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    {
      "speaker": "Leah Bucholz",
      "startTime": "5.44",
      "endTime": "30.05",
      "body": "A lot of veterans remember the day that it started or the moment that it started. So you finish a day at the range, everything finally gets quiet, and suddenly there is just this ringing in your ears. At first, you assume that this is just gonna be temporary. Maybe it's just your ears adjusting after the noise. But for millions of veterans, self included, that ringing never really goes away."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "30.53",
      "endTime": "70.4",
      "body": "That condition is called tinnitus, and it's actually the number one VA rated condition and has been for a really long time, in the in the entire VA disability system. Today, I wanna break down the science behind tinnitus and why it happens so often in military members. So tinnitus is an extremely common condition that veterans and service members suffer from. So service members are routinely exposed to very high intensity noise environments. The Department of Defense has long recognized that military noise exposure, particularly weapons fire and explosive impulse noise, can damage the auditory system."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "70.880005",
      "endTime": "109.215004",
      "body": "Once that damage occurs, the effects can persist for years or even decades. To understand why tinnitus is so common in veterans, it helps to break down the science, and and really breaking it down into five major factors. Reason number one, extreme noise levels. So military environments expose service members to some of the loudest occupational noise levels that exist. Examples can include things like rifle and machine gun fire, so just range fire, artillery, aircraft engines, explosions, breaching charges, arm armored vehicles."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "109.375",
      "endTime": "130.56",
      "body": "There's just a ton of different I mean, even equipment in the lab. Dental dental hygienists have really noisy equipments as well. So many of these sounds exceed a 140 decibels, which is the threshold where instant acoustic trauma can occur. So for comparison, a chainsaw is about a 110 decibels. A rock concert is gonna be about a 120 decibels."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "130.965",
      "endTime": "162.225",
      "body": "So the types of exposures common in military environments can be far louder than what most people experience in civilian life. Even a single high intensity exposure can damage hearing structures. Repeated exposures increase that risk significantly. So before we go any further, here's something that surprises a lot of veterans. You might assume that tinnitus happens because the ear is damaged, but the ringing sound you hear isn't actually coming from the ear itself."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "162.705",
      "endTime": "189.235",
      "body": "In many cases, the brain is creating that sound. That happens because the hearing system is trying to compensate for signals that were lost after noise exposure. So under so to understand tinnitus, we need to look at what loud noise actually does to the hearing structure inside the ear. So damage to cochlear hair cells. Inside the ear is a spiral shell shaped structure that is called the cochlea."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "189.475",
      "endTime": "215.955",
      "body": "The cochlea contains thousands of specialized sensory cells known as hair cells. These cells convert around vibrations into electrical signals that travel through the auditory nerve, k, the the nerve itself to the brain. But these hair cells are extremely delicate. When exposed to excessive noise, they can become damaged or destroyed. Unlike many other cells in the body, hair cells generally do not generate."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "216.595",
      "endTime": "235.22",
      "body": "Once, they they do not regenerate. Sorry. So once they are lost, the auditory system must function with permanently reduced sensory input. This disruption and signal transmission is one of the key biologic, triggers for tinnitus. So reason number three, hidden nerve damage."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "235.3",
      "endTime": "258.08002",
      "body": "So another important discovery in hearing science involves something called cochlear synaptop synaptopathy. What a mouthful. Right? So even when hair cells survive noise exposure, the connections between hair cells and auditory nerve cells and fibers can still be damaged. These connections are called synapses, and they transmit sound information to the brain."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "258.56",
      "endTime": "287.90997",
      "body": "Research in the Journal of Neuroscience demonstrated that noise exposure can cause permanent loss of these synaptic connections even when hearing thresholds appear to recover after exposure. This means someone can pass a hearing test but still have underlying neural injury within the auditory system. This type of hidden damage can contribute to tinnitus and difficulty understanding speech in noisy environments. So reason number four, the brain turns up the game. K?"
