness of this this affecting the patient or is it the psychology of the kids or the psychology of the patient that’s affecting the reaction? So then there’s also the old, old way that most ear, nose and throat doctors categorize in this is based on the presence or absence of hearing loss that you have tinnitus because you have hearing loss or you have hearing loss and tinnitus or the just the tinnitus. A lot of people up. As much as 40% of patients with tinnitus do not have any hearing loss. There will be none. So they know they need to be categorized different or it would be a really good idea if we could have a way of categorizing them based on the severity that is broadly objective. Now because this is a very complicated condition, which most of the time is multifactorial, which means that a little parting, a little fall, a little aging, or maybe some side effect of certain medication could break the camel’s back. I don’t know if you guys use that. The straw that broke the camel’s back to use that in in Australia. So that’s probably what it does. And then we have so many patients whose tinnitus is noise. And so 70% of people are a major factor as as all the excessive noise. And these patients could have a totally different brain on the box copy than than someone who gets it as a result of a side effect of medication. So having this type of research could create a much better categorization for that. We will create programs and treatments, and we could objectively determine what what treatment worked with which category of this patient. For example, I told you that 40% of patients with tinnitus do have some level of sensitivity. And the fact that, you know, people would have normal hearing. So there’s a lot of work that needs to be done. I mean, it’s full of is very helpful. The success rate. Now, if when a patient comes to my office, the only thing I can do is it’s matching and masking. And another thing called control. And this is presenting a noise. And finding out if that noise will fly in this or completely stop it, which happens. All of that is also subjective. I mean, I ask the patient, which one is it that you hear the sound or the sound? The attitude is only going to be at that point and it’s going to be in a booth. So most people don’t live in a booth. So it’s a very, very artificial way of measuring. But without having any sort of measurement, you don’t know whether we’re dealing with a high frequency or low frequency. So you have to still do it at this time. So when you rely so much on a patient response, then the variance of the data increases, which creates a very, very difficult way. Study for being a researcher. And one of the biggest problems that this research has is the high level of placebo. Are there a bunch of studies that indicate that you have as much as a 40% placebo effect in Canada’s treatment paradigm? And without an objective measure, when you are a clinician, very difficult to figure out, ah, is your tinnitus? Treatment effective because the actual candidate, because the patient is doing better, because you’ve done a lot of great psychological work as well as counseling and bouncing. And Vernon’s study showed that by just asking the patient to rate the loudness of tinnitus, you are not going to get a good response because of the difference between the loudest group in Vernon study and the softest group was only three decibels. So is there are some other factors. Which is mostly cerebral, in my opinion, that determine whether the patient becomes a not really bothersome tinnitus patient or just the person who experiences this. So like they said, that if the condition is invisible and you don’t have an objective test. Then how can you determine if it are efficacious or not? Now. If we are able to diagnose it and we could create maybe in the future some reliable way to measure the degree and the severity of the incident. We will use this gold standard in in in a paradigm to examine the efficacy of the treatment, for example, in Ireland. And that’s coming along and has been around called linear. It uses two types of stimulation, auditory and through somatosensory through a tongue and they have to you look to try and this is the first technique that claims they could reduce the loudness of the room interesting we use. And if I are to figure out if this is really objectively showing the same thing pre post treatment and all, they are claiming that you have to use this for eight weeks. So it’s going to be extremely fast and extremely reliable if we have something that has about 85 to 87% success in permanently in its presence or absence or degree of it. So we could use this also in order to reduce the cost of the entity’s treatment into this payment. Because, like doctors already extended on the first flight, more than $1,000,000,000 in the United States is being paid just because their best opportunity. Now the bionic pieces would work or create some form of stratification effectively. Erm erm if we could get a prototype that would be available in the office and we could do this the best way. All requires work and work and hard work. Then we could probably classify groups that need intervention so that people would not get into classes who are suicidal ideation. After a while it could be determined, okay, this is, let’s say, type A and type A need counseling and quickly get into audiology clinics for treatment versus someone who is having it is mild, but they are really, really distraught because they have never have to cope with anything. This way we could. We need here according to the patients. We. And then, as I said, we could of determine how effective it was and and fund for treatment. I appreciate everybody. And I would like to take over.

Ann Fazakerley [00:33:02] Thank you very much, Dr. Marghzar. I’d like us now to go back to Dr. Mehrnaz Shoushtarian to explain the work that we’re doing at the Bionics Institute. We’ve created a new way of measuring tinnitus by recording brain activity, and many others will explain to us how this could help people with tinnitus in the future.

