Health Alert

Tin­ni­tus cre­ates con­tin­ual noise, even when there is noth­ing to hear. Know all about its causes and pos­si­ble so­lu­tions.

Health & Nutrition - - CONTENTS -

Know all about tin­ni­tus

Wil­liam Leighton heard hun­dreds, if not thou­sands, of fire alarms and sirens in his 27 years as a fire­fighter. But they didn’t bother the semi-re­tired lieu­tenant nearly so much as the sound he hears now when it’s dead quiet. “It’s a metal­lic ringing,” says Leighton, 59. “It’s like the noise you hear when you stand un­der high­t­en­sion wires, but this is in my head.”

Leighton has tin­ni­tus: The per­cep­tion of sound with­out an ex­ter­nal source. We’ve all had ringing in our ears at one time or an­other, but usu­ally tem­po­rar­ily af­ter, say, a loud con­cert. But for tin­ni­tus (pro­nounced tin-NIGHT-us or TIN-it-us) suf­fer­ers like Leighton, the sound of­ten seems to start for no rea­son – and then won’t go away. He had been re­tired from ac­tive fire­fight­ing for over a decade when his tin­ni­tus started about a year-and-ahalf ago. Ringing is com­mon, but peo­ple also ex­pe­ri­ence re­lent­less buzzing, crick­et­like noises, hiss­ing, or hum­ming. Men ex­pe­ri­ence it more than women, and like so many other con­di­tions, it be­comes more com­mon with age. By some ac­counts, up to 90% of all tin­ni­tus pa­tients have some level of nois­ere­lated hear­ing loss. Tin­ni­tus is a prob­lem for rock ‘n’ roll mu­si­cians, per­form­ers who have been ex­posed to loud noises, hunters, mil­i­tary vet­er­ans, and fire­fight­ers like Leighton who didn’t wear the ear pro­tec­tion now re­quired by fed­eral safety reg­u­la­tions. Beethoven is the most fa­mous tin­ni­tus suf­ferer, al­though his case was prob­a­bly not re­lated to dam­age from loud noises. He com­plained about a con­tin­ual ‘whis­tle and buzz’ in his ears as his hear­ing wors­ened in his 30s be­fore he went com­pletely deaf at 44. Tin­ni­tus is strongly as­so­ci­ated with hear­ing loss, but it’s un­clear why. One hy­poth­e­sis is that brain cells in the re­gions of the brain that or­di­nar­ily process sound be­come dis­in­hib­ited and spon­ta­neously ac­tive when they aren’t re­ceiv­ing enough in­put from the ear and its au­di­tory nerves. For that rea­son, tin­ni­tus has been com­pared to the phan­tom limb pain ex­pe­ri­enced by am­putees. Doc­tors don’t have any sure­fire sur­gi­cal or phar­ma­ceu­ti­cal treat­ments for many cases of tin­ni­tus, so of­ten there’s a great deal of trial and er­ror – with no guar­an­tee of suc­cess.

We’ve all had ringing in our ears at one time or an­other, but usu­ally tem­po­rar­ily af­ter, say, a loud con­cert. But for tin­ni­tus (pro­nounced tinNIGHT-us or TINit-us) suf­fer­ers, the sound of­ten seems to start for no rea­son – and then won’t go away.

The phys­i­cal ex­am­i­na­tion fo­cuses on the head, neck, and, of course, the ears. A thor­ough hear­ing test is im­por­tant be­cause of the as­so­ci­a­tion be­tween hear­ing loss and tin­ni­tus.

Leighton, a life­time fire­fighter, said his doc­tor told him that he was go­ing to have to as­sume a new role when it comes to his tin­ni­tus: “He ex­plained to me that you need to be your own de­tec­tive.”

Causes

Tin­ni­tus is of­ten di­vided into ob­jec­tive and sub­jec­tive cases. The cochlea (pro­nounced COKE-lee-ah) is the coiled struc­ture in­side the ear that con­tains the hair cells that vi­brate and trans­late sound vi­bra­tions into nerve sig­nals. In ob­jec­tive tin­ni­tus, the cochlea is be­ing stim­u­lated, but from within the body, not by sound waves ar­riv­ing from else­where. The classic ex­am­ple is a pul­satile tin­ni­tus caused by tur­bu­lent blood flow through the blood ves­sels near the cochlea. Some­times the hair cells spon­ta­neously vi­brate on their own, cre­at­ing noise that can be heard with spe­cial in­stru­ments. Ob­jec­tive tin­ni­tus can also be caused by twitches in the mus­cles near or within the ear that cause a click­ing sound. Sub­jec­tive tin­ni­tus is an un­for­tu­nate term be­cause it sug­gests that the prob­lem is a mat­ter of opin­ion or just in the per­son’s mind. Doc­tors have used it to high­light the lack of any ob­jec­tive sound stim­u­lus. The vast ma­jor­ity of peo­ple with tin­ni­tus have sub­jec­tive tin­ni­tus. Some­times it’s also called tin­ni­tus orig­i­nat­ing from the au­di­tory sys­tem – with the au­di­tory sys­tem com­pris­ing the cochlea, the nerves that pro­ject from it, the brain­stem, and the au­di­tory cen­tres of the brain. It’s not an el­e­gant phrase, but it does paint a more ac­cu­rate pic­ture. There are many causes of so-called sub­jec­tive tin­ni­tus (see chart). The uni­fy­ing theme is some kind of dam­age to the ear, the au­di­tory cen­tres of the brain, or both.

