Sunday, September 17, 2023

Music in the Streaming Age

In the grand tapestry of human evolution, our sense of hearing has played a pivotal role in our survival and cultural development. Over time, our hearing has evolved in response to environmental cues and the intricate dance of language and communication. This journey has left its imprint on the very structure of our inner ears and the regions of our brains responsible for language processing. 

As our societies grew in complexity, so did our music. It was evolving from simple and rhythmic, to intricate compositions of classical music and avant-garde, experimental, serialist, highly spatialized music. It was changing from danceable to complex and dissonant rhythms. Some complex music was very popular - such as psychedelic rock band Pink Floyd; other not so much - such as Karlheinz Stockhausen's compositions. Modern music was incorporating elements of many other genres - eg alternative rock: punk rock, heavy metal, and experimental music and even simpler Hip Hop: jazz, funk, and soul. The most popular music was not always simplest but was more accessible.

In the 2020s, the world of music experienced a seismic shift with the rise of streaming platforms like Spotify, Tencent, and Apple Music. The impact was profound, not only revitalizing the music industry's revenue but also redefining the very essence of music itself.

Traditionally, music was a patient storyteller, often taking its time to build up to a climactic chorus or hook. Yet, the economics of streaming introduced a new imperative – capturing the listener's attention within the first 30 seconds. Enter the "Pop Overture," a clever technique where a song hints at its chorus within the initial moments, engaging the listener and encouraging them to stay for the full musical journey. 

To keep the dreaded "skip rate" at bay, artists began to craft shorter songs. Lengthy instrumental intros were swapped for immediate engagement, resulting in a significant reduction in the average duration of hit songs. In 2021, nearly two-thirds of chart-toppers clocked in at under three minutes, a departure from the days when a four-minute+ song was the norm.

As individual songs shrank, albums expanded. Streaming listeners, keen to maximize their musical experience, embraced longer albums. More songs equaled more income, with Taylor Swift's "Midnights" dominating the Hot 100 chart by offering an extensive musical journey.

Streaming opened doors for genres that once struggled for visibility. Latin and K-Pop artists rose to prominence on Spotify's Global Top 100, fostering a rich tapestry of cross-genre collaborations. Remixes featuring artists from different backgrounds expanded a song's appeal and audience, exemplified by Justin Bieber's "Sorry (Latino Remix)" with J. Balvin.

While artistic creativity remains paramount, commercial considerations loom large. The streaming economy's dynamics, with its emphasis on plays, playlists, and recommendations, have compelled artists and labels to explore innovative strategies to maximize reach and revenue.

In this ever-evolving landscape of sound, music's essence has been reshaped by the streaming revolution. The emphasis on retaining listeners and optimizing plays has redefined how songs are crafted and albums are composed. With an emphasis on retaining listener engagement and maximizing plays, the industry has adapted to the evolving preferences and economics of the streaming era.


Streaming is changing the sound of music(

Acknowledgements: ChatGPT, Bard and Bing image creator

Friday, September 8, 2023

A Leap Towards Curing Genetic Deafness

In recent years, gene therapy has surfaced as a beacon of hope for those grappling with genetic hearing loss, showcasing promising results in neonatal mice. However, when it comes to adults, the complex structure of the cochlea, nestled within the temporal bone, has made treatment significantly more challenging. A recent study reported results that could change this narrative, opening new avenues in auditory research with the potential to revolutionize treatment for progressive genetic-mediated hearing loss in adults.

The crux of this breakthrough lies in the innovative method of gene delivery through the cerebrospinal fluid (CSF), a channel that has not been explored extensively in previous research. This study illuminates the lymphatic-like characteristics exhibited by the cochlear aqueduct in mice, indicating a pathway for the diffusion of gene therapy to the inner ear. Leveraging in vivo time-lapse magnetic resonance imaging, computed tomography, and optical fluorescence microscopy, the research team traced the journey of large-particle tracers from the CSF to the inner ear, demonstrating a viable route for targeted gene delivery.

By utilizing a single intracisternal injection of an adeno-associated virus carrying the Slc17A8 gene, known for encoding the vesicular glutamate transporter-3 (VGLUT3), the researchers successfully restored hearing in adult deaf mice. This restoration was achieved without any discernible ectopic expression in the brain or the liver, emphasizing the precision of this approach.

This pivotal study marks a significant stride in auditory research, presenting a feasible and innovative method to treat genetic deafness in adults, a segment that was previously considered hard to reach due to the risks associated with potential damage to inner ear structures. The CSF administration through the cochlear aqueducts emerges as a promising route, promising not just advancements in rodent studies but potentially paving the way for human applications.

In essence, this research might herald a new era where genetic deafness in adults could be treated more effectively and safely. As the world of medical science stands on the brink of this significant advancement, it brings renewed hope and anticipation for individuals affected by progressive genetic-mediated hearing loss, inching us closer to a future where hearing restoration is within reach for all.


Mathiesen BK, Miyakoshi LM, Cederroth CR, Tserga E, Versteegh C, Bork PA, Hauglund NL, Gomolka RS, Mori Y, Edvall NK, Rouse S. Delivery of gene therapy through a cerebrospinal fluid conduit to rescue hearing in adult mice. Science Translational Medicine. 2023 Jun 28;15(702):eabq3916.