Dr Mehrnaz Shoushtarian [00:33:32] thank you very much to Victoria and Sol for sharing their experience. So to go back to our work at Bionics Institute, as Victoria and I have both mentioned already, we are working on developing an objective clinical test for this. This is an overview of our work and the main components that it involves. So we are using a brain imaging technique called functional infrared spectroscopy to measure brain activity. And we are using artificial intelligence algorithms to find the best way of analyzing this data and extracting genetic related information for it. And our ultimate goal is to have an imaging system with our algorithms integrated that a clinician can so they use to give them information such as whether a person has tinnitus, as is its presence, and how severe it’s, for example, whether it’s mild or sweet. And I’ll talk a bit more about. It is to explain a bit more about the imaging technique that we using functional near-infrared spectroscopy. If this is NIS uses near infrared light to measure changes in blood oxygen levels in the brain and it does this using a montage of light sources and detectors that we can arrange on a tap that grows on the head. Depending on which parts of the brain we want to sets. And briefly, how this works is that when a part of the brain is active, there’s a demand for increased oxygen. So what we see in a typical response chart at the bottom of the screen is an increase in oxygenated hemoglobin and a decrease in deoxygenated hemoglobin. We. So this is just a short clip of our reporting system that we’re using at the moment. There you can see the cat that has the light sources and pictures that I mentioned that person it. And we record brain activity under different conditions. So when the person’s not doing anything, when they’re looking at visual patterns and when they’re listening to sound. And we’re combining all this information together. So research on tinnitus is done using other imaging techniques as well. But we think that functional near-infrared spectroscopy has a number of advantages that will make it suitable for eventual clinical use. And some of these are that it’s portable and cost effective compared to an MRI machine, for example. Also, it operates quietly, so there’s no scanner noise, which makes hearing research difficult because it uses near infrared light. It’s safe to use with implanted devices, and it’s not affected by electrical artifacts, electrical artifacts or interference from other systems, other electrical systems, for example. And it’s also not regular. This is a typical signal that we get from this imaging technique. This is from one location on the right. And usually the signal that we get, it would be it would sort of take it from several conversions and would be converted to density and oxygen globin that I mentioned before. Then from those signals, we would extract features and then compare these features in groups. So perform statistical group comparisons between, for example, a group of patients in iness and a group without. But what we’re doing in our research is replacing those last two steps with artificial intelligence. So. And the reason we’re doing that. Is that artificial intelligence techniques have capabilities that are akin. Helpful to the eventual clinical use of this technique. So I methods, for example, are capable of extracting disease related information from large amounts of data. So you can see the imaging cap on the right has several light sources and detectors on different parts of the brain. At the moment we’re reporting from about 40 different channels or brain locations, and we’re reporting them under different conditions, resting state in response to different stimulation. So that’s a huge amount of data and we for clinical use we might not need or so I methods will enable the optimization of these data sources. They can also be used. Our methods can also be used for what’s called single subject prediction, which means that rather than looking at group differences, we can take data from a single person. And with the model that we’ve built from all tendencies, patients, health problems, we can predict whether the data comes from a tinnitus group or a control sample or whether it’s model tinnitus or severe, which again is need for clinical. So Victoria and Dr. Mansour have already spoken about the impacts of an objective measure and how it’s changed things clinicians and patients. So the general idea is to improve treatments. So having an objective measure would provide key information on whether treatments are working or whether a change of treatment is needed. It can also help identify subtypes of tinnitus and what treatments they would benefit. Also for drug development a few years ago now, in 2005, it was estimated that a novel tinnitus drug is estimated to have a product value of 689 million USD in its first year of launch alone. So there is definitely it is definitely a worthwhile drug as well. The Brits need to talk about the work that we’ve done to date. We started off with a small study on 25 Genesis patients and 18 healthy controls. We published those findings at the end of 2020 and briefly summarized the results of that study. We showed that we could distinguish using our imaging technique with the distinguish signals from tinnitus patients and healthy controls, as well as mild, less severe cases with high accuracy. And also, we showed that our features were associated with our now found opportunities to be or how annoying they found it to be, which is again important for prescribing different treatments to two different. So the study was received really well and there was worldwide interest media and scientific news, news websites. There was a story about it. And if you’re interested, I’m saying basically highlighting the need for this clinical measure. And since then we have received over 400 expressions of interest from individuals with tinnitus, expressing interest in taking part in our study, again, highlighting the needs that patients feel for more work on this condition. We’ve filed an international application since that study. So throughout last year and in between pandemic lockdowns, we’ve collected further imaging data from 141 individuals nine to your daughters have tinnitus restored multiple roles to give us comparison data. And the data is still showing significant correlations of disease characteristics with imaging. So we. Now our next steps are to complete our artificial intelligence algorithms using using this bigger dataset that we now have. As I mentioned, what we need to do with in terms of program development is to have an imaging system with our algorithms integrated that can be easily used in a clinic. And a very important step to evaluate to and progress. This objective measure is the evaluation of potential treatments for tinnitus. Using our objective measure, and we are in discussion with several groups working on treatments who would benefit from from this objective. So thank you very much for listening and I’ll get back.

