Can any­thing cure the mer­ci­less mis­ery of my full-blown tin­ni­tus?

China Daily (Hong Kong) - - HEALTH - By CHERRILL HICKS

There’s a con­stant hiss­ing in my right ear — like a pres­sure cooker let­ting off steam. Some­times it changes to a high pitched whis­tle, like a stove­top ket­tle on the boil. Hiss­ing or whistling, the sound rarely goes away.

I’ve had full-blown tin­ni­tus for over a year now, and it’s tak­ing over my life. Noises which used to oc­cur only oc­ca­sion­ally have be­come re­lent­less. They ac­com­pany me on peace­ful coun­try walks, dis­turb din­ner with friends and even in­ter­rupt when I’m watch­ing a movie.

I can’t just pop a pill to get rid of it. It’s get­ting to the point where I would trea­sure a mo­ment of si­lence.

Al­though re­searchers are start­ing to un­der­stand more about tin­ni­tus its pre­cise cause re­mains a mys­tery. The sounds that I and oth­ers hear are thought to be gen­er­ated by over­ac­tive nerves in the au­di­tory path­way which runs from ear to brain. Suf­fer­ers de­scribe the sounds as buzzing, ring­ing, hum­ming, hiss­ing, whoosh­ing, roar­ing — one un­for­tu­nate com­pared it to a “jet en­gine in the head.”

Tin­ni­tus may be present all the time — or it may come and go. It may seem to come from one ear, or both — or from the mid­dle of the head. Al­though more com­mon after the age of 40, it af­fects all age groups, in­clud­ing chil­dren. It also af­fects both sexes, al­though women tend to hear ‘more com­plex sounds’ than men.

I’m not sure what caused my tin­ni­tus, which I’ve had on and off since my mid 50s (I’m now in my early 60s). Ex­po­sure to loud noise is one es­tab­lished risk fac­tor, but I was never one for ear-split­ting gigs. How­ever I do sing so­prano in the lo­cal choir: could those pierc­ing top notes be to blame? Emo­tional up­heaval is another known trig­ger. Maybe my tin­ni­tus is re­lated to the stress of the last year, when we sold the fam­ily home?

An es­ti­mated 6 mil­lion peo­ple in the UK have the con­di­tion, 1 per cent of whom are se­verely af­fected, ac­cord­ing to the Bri­tish Tin­ni­tus As­so­ci­a­tion. Many suf­fer­ers feel quite des­per­ate, judg­ing by the num­ber of on­line fo­rums on the topic. A range of on­line pills and po­tions help feed that des­per­a­tion, in­clud­ing home­o­pathic sprays and drops, herbal sup­ple­ments such as gingko, a bat­tery op­er­ated “tin­ni­tus mas­sager” and an at home tin­ni­tus ear laser treat­ment, cost­ing a hefty £300. All un­proven to help, ac­cord­ing to the BTA. “We would want more ev­i­dence that any of these work,” says chief ex­ec­u­tive David Stock­dale.

So far, I have stuck to self help ther­a­pies. I med­i­tate reg­u­larly to help me re­lax, espe­cially at night when tin­ni­tus keeps me awake. And to avoid my catas­trophist ten­den­cies, I also do DIY cognitive ther­apy, telling my­self that tin­ni­tus is rarely a sign of any­thing se­ri­ous. There is good ev­i­dence that CBT can help, as anx­ious thoughts about the sounds can make them seem louder and more in­va­sive.

More re­cently, I’ve down­loaded a free app which claims to help tin­ni­tus by gen­er­at­ing white noise (as well as pink noise and brown noise, the “colour” of noise be­ing re­lated to the spec­trum of sound fre­quen­cies). Dozens of sim­i­lar sound apps are avail­able and some peo­ple swear by them. As I write, I’m plugged into “pink noise”, which sounds like a water­fall and is oddly com­fort­ing. Tem­po­rar­ily my tin­ni­tus dis­ap­pears but once the ear­phones are out, my self-gen­er­ated noises come back with a vengeance.

In fact, my tin­ni­tus has wors­ened since I be­gan re­search­ing this ar­ti­cle. Which, ac­cord­ing to Mark Wil­liams, chief au­di­ol­o­gist at Har­ley Street’s Tin­ni­tus Clinic, only goes to show just how far the brain re­acts to the im­por­tance we at­tach to the con­di­tion.

Mr Wil­liams ex­plains that in most cases, tin­ni­tus de­vel­ops after hear­ing loss (which is why it is as­so­ci­ated with age, ex­po­sure to loud noise and ear in­fec­tion), espe­cially loss of the higher fre­quen­cies. “It’s a bit like a pi­ano where keys at the higher end of the scale don’t work any more,” he says. As the brain re­ceives fewer sig­nals from the ear, nerve cells in the au­di­tory sys­tem go into over­drive to com­pen­sate, cre­at­ing sounds that the brain “hears”.