Monday, September 4, 2023

The Promise of Bimodal Neuromodulation

Tinnitus, often described as a persistent ringing or buzzing in the ears leading to distress and discomfort, affects more than 10% of the population worldwide. For years, finding an effective treatment for this phantom auditory condition has been a challenge. One promising approach is bimodal neuromodulation. 

Extensive animal studies demonstrated the ability of bimodal neuromodulation to induce neural plasticity in the auditory brain. 

The TENT-A1 clinical trial ( NCT02669069) conducted in 2020 involved 326 participants and demonstrated the safety and effectiveness of bimodal neuromodulation using the Lenire device. This therapy combined sound and tongue stimulation and significantly reduced tinnitus symptom severity scores in over 80% of participants during the 12-week treatment period, with effects lasting up to 12 months after treatment. The trial used three different parameter settings (PS1, PS2, and PS3) involving synchronized sound and tongue stimulation, short interstimulus delays, and lower-frequency tones, respectively, along with background wideband noise. TENT-A2, which was statistically powered to evaluate the necessity of wideband noise, found that it was not required for therapeutic benefit in arm 2 (absent in parameter settings). Furthermore, TENT-A2 completed in 2022 ( NCT03530306) explored the impact of adjusting sound and tongue stimulus parameters, demonstrating significant findings in both arms (PS1-PS4 and PS6-PS10). These results represent significant progress in tinnitus treatment.

The study found that these therapeutic effects were sustained up to 12 months after the treatment ended. This long-term relief is a promising development for tinnitus sufferers.

Tinnitus treatments can be categorized into three main groups based on a recent scoping review:

Medical Technology Therapies: This category includes therapies that involve the use of medical devices or technology to manage tinnitus. Notably, the study highlighted the effectiveness of stimulation therapies, although evidence-based guidelines did not strongly recommend them. Stimulation therapies encompass approaches such as tinnitus masking, which uses external sounds to reduce the perception of tinnitus, and acoustic therapies.

Behavioral/Habituation Therapies: These therapies focus on behavioral interventions to help individuals habituate to the perception of tinnitus. Common approaches mentioned in the review include counseling, tinnitus retraining therapy (TRT), cognitive-behavioral therapy (CBT), relaxation techniques, and attention diversion strategies.

Pharmacological, Herbal, Complementary, and Alternative Medicine Therapies: This category encompasses treatments involving medications, herbal remedies, complementary therapies, and alternative medicine. However, the review noted a lack of significant findings and strong recommendations for these interventions, indicating the need for further research in this area.

Tinnitus research has predominantly focused on stimulation therapies and acoustic therapies. However. digital therapies, including internet-based interventions, are more cost-effective and are gaining traction in the treatment and management of tinnitus. They are showing promise in improving the effectiveness of interventions, particularly cognitive-behavioral therapy (CBT). They have the potential to improve patient outcomes and provide accessible options for individuals with tinnitus. However, their integration into healthcare systems requires careful consideration and the accumulation of strong evidence to support their effectiveness and long-term benefits.


Conlon B, Hamilton C, Meade E, Leong SL, O Connor C, Langguth B, Vanneste S, Hall DA, Hughes S, Lim HH. Different bimodal neuromodulation settings reduce tinnitus symptoms in a large randomized trial. Sci Rep. 2022 Jun 30;12(1):10845. doi: 10.1038/s41598-022-13875-x. Erratum in: Sci Rep. 2023 Jul 10;13(1):11152. PMID: 35773272; PMCID: PMC9246951.

Chhaya, V., Patel, D., Shethia, F. et al. Current Therapeutic Trends for Tinnitus Cure and Control: A Scoping Review. Indian J Otolaryngol Head Neck Surg (2023).

Monday, April 10, 2023

Improving Accessibility and Affordability for Age-Related Hearing Loss

While hearing aids are the most common treatment for age-related hearing loss, low uptake of hearing aids is due to high cost, stigma, and a lack of perceived need. To increase accessibility and affordability, the U.S. Food and Drug Administration created a new OTC hearing aid category. Currently, there are various hearing devices available for individuals with and without hearing loss, including medical devices (prescription hearing aids, self-fitting OTC hearing aids, and pre-set OTC hearing aids) and non-medical devices (PSAPs, hearables, and consumer audio devices such as Apple's AirPods Pro and Live Listen feature, Samsung's Galaxy Buds and Hearing Aid feature, and Bose Hearphones). 

Regulated by the FDA, hearing aids have evolved rapidly in the last decade, with features, functionalities, and designs improving significantly. However, there is a lack of research on all aspects of OTC hearing aids currently on the market. High-quality independent research is necessary to supplement evidence provided by OTC hearing aid manufacturers for regulatory approval purposes. Recently published article has reviewed existing research on direct-to-consumer (DTC) hearing devices such as PSAPs and highlighted the need for immediate research on OTC hearing aids and service delivery models to inform policy and clinical care.


Manchaiah V, Swanepoel W, Sharma A. Prioritizing research on over-the-counter (OTC) hearing aids for age-related hearing loss. Front Aging. 2023 Mar 23;4:1105879. doi: 10.3389/fragi.2023.1105879. PMID: 37033402; PMCID: PMC10078955.