Ann Fazakerley [00:44:14] Thank you very much, Mehrnaz. We’d now like to move to questions. We’re going to spend a little bit of time collating the questions and James and Mehrnaz will take questions with James facilitating. Before we get there, I’d just like to say thank you to everybody who has submitted questions. If you’ll like, you can still get a couple more questions. And I just wanted to say, you know, we are doing some amazing work at the Bionics Institute. We believe that our work can have a really dramatic impact on patients lives, just as the pharmacare did all those years ago. I like to say that we rely on donations from members of the public. We have a wonderful group of friends, donors and supporters, and your funding is really important for us to accelerate the move from this objective test, which we’re currently working on in the laboratory, to move that more quickly into clinics and really help to change people’s lives, people who are suffering from this very debilitating condition. So I’m going to hand back to James and Merhnaz and we’ll take your questions. Thank you.

Professor James Fallon [00:45:39] Thanks, Ann. The first question I think we might take is, does this test work on all types of tinnitus .

Dr Mehrnaz Shoushtarian [00:45:51] I guess to answer that, we would need to test the different types of different types of tinnitus, and that’s what we’re aiming to do. One of the reasons we raised funds to be able to do larger clinical trials at different times, but. It could well be that even though it might not work on alternative sites, but it could help differentiate rule out a certain group that a person below a certain subtype person. But we would need more data.

Professor James Fallon [00:46:32] I also know that you are having some promising results with differentiating some different aspects of genetics. You want to go into that more detail?

Dr Mehrnaz Shoushtarian [00:46:42] That’s right, yes. So differentiating how loud a person, how loud rinsing tinnitus sound and how distressing it is to them is very important for developing the right treatments and sort of guiding patients to the right treatment. So our data so far is showing promise in being able to differentiate those two aspects.

Professor James Fallon [00:47:13] Right. Another question is, is there any international collaboration going on with these researchers at all? I’m going to try to.

Dr Mehrnaz Shoushtarian [00:47:24] At the moment it’s it’s all in Australia. But we would like to hear from Central International as well.

Professor James Fallon [00:47:40] And again, as I think you’re being a little modest, I might prompt you with palettes there in terms of it, you know, the equipment we use and who who supplies that and what’s our relationship with them?

Dr Mehrnaz Shoushtarian [00:47:54] So if these equipment were used at the moment, the brain imaging equipment is managed by a German company. Eric’s and we are in discussions with them to work together to further develop the hardware for clinical use. And as part of that, that’s discussions and preparations near supplied us with very expensive imaging equipment for six months last year, which allowed us to accelerate our data collection.

Professor James Fallon [00:48:30] There’s a question about the cause of this that $60 million question or probably more given inflation nowadays, is is the results that you’re gathering today leading any insight into the cause or whether there’s even just one cause or multiple causes?

Dr Mehrnaz Shoushtarian [00:48:50] We wouldn’t be able to tell directly what the cause of tinnitus is, but being able to differentiate subtypes based on out based on the brain signals that we gather in. Could assist with that, but not directly so.

Professor James Fallon [00:49:18] Right. And I’ll add a little bit there. The Institute has a product in this rated program where we are certainly looking at other aspects of this to try and establish or help unravel some of those cause and effect. And certainly is you know, it’s one of those multi-stage things as an instance as well where, you know, this is not static and therefore may change with progression. And therefore, it’s a you know, it’s a very difficult question, but certainly one we’re spending quite a bit of time trying to address is a question for Victoria about whether she’d care to talk about how does she cope with her with her this.

Ms Victoria Didenko [00:49:59] Yes. Well. I hope that I would rather live. I’d rather live life as opposed to just coping with it. But it’s a convoluted process. Some days I don’t use hearing aids. I have enjoyed my hearing aids on the days where, as you said, tinnitus is its material. It’s it’s sometimes it’s really loud. And today it is. And I have hearing aids, which amplifies the ambient sounds, and it makes my tinnitus appear less intrusive. Sound machines. I have music playing much to the chagrin of my husband. Crickets. I love cicadas and thickets and birds. High pitched like ringing is lovely to my ears because it drowns out that whistling and sound in my head. And you know what? Being proactive. I felt a victim when I first acquired tinnitus. And by being proactive and working hard together with the Bionics Institute all volunteer, I’m getting that message across that I’m not happy. I don’t like having tinnitus, I don’t want it. And I’m going to do everything in my power to find a way to live and accept the tinnitus until there’s a remedy or a way for the brain to switch off. It’s it’s I’m on all the time with sound machines, hearing aids, sometimes hearing aids, not music and lots of love, good humor and not too much else. A little bit.