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "287.90997",
      "endTime": "325.46002",
      "body": "So one of the most interesting aspects of tinnitus is that the sound itself is not actually produced by the ear. It like I said before, it's produced by the brain. And when cochlear damage reduces the signals reaching the brain, the auditory system attempts to will attempt to compensate, and, essentially, the brain turns up the gain in the auditory pathways to try to detect missing signals. Research describes this as maladaptive neuroplasticity. Studies published in journals such as Trends in Neuroscience and The Lancet show that these increased neural, that this increased neural activity can produce spontaneous electrical firing and auditory circuits."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "326.01498",
      "endTime": "348.28",
      "body": "The brain interprets that abnormal activity as sound. That perceived signal becomes the ringing, buzzing, or humming sensation known as tinnitus. So reason number five, re repeated exposures over time. Military military noise exposure rarely happens just once. Instead, it occurs repeatedly over years of training, deployments, and and, you know, other things."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "348.28",
      "endTime": "378.67",
      "body": "Right? So even when hearing protection is used, repeated exposure is high intensity. Repeated exposures to high intensity impulse noise can cause cumulative injury to the auditory system. Service members and occupations like infantry, artillery, aviation, armor, combat engineering often experience frequent exposure to extremely loud environments. Over time, that cumulative exposure significantly increases the likelihood of developing tinnitus."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "379.765",
      "endTime": "405.69",
      "body": "So what does the research show? Several studies have helped explain how noise exposure leads to tinnitus. Research showed that even temporary noise exposure can produce permanent degeneration of auditory nerve connections in the cochlea. Other reviews, including work in trends in neuroscience in The Lancet describe, those activities that we discussed earlier, with the neural activity. These findings support the idea that tinnitus is not simply an ear problem."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "405.995",
      "endTime": "447.445",
      "body": "It involves changes in the brain's auditory processing system, falling damage to the hearing structure itself. So the VA's perspective is that, essentially, from a disability standpoint, tinnitus has become the most common service connected condition as we mentioned. Millions of veterans receive disability compensation for tinnitus. One reason is that military service often involves that documented exposure to extremely loud environments, and tinnitus can develop can develop even when, the hearing loss is mild or difficult to detect on standard hearing tests. Because of this, tinnitus is widely recognized as a condition associated with occupational noise exposure during military service."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "448.725",
      "endTime": "475.185",
      "body": "So why does tinnitus, often become chronic? Once tinnitus develops, it can persist because of long term changes in the auditory nervous system. The brain adapts to altered auditory input. These adaptation can involve changes in things like auditory cortex activity, neural synchrony, brainstem signaling processes. Because of these neuroplastic changes, tinnitus can become chronic even if the original injury occurred years earlier."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "475.505",
      "endTime": "501.655",
      "body": "This helps explain why many veterans report tinnitus that began during service and never fully resolved. So I have three things that veterans should know about tinnitus. One, so I guess before we finish, these important things are are sort of those key things I want you to keep in mind. So first, tinnitus is extremely common after repeated noise exposure. If you experience loud environments during military service, you are not alone in experiencing these symptoms."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "502.055",
      "endTime": "531.055",
      "body": "Second, tinnitus does not always occur with obvious hearing loss. Because of hidden nerve damage, some people may have tinnitus even when a standard hearing test appears normal or relatively normal. Third, tinnitus symptoms can vary significantly. Some people experience mild ringing that is mostly noticeable in quiet environments, while others experience more persistent symptoms that affect sleep or concentration. Understanding these differences helps explain why tinnitus affects people in different ways."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "531.855",
      "endTime": "563.485",
      "body": "And if you're a veteran watching this, I'm curious when did you first notice your tinnitus? So please drop some comments and let me know. Was it after time on the range, during deployment, or sometime after service? So tinnitus is so common in veterans because military service often involves that repeated exposure to high noise levels that can damage the delicate structures of the ear. That damage disrupts how sound signals re can reach the brain, and the brain's attempt to compensate can produce the persistent ringing known as tinnitus."
    },
    {
      "speaker": "Leah Bucholz",
      "startTime": "563.485",
      "endTime": "584.845",
      "body": "Understanding the science behind tinnitus helps explain why it has become the most common disability. If you want more educational videos, please like and subscribe, about medical issues related to VA disability or just veteran conditions. And as always, this content is, of course, not medical advice or legal advice. So thank you for watching, and I'll see you guys next time."
    }
  ]
}