How­ever, Wil­liams says it’s also vi­tal to look at stress and the pa­tient’s emo­tional re­sponse to their tin­ni­tus.

“Tin­ni­tus of­ten first ap­pears after some ‘neg­a­tive life event’ as­so­ci­ated with ‘ex­ci­ta­tory’ emo­tions such as anx­i­ety or anger — less so with de­pres­sion,” says Wil­liams.

“The au­di­tory sys­tem is highly re­ac­tive to our emo­tional state. It is like a prim­i­tive mech­a­nism which warns us of dan­ger.”

Peo­ple com­ing to his clinic, he says, are of­ten the most se­verely af­fected. “It’s a vi­cious cy­cle be­cause as suf­fer­ers be­come more anx­ious, the brain be­comes more in­ter­ested and the tin­ni­tus gets worse. There may be sleep prob­lems, work prob­lems, re­la­tion­ship prob­lems, even men­tal health is­sues.”

Wil­liams’ clinic is now of­fer­ing a new sound-based treat­ment called Levo ther­apy, de­signed for use dur­ing sleep. Us­ing an Ipod with per­son­alised ear­phones, the pa­tient hears sounds de­signed to match their own tin­ni­tus in pitch, vol­ume and band width. The the­ory is that once the brain be­comes used to the ex­ter­nal sound, it will fil­ter out the tin­ni­tus sig­nal in the same way it fil­ters out other noises — like a fridge hum­ming or a clock tick­ing.

Could Levo help me? I am not, at this mo­ment, des­tined to find out: mor­ti­fy­ingly, hav­ing looked in­side both ears, Wil­liams has de­tected a large mass of hard, im­pacted wax in the right one, which is prob­a­bly ex­ac­er­bat­ing my tin­ni­tus — and which I need to ur­gently have re­moved.

These in­di­vid­u­alised sound ther­a­pies aren’t avail­able on the NHS and they don’t come cheap — Levo costs in the re­gion of £4,000. Do they work? While the clinic says that ev­i­dence is “grow­ing all the time”, David Stock­dale stresses that fur­ther good qual­ity, in­de­pen­dent re­search is needed.

“It is quite dif­fi­cult to pro­duce sounds which ac­cu­rately match some­one’s tin­ni­tus be­cause of­ten the tin­ni­tus sounds fluc­tu­ate in pitch and sever­ity,” he says. “And the ef­fects haven’t been proven.”

Sound ther­apy or “en­rich­ment” is used to dis­tract from the tin­ni­tus — prod­ucts range from pil­lows with built in speak­ers to apps with sooth­ing noises such as waves lap­ping on a beach — while phar­ma­ceu­ti­cal so­lu­tions are also be­ing stud­ied, in par­tic­u­lar around drugs used in epilepsy.

What the ex­perts all agree on is that if we can stop ob­sess­ing about our tin­ni­tus, the brain will even­tu­ally stop notic­ing it too.

“There is no cure for tin­ni­tus as yet,” says Stock­dale. “But we can give peo­ple the tools to man­age it ef­fec­tively.”

Find out more at tin­ni­tus.org.uk How to deal with the con­di­tion

Tin­ni­tus is rarely an indi­ca­tion of a se­ri­ous dis­or­der, but it is wise to see your doc­tor if you think you might have it. Should some­thing treat­able be caus­ing it, you may be re­ferred to a spe­cial­ist.

Try not to worry: The noises may seem worse if you are anx­ious or stressed. When tin­ni­tus starts, par­tic­u­larly if it’s sud­den, you may nat­u­rally be fright­ened and your con­cen­tra­tion or your sleep may be dis­turbed. Find out more: You will prob­a­bly feel bet­ter when you find out more about the con­di­tion — that it’s very com­mon and you’re not alone. There is lots of in­for­ma­tion on the BTA web­site for you to ex­plore, writ­ten by ex­perts in the field. Stay busy: Many peo­ple say they no­tice tin­ni­tus less when they are do­ing some­thing. Keep­ing your mind oc­cu­pied helps (but don’t overdo things). If the noises seem louder at quiet times, par­tic­u­larly dur­ing the night, it may help to have sooth­ing mu­sic or some other en­vi­ron­men­tal or nat­u­ral sound qui­etly on in the back­ground. Re­lax: Prac­tis­ing re­lax­ation and tak­ing time out for your­self can also be a great help. See your GP: Tin­ni­tus is rarely an indi­ca­tion of a se­ri­ous dis­or­der, but it is wise to see your doc­tor if you think you might have it. Should some­thing treat­able be caus­ing it, you may be re­ferred to a spe­cial­ist.

PRO­VIDED TO CHINA DAILY

The pre­cise cause of tin­ni­tus re­mains a mys­tery.

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