大学同学曾经提起她有“耳鸣”。我印象中，不少人有耳鸣。

前几天，偶然听了TED talk。

耳鸣：大脑里的“铃声”

Tinnitus: Ringing in the Brain 

by Josef Rauschecker 

at TEDxCharlottesville (Transcript)

Health & Wellness / By Pangambam S / January 12, 2018 12:47 pm

Here is the full transcript of Josef Rauschecker’s TEDx Talk on  Tinnitus: Ringing in the Brain at TEDxCharlottesville conference. 

Listen to the MP3 Audio: Tinnitus_ Ringing in the Brain by Josef Rauschecker at TEDxCharlottesville

下面，我借用Google翻译狗，和大家分享主要内容（快速翻译了90%）。

TRANSCRIPT （演讲记录稿）: 

I would like to talk with you about a medical disorder that is incredibly common, and yet it gets often underestimated – misunderestimated, as one of our former presidents would have said – in its impact on our psychology and on the patients. The patients really suffer from it.

我想和你谈一种病，一种非常普遍的病，但它对我们的心理和患者的影响经常被低估
（underestimated ）——正如我们的一位前总统会说的那样，被错误地低估了
（misunderestimated）。病人真的很痛苦。

【翻译者注：指的是一位2018年以前的美国总统，比较文盲，创造了不少“英文词”：

https://en.wikipedia.org/wiki/Bushism】

And it’s very pervasive; about 50 million Americans suffer from it. I bet many of you in the audience will have friends or family that suffer from it.

而且这种病非常普遍；大约有 5000 万美国人深受其害。我敢打赌，听众中的许多人，
会有朋友或家人因这种病而受罪。

What I’m talking about is tinnitus, the ringing in the ears. It’s often depicted in this painting by Edvard Munch although we don’t know for sure whether he actually had tinnitus himself. But the person in the painting is sort of covering his or her ears, and it doesn’t help because the ringing is actually generated in the brain.

我说的是耳鸣，耳朵里面的“铃声”。就像爱德华·蒙克（Edvard Munch）《尖叫》
这幅画，尽管我们不确定他自己是否真的患有耳鸣。画中的人捂住耳朵，但这并没有
帮助，因为铃声实际上是在大脑中产生的。

It’s not a real sound that, that a person hears; it’s a phantom sound. So we often talk about it as ringing in the brain rather than ringing in the ears.

病人听到的不是真实的声音；而是幻音。所以我们经常把它说成是在大脑里响的铃声，
而不是在耳朵里响的铃声。

And of those 50 million Americans that suffer from it, about 10 million of them really suffer very badly – they go to the extent that they have depression and suicidal thoughts. And I get emails every day from patients that are asking, “Is there not a cure?” There is no cure, unfortunately, at this point. And part of our research is aiming for that, of course, that we’re trying to find ways to help these patients.

在遭受这种病痛的 5000 万美国人中，大约有 1000 万人遭受了非常严重的病痛——
达到了有抑郁和自杀念头的程度。
我每天都会收到病人发来的电子邮件，他们问：“没有治愈方法吗？”不幸的是，目前
无法治愈耳鸣。当然，我们研究的目标之一是寻找帮助这些患者的方法。

And I can play some examples for you, (high-pitched tone) of what that sounds like. This is just a pure tone of a single frequency, relatively rare. Usually, tinnitus sounds more like the next one… (hissing sound). You can imagine how annoying that is. If you hear that all the time in one of your ears or both of your ears. You can’t turn it off, you can’t run away from it; it’s always there.

…你可以想象那是多么的烦人。如果您一直在一只耳朵或两只耳朵中听到这种声音。
你不能关掉这种声音，你不能逃避这种声音；这种声音总是在那里。

(cricket sound) Sometimes, you get this more sophisticated cricket sound that you hear. So, people suffer from it. There are groups that are more affected or at risk than others. Musicians get it surprisingly often because they are exposed to louder sounds than they realize. I once remember being at the Kennedy Center in Washington, DC, where we live, and went to a concert there, symphony concert by the National Symphony. They played Shostakovich’s War Symphony. Very loud, of course.