Professor James Fallon [00:51:38] Right. Probably a good recipe for us all that Victoria kind of there’s a question around. You said variation in new brain signals that you’re recording men as between people who have achiness with hearing loss or without a hearing loss. Or is there any other variations on hearing status we’ve been able to investigate that might shed some light on what’s going on.

Dr Mehrnaz Shoushtarian [00:52:05] It’s certainly something we’re looking at. So when we have participants coming for testing, we also have the hearing tests on them. So we have data about their level of hearing and we are looking at differences or effects of hearing loss. We’re in the midst of looking at data, but it’s certainly a question we’re trying to answer.

Professor James Fallon [00:52:33] Excellent. There’s a there’s a complication related on a similar theme around when might this test be available and when water treatment be available. Andy, do you have any good answers for it for anyone out there? And I.

Dr Mehrnaz Shoushtarian [00:52:52] Wonder if you’d have a better answer come.

Professor James Fallon [00:52:55] Out as being honest. Again, look, we believe these tests is actually pretty close to ready to go. But as you saw, the captain in some of those images and as Shrine is great for experimental research and is great for a participant to come in and volunteer at the institute. But he’s far from ready for prime time to put in the hands of a clinical colleagues and a little bit of leadership to the other side of the world for us based colleagues to try that in their life as well. So certainly within Gray on a pretty clear path at the moment. We’re hoping within two or three years would have a test app in the clinic being thoroughly tested. And obviously, as for all of these things, the right limiter is the funding and the people power and the resources to get it through. And some of the most exciting work has been done by Menzies already in this some good old fashioned engineering left today, which I’m happy to help out with, and that’s why we’re working at multiple multi-disciplinary institute. So we would be hopeful of accelerating that deployment with additional injection of funds. And as we’ve tried to point out, we actually think there’s possibly already some quite good treatments out there, but it’s actually matching the right treatment with the right you know, the sufferer is is perhaps part of the issue we’re missing as well at the moment. And that’s why, as Dr. Marghzar spoke about, one of the things actually being able to categorize the tennis in the correct way, and we believe that this test is really helpful. And perhaps one of the most exciting things is Mehrnazspoke about is using artificial intel and just help us do diagnostics on an individual basis. So it’s great to have things that work for a group. But you know, as Victor, I’m sure Will would say, you know, she’s not a great person to suffer as she’s an individual. And we need a test that suits Victoria, not a whole group. And so being able to actually tweak those tests for individuals is what we’re hoping we can really achieve. Anything you can admit or anything? I’ve covered that one’s way.

Dr Mehrnaz Shoushtarian [00:54:56] No, that’s fine. Thank you.

Dr Mehrnaz Shoushtarian [00:55:00] Sorry. It’s important that the matter is asking if an instance has changed after they go through the imaging. And so we ask people to write it. Tinnitus, loudness and annoyance before and after the imaging. And there’s usually not much change. Sometimes sitting on the comfortable chair for half an hour. So people find that relaxing. But other than that, there’s no change in.

Professor James Fallon [00:55:37] Do you have any evidence or otherwise around any of those other potential testing regimes that you mentioned and the effects they may have on people as journalists? In terms of the study, an MRI scan of people’s tennis worse or trigger events?

Dr Mehrnaz Shoushtarian [00:55:51] Well, MRI scan is a very loud act. Sending a lot of people with tinnitus say they find it very uncomfortable to have that kind of sound. While staggering through the image.

Professor James Fallon [00:56:09] Right. I think I’m getting near the end of the questions that it was another one that popped up around How can I be involved in your study minutes?

Dr Mehrnaz Shoushtarian [00:56:17] So at the moment we have our imaging set up here in Melbourne, in East Melbourne. So and our details on our on the appliances website. So you send us an email, we can go through some questions about your tenancies and other conditions. And then we come in. But we’re only.

Professor James Fallon [00:56:46] And I’ve done my best to get through the questions. We did have a rapid barrage there at the end. Sorry if I’ve missed yours. I do apologize, but I do hope you have enjoyed the session and a hand back and now for closing remarks.

Ann Fazakerley [00:56:58] Thank you, James. Thanks, members and thanks to all our speakers James, Mehrnaz, Victoria and Dr. Marghzar. So that brings us to the end of our session on measuring tinnitus, detecting an invisible condition. The recording of this will be available shortly on our website, so keep an eye on our website and we hope in any case, you’ll stay in touch with the Bionics Institute community and we would love your thoughts and your feedback on the work that we do. We’re always open to comments and suggestions from everybody. So thank you so much for joining us today. Thank you for your support and we look forward to staying in touch with you. Thank you very much.