Di­ag­no­sis

Tin­ni­tus is re­ally a symp­tom, so as you might ex­pect, treat­ment choices hinge on the un­der­ly­ing cause. For that rea­son, ex­perts say it’s es­pe­cially im­por­tant

Up to 90% of all tin­ni­tus pa­tients have some level of noise-re­lated hear­ing loss. Tin­ni­tus is a prob­lem for rock ‘n’ roll mu­si­cians, per­form­ers who have been ex­posed to loud noises, hunters, mil­i­tary vet­er­ans and fire­fight­ers.

for doc­tors to ask pa­tients a lot of ques­tions. Does the sound seem to come from one ear or both? Is it high- or low-pitched? (Low-pitched is of­ten seen in pa­tients with Ménière’s dis­eases.) Have you been ex­posed to loud noises or taken med­i­ca­tions that might have been oto­toxic (harm­ful to the ears)? Some physi­cians might ask pa­tients about their so­cial lives and men­tal health. Tin­ni­tus is of­ten worse for peo­ple who are iso­lated, de­pressed, anx­ious, not able to move about eas­ily, or in pain from other con­di­tions. The phys­i­cal ex­am­i­na­tion fo­cuses on the head, neck, and, of course, the ears. A thor­ough hear­ing test is im­por­tant be­cause of the as­so­ci­a­tion be­tween hear­ing loss and tin­ni­tus. Fi­nally, de­pend­ing on the re­sults from all of the above, an MRI or some other imag­ing test may be needed.

Treat­ments

The kinks and bulges in blood ves­sels that cause tur­bu­lent blood flow can be re­paired sur­gi­cally. If the prob­lem is twitchy mus­cles, some re­search had shown that in­jec­tions of bo­tulinum toxin (Botox), the mus­cle re­lax­ant, will help. Op­er­a­tions to cut part of the au­di­tory nerve, or take pres­sure off of it, have been tried, and a few suc­cess sto­ries have been re­ported. But this ap­proach is con­tro­ver­sial and should be avoided. Many med­i­ca­tions have been stud­ied, but none have emerged as re­li­ably ef­fec­tive. Some ex­perts say clin­i­cal tri­als have been dif­fi­cult to in­ter­pret be­cause the placebo ef­fect is stronger than usual in tin­ni­tus tri­als. Li­do­caine, fa­mil­iar as a top­i­cal pain re­liever, does seem to be ef­fec­tive against low-pitched tin­ni­tus. But the treat­ment in­volves in­tra­venous ad­min­is­tra­tion of the drug, so it’s not widely used. Side ef­fects are a prob­lem, too. Un­for­tu­nately, oral med­i­ca­tions sim­i­lar to li­do­caine haven’t worked. When peo­ple are de­pressed, they tend to fo­cus more on prob­lems like tin­ni­tus, and an­tide­pres­sants some­times help by re­liev­ing the un­der­ly­ing

de­pres­sion and thus the tin­ni­tus. But there’s also a the­ory that tin­ni­tus is caused by im­bal­ances of some of the same neu­ro­trans­mit­ters (sero­tonin and gam­maaminobu­tyric acid, or GABA) that cause de­pres­sion. If that’s true, then anti-de­pres­sants may be in­flu­enc­ing brain chem­istry caus­ing tin­ni­tus, not sim­ply the de­pres­sion that makes peo­ple more aware of the prob­lem.

Other ap­proaches

Some ther­a­pies aim to get peo­ple to ig­nore – or at least be less an­noyed by – tin­ni­tus in­stead of try­ing to at­tack the cause. Mask­ing de­vices, which look like hear­ing aids, pro­duce a low-level sound. By tun­ing into the mask­ing device, the ear and the brain seem to for­get about tin­ni­tus – at least tem­po­rar­ily. But the de­vices don’t work for ev­ery­body, and for some, they make it worse. Tin­ni­tus re­train­ing pro­grammes com­bine coun­selling with low-level noise gen­er­a­tors sim­i­lar in prin­ci­ple to the mask­ing de­vices. Pro­po­nents claim a 75% suc­cess rate, but the pro­grammes can take a long time (1½ years by some ac­counts) to com­plete. Crit­ics say the favourable stud­ies are se­ri­ously flawed. When­ever con­ven­tional medicine lacks an­swers, par­tic­u­larly to a trou­bling chronic con­di­tion, peo­ple turn to al­ter­na­tive medicine. Tin­ni­tus is no ex­cep­tion. Many of the usual sus­pects are in­volved: Acupunc­ture, ginkgo biloba, var­i­ous vi­ta­mins and min­er­als. They don’t hold up well un­der the scru­tiny of stud­ies, but doc­tors tend to be tol­er­ant of – or even en­cour­age – ex­per­i­men­ta­tion as long as no harm is done.

Hear­ing pro­tec­tion is im­por­tant

Leighton thought his de­tec­tive work was pay­ing off. When he restarted his B vi­ta­mins, the tin­ni­tus went away: “I called my son Scott and told him I think I have got the an­swer.” A few days later, though, the metal­lic ringing came back. He copes by stay­ing ac­tive (the noise goes away when he goes kayak­ing) and keep­ing the tele­vi­sion on in the evening when there isn’t much noise or ac­tiv­ity. Leighton knows that his tin­ni­tus is re­lated to hear­ing loss from the high-deci­bel sirens and alarms that bom­barded his ears on the job. Now he does what he can to pro­tect them from loud noises. Tin­ni­tus does tend to get worse with fur­ther hear­ing loss. Leighton looks for­ward to the oc­ca­sional ‘quiet days’ and dreads the noisy ones: “At times, it’s so bad you are at your wit’s end. You can’t con­cen­trate. It’s like hear­ing some an­noy­ing sound, but it’s in your head and you can’t get rid of it.”

Tin­ni­tus re­train­ing pro­grammes com­bine coun­selling with low-level noise gen­er­a­tors sim­i­lar in prin­ci­ple to the mask­ing de­vices.

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