One of the violinists in the first or the second row was sitting right in front of the trombones behind her. The trombone was sort of blowing right into her ear and she was reflexively covering her ears to protect herself.

第一排或第二排的一位小提琴手，正好坐在长号前面。长号正对着她的耳朵吹来，
她反射性地捂住耳朵保护自己。

This is actually the right reaction, just to avoid loud noises in order to avoid getting hair cell damage, and then hearing loss, and ultimately tinnitus.

捂住耳朵其实是正确的反应，为了避免大的燥音，以免损伤毛细胞[毛细胞（英文：Hair cell）是所有的脊椎动物中听觉系统和平衡系统的感觉接收器]，进而导致听力下降，最终导致耳鸣。

So, loud noise exposure is certainly one of the biggest risks. And then you take a group like construction workers. If they don’t wear hearing protection, that can be very risky. The group most at risk are our war veterans, of course. They are constantly exposed to artillery fire, to bombs, explosives and so on, you know.

因此，暴露于大的噪音无疑是最大的风险之一。还有一个例子是一群建筑工人。如果
他们不佩戴听力保护装置，那将是非常危险的。当然，最危险的群体是我们的退伍军人。
你知道，他们经常暴露在炮火、炸弹、爆炸等情况之下。

In addition – this is a very important factor, which I want to stress in this presentation – stress is a very important factor. So, it’s not just the loud noise exposure that can give you tinnitus – it actually doesn’t always do that – but if it combines with a stressful situation, this is the most likely scenario where you end up getting tinnitus.

此外——这是一个非常重要的因素，我想在本次演讲中强调——压力是一个非常重要的
因素。
所以，不仅仅是暴露在大的噪音环境会给你带来耳鸣——实际上并不总是这样导致耳鸣
——但如果它与压力山大相结合，这就是你最终患耳鸣的最可能的情况。

So, our veterans are much more likely to come home from the battlefield with tinnitus. In fact, the Veterans’ Administration, if you look up the statistics, they show that tinnitus is the most frequent cause for benefits paid to veterans. Hearing loss is the second most frequent one.

Tinnitus has often been compared with other phantom sensations like phantom limb pain, which you might have heard about. In this case, somebody misses a limb because of an accident or an explosion that damaged his arm or her leg. And it’s a very similar thing. In this case again, the brain is the cause for this.

耳鸣经常与幻肢痛等其他幻觉感觉比较。幻肢痛是有人因为事故或爆炸损坏了他的
手臂或她的腿而失去了一条肢体。这是一个非常相似的事情。在这种情况下，大脑
也是造成这种幻肢痛的原因。

Even though the leg may be missing, the neurons in the brain that represent the brain are still there and they are firing along. On occasions, the person might get the impression that his leg is still there. And you can actually feel pain in that leg.

即使腿不在了，大脑的那些相关的神经元仍然存在，并且它们还在工作。有时，这个人
可能会觉得他的腿还在那儿。他实际上可以感觉到那条腿的疼痛。

And animal experiments have shown – that’s shown on the right of that slide here – that this is in fact what’s happening. In monkeys that have lost a hand, for example, the hand representation gets filled in with input from the face representation, which is right next to it.

Ramachandra and then neuroscientists in California did studies on amputees, where he showed that if you touch the face of an amputee, they actually feel their phantom hand, in this case, more frequently than not. So, there’s a profound reorganization going on in the brain, both in a phantom limb and in tinnitus, which is the equivalent in the auditory domain.

People have referred to this often as maladaptive plasticity. Plasticity, by definition, should be something good, right? We are learning: this is plasticity; memory is kind of a form of plasticity, so we associate this with an adaptive function. But in this case, is it really adaptive? I would think so. It’s not necessarily maladaptive, because the brain has set out a plan how to deal with these kinds of situations.

人们经常将此称为适应不良的可塑性。根据定义，可塑性应该是好事，对吧？我们正在
学习这种可塑性；记忆是一种可塑性形式，因此我们将其与自适应功能联系起来。
但在这种情况下，它真的是自适应的吗？我会这么认为。这不一定是适应不良，因为
大脑已经制定了如何处理这些情况的计划。

So, if you have loud noise exposure, you kill some of your hair cells in the inner ear, and they can’t be replaced; they don’t grow back. So, what the brain does, it kind of fills in that gap. Nature doesn’t like gaps. So, the gap is filled in with neurons that normally respond to other frequencies, like on the left or right of that gap.

所以，如果你暴露在大的噪音中，你会杀死你内耳中的一些毛细胞，而且它们是无法
替代的；他们不会长回来。所以，大脑怎么办？它填补了这个空白。自然(Nature)
不喜欢“空白”。因此，空白被通常响应其他频率的神经元填充，例如在该空白的
左侧或右侧。

Another example is the blind spot in your eye. You all know we have a blind spot in our retina where there are no photoreceptors, so the blood vessels go in and out from there. The optic nerve goes in from there. We don’t see, but we don’t notice that hole because with the same mechanism the brain fills in that hole. And the same thing happens – we call this lesion-induced plasticity. The same thing happens in tinnitus.

So, it is per se an adaptive mechanism. But it has an unintended side effect, this hyperactivity that I’ve been talking about, that we can actually visualize with fMRI, for example.

因此，它本身就是一种自适应机制。但它有一个意想不到的副作用，就是我一直在谈论
的这种过度活跃（hyperactivity），例如我们实际上可以用 fMRI 来可视化。

And then, the next step is missing in tinnitus patients. Normally, the brain is even more clever. It realizes there is this internal noise being generated, so it puts its executive sentence in play and they would suppress that noise. So, most people actually even after extensive loud noise exposure don’t get tinnitus. You might have hearing loss but you don’t end up with tinnitus. You go to a loud noise concert, for example, loud rock concert, and you have tinnitus maybe the next day, but then it goes away after a few days. So, many people have just temporary tinnitus which gets repaired by the brain; there are mechanisms for that.

耳鸣患者缺少下一步。通常情况下，大脑会更加聪明。它意识到正在产生这种内部噪音，
因此它会发挥其执行语句的作用，它会抑制这种噪音。因此，大多数人实际上即使
在超大的噪音暴露后也不会出现耳鸣。您可能有听力损失，但最终不会出现耳鸣。
你去听一个嘈杂的音乐会，例如，非常大声的摇滚音乐会，你可能会在第二天出现耳鸣，
但几天后它就会消失。所以，很多人只是暂时的耳鸣，大脑能够修复它；大脑有这种
修复机制。

But in those unfortunate people where these mechanisms don’t work, they are the ones that are becoming the chronic tinnitus patients.

这些机制不起作用的不幸人群，成为慢性耳鸣患者。

【下面是我用手机复制的后面部分】

So, in the next few slides, I’ll show you the brain and how it is organized, how it reacts to these events and these situations. Here’s the brain as a whole, and you see the auditory cortex somewhere in the middle there; it’s been exposed. And this is just a drawing. You see the tonotopic map, how the different frequencies are laid out along the auditory cortex.

因此，在接下来的几张图中，我将向您展示大脑以及它是如何组织的，它如何对这些
事件和这些情况作出反应。这是整个大脑，你可以看到中间某处的听觉皮层；它对声音
的“反应”。这只是一张绘制的图。你会看到音调图，不同的频率是如何沿着听觉皮层
排列的。

And you see how – Normally this is pretty regular. All the frequencies are equally spaced, but after you lose that yellow region there, then the green and the orange region move in, and they are the ones that are overrepresented and give you the tinnitus noise, the tinnitus signal.

你看， 通常这是很有规律的。所有的频率都是等距的，但是当你失去那个黄色区域之后，
绿色和橙色区域就会进入，它们是那些被过度代表，给你耳鸣噪声，耳鸣信号。

So, now we have a real picture. This is an old research scanner at NIH, where some of these techniques have actually been established. Now you can do this with any MRI scanner that you’ve probably seen and been in, yourself. And we can visualize the auditory cortex in normal controls without tinnitus. You see a nice activation in the auditory cortex. And in the patients that constantly have tinnitus, this activation is doubled or tripled; it’s very significantly increased. So this is the physical realization of what people actually perceive.

现在我们来看一张真实的照片。这是 NIH 的旧的研究扫描仪，其中一些技术实际上
已经建立。现在，您可以使用任何您可能见过和用过的 MRI 扫描仪来执行此操作。
我们可以看看在没有耳鸣的正常对照组中可视化听觉皮层。你在听觉皮层看到了
很好的激活。而在经常有耳鸣的患者中，这种激活会增加一倍或三倍；它非常显着增加。
所以这是人们实际感知的物理实现。

But this is not the whole story. The rest of the talk will try to convince you that tinnitus is not just an auditory disorder; it is more than that. It has to do with the higher brain functions in the frontal cortex, in the limbic system. And if you think about it, there’s a good reason to assume that it’s more than an auditory disorder, because not everyone, as I said, ends up getting tinnitus, even if you have a hearing loss and have suffered from loud noise exposures many times.

但这还不是全部。剩下的时间，我将试图让你相信耳鸣不仅仅是一种听觉障碍。
不仅如此。它与边缘系统中额叶皮层的高级大脑功能有关。如果你仔细想想，有充分的
理由假设它不仅仅是一种听觉障碍，因为不是每个人，正如我所说的，最终都会得到
耳鸣，即使你有听力损失并且多次暴露在大的噪音中.

A lot of people only have intermittent tinnitus. If you’re like me, you often have stressful situations, like a deadline that you have to meet. You’re working very hard, you get less sleep during that period, and then your tinnitus suddenly appears. Even if you don’t have it normally, you might get tinnitus in a situation like this.

很多人只有间歇性耳鸣。如果你像我一样，你经常会遇到压力山大的情况，比如你必须
赶期限。你工作很努力，这段时间睡眠少，然后突然出现耳鸣。即使您平时没有耳鸣，
在这种情况下您也可能会有耳鸣。

Then you submit the grant or the project that you’ve been working on. You’re finished, you have a good feeling, you get a good night’s sleep. Next day the tinnitus is gone. So that shows you that it’s not just auditory. There’s something regulatory higher up in the brain that can normally take care of this.

然后，你提交你一直在做的经费申请或项目。你已经完成了，你有很好的感觉，你可以
睡个好觉。第二天耳鸣就消失了。因此，这向您表明，这不仅仅是听觉上的。大脑中
有一些更高的监管机构，它通常可以解决这个问题。

And there’s also comorbidity with depression. If you feel bad and you have sort of a – if you’re sad or if you’re stressed out, then your tinnitus is much more likely to come up and get worse. So, there’s clear comorbility with these kinds of mechanisms which we refer to often as the limbic system.

还有合并症，即抑郁症。如果您感觉不好，如果您感到难过或压力山大，那么您的耳鸣
就更有可能出现并变得更糟。因此，我们通常将其称为边缘系统的这些机制具有明显的
共存性。

So, on the left, the blue region is the auditory system. Every sensory system has its representation in the brain. And then, in the frontal cortex, sort of in the front part of the brain, there’s this green system, which we often refer to as the limbic system; it regulates our emotions. And it has some very well-defined building blocks in there, which I’ll show you in a minute: ventral medial prefrontal cortex and nucleus accumbens. They all play their role and they interact with the sensory systems and kind of are able like an operating system in a way in a computer to emphasize or de-ephasize what you hear, what you see, and sort of give you the actual percept, experience of your daily lives.

所以，在左边，蓝色区域是听觉系统。每个感觉系统在大脑中都有其代表。然后，
在额叶皮层，有点像大脑的前部，有这个绿色系统，
我们通常称之为边缘系统；它调节我们的情绪。它有一些非常明确的构建块，我稍后
会向你展示：腹侧内侧前额叶皮层和伏隔核。
它们都扮演着自己的角色，它们与感觉系统交互，并且能够像计算机中的操作系统一样
强调或淡化你所听到的、你所看到的，并给你日常生活中的实际的感知、体验。

So, the upshot of all that is that tinnitus as a phantom sensation depends on three things. First of all, in most cases there is a peripheral auditory lesion; there’s no way around it. Some people say there is tinnitus without hearing loss, but it’s very, very rare. It may happen sometimes with accidents. But in regular cases, there’s a lesion there.

所以，耳鸣作为幻觉的结果取决于三件事。首先，大多数情况下存在外周性听觉损伤；
这是没有办法解决的。有人说有耳鸣而没有听力损失，但这种情况非常非常罕见。
有时可能会发生，因为事故。但在正常情况下，耳鸣是因为有病变。

And there’s central auditory organization, as I’ve shown you, the fMRI, and then there’s this non-auditory gating system, and the rest of the talk is only about this.

还有中央听觉组织，正如我向你展示的那样，fMRI，然后是这个非听觉门控系统。
剩下的演讲，就是关于这个。

So we found — about 10 years ago, we had a crucial finding. That was, again, a brain imaging study that we did in collaboration with the German MIT. He just said in the introduction, in Munich. And we found that in tinnitus patients there’s a very significant shrinkage in one region. We call it a volume decrease because the MRIs determine the volume of a part of the brain, of the brain tissue.

大约 10 年前，我们有一个重要的发现。这又是一项我们与德国MIT（Munich Institute of Technology ）合作进行的脑成像研究。演讲主持人刚刚在介绍中说，

德国MIT在慕尼黑。我们发现，在耳鸣患者中，一个区域的萎缩非常显着。我们

称其为体积减少，因为 MRI 确定了大脑一部分的体积，即脑组织的体积。

And this was in the ventral medial prefrontal cortex, which normally is there for the perception of unpleasant sounds, say. There was a study before that showed if we hear unpleasant sounds, the same region lights up. So, it makes sense that this region was affected, but we didn’t know at the time how crucial it was.

这是在腹侧内侧前额叶皮层，通常用于感知不愉快的声音。之前有一项研究表明，
如果我们听到不愉快的声音，同一区域会亮起。
所以，这个地区受到影响是有道理的，但我们当时并不知道它有多重要。

Another finding that helped us understand what was going on is that this region in the ventral striatum in the basal ganglia, right in the middle there – you see this red spot there. This is called the nucleus accumbens. It’s a small center that regulates our emotions. It’s often being called the pleasure center. It’s actually involved in giving you addictions and has all kinds of roles in terms of emotional regulation. And surprisingly, this region was highly hyperactive. This was increased in its activity in tinnitus patients. A very, very significant effect, as you can see on the right if you understand statistics.

另一个帮助我们理解发生了什么的发现是基底神经节腹侧纹状体的这个区域，就在中间
——你可以看到那里的这个红点。这被称为伏隔核。
这是一个调节我们情绪的小中心。它通常被称为娱乐中心。它实际上涉及让你上瘾，
并且在情绪调节方面具有各种作用。令人惊讶的是，
这个区域非常活跃。这在耳鸣患者中的活性有所增加。一个非常非常显着的效果，
如果您了解统计数据，您可以在右侧看到。

So, those two regions together form an internal noise cancellation system. It’s what we figured. You’ve all had noise cancellation headphones on the airplane. And what this does is it can’t make this noise really go away; the noise is still there but the system adds another form of noise to a signal. And that’s the negative form of the original noise and that cancels out – there’s some noise and therefore you don’t hear anything or you get sort of much milder effect.

因此，这两个区域共同形成了一个内部噪声消除系统。这是我们的理解。你们都在
飞机上戴过降噪音耳机。它的作用是不能让这种噪音真正消失；噪声仍然存在，
但系统为信号添加了另一种形式的噪声。这就是原始噪音的负面形式，它被抵消了
——有这些噪音，因此你什么噪音都听不到，或者你听到的噪音要小得多。

And that system normally, with the red box there, inhibits the internal noise signal and you don’t have tinnitus. But if that system is broken, then you end up having tinnitus.

那个系统通常（看红色框）抑制内部噪声信号。所以你没有耳鸣。但是，如果该系统
被破坏，那么您最终会有耳鸣。

So, here in a close-up, you see that the nucleus accumbens is part of that evaluation system and the medial prefrontal cortex does the volume control; it turns down the gain when the nucleus accumbens tells it so. And then together, this works or it doesn’t work.

在这个特写镜头中，您会看到伏隔核是该评估系统的一部分，而内侧前额叶皮层负责
音量控制；当伏隔核告诉它时，它会降低增益。
叠加在一起后，结果是“行得通”或“行不通”。

So, where do we go from here? We have hints from this last slide. You see the boxes on the right. That’s dopamine and serotonin. These are two transmitters. They have to be high for you to feel good and feel happy. If they are low, then you get depression, for example, and you get tinnitus.

那么，我们该何去何从？我们从最后一张图片中得到了提示。您会看到右侧的框。
那是多巴胺和血清素。这是两个发射器。
它们必须很高才能让您感觉良好并感到快乐。例如，如果它们很低，那么您可能
会患上抑郁症，您会患上耳鸣。

So, this may be opening an avenue for drug treatment in the long term. But there’s another form of treatment that we might be able to use in the future. This is called Deep-Brain Stimulation, and it’s been established for Parkinson’s disease and major depression.

因此，从长远来看，这可能为药物治疗开辟一条途径。但是我们将来可能会使用
另一种形式的治疗方法。这被称为深部脑刺激，它已被用于治疗帕金森病和重度
抑郁症。

I’ll show you in a brief video a patient that actually undergoes this treatment. It may be shocking for you at first, but it’s become routine in many disorders. The patient actually lies there awake. She’s slightly sedated. She’s able to talk to the surgeon and report her feelings.

我将在一个简短的视频中向您展示一位实际接受这种治疗的患者。一开始你可能会感到
震惊，但它已成为治疗许多疾病的常规。
病人实际上醒着躺在那里。她用了一点点镇静剂。她依然能够与外科医生交谈，
并报告她的感受。

[Video clip) Mayberg: Does it have any mental qualities to it or is it still mostly physical? 

Patient: Actually, that time it kind of was – there was a lighterness of my mood that went with the lighterness of my feeling. 

Voice-over: The transformation was dramatic: a sudden remission from despair in a person who has spent years in a nearly vegetative depression. Happiness felt like a possibility again. – Video ends]

So, I hope I’ve been able to tell you that we’re getting closer to understanding what tinnitus is, and with these considerations that I’ve just said, we may be able to ultimately find a cure, and I may be able to respond to those emails that I’m getting and say, “Well, help is on the way. We’re not there yet, but help is on the way, though. I’ll have something for you soon.”

我希望我能够告诉你们，我们越来越接近于了解什么是耳鸣，基于我刚才所说的这些
考虑，我们可能最终能够找到治愈方法，使我能够回复我收到的那些电子邮件，
并说：“嗯，有希望。我们还没有找到治疗方法，但是正在努力中。我很快就有
好消息给你。”

ps. The format is still off, no auto-wrapping. What a pity!