You’re not crazy, it’s TINNITUS!
It can drive a person nuts, and doctors are usually at a loss to explain it or cure it, but the good news is that tinnitus, which is defined broadly as hearing noise that does not come from a source outside the body, is typically a benign condition that causes little or no critical damage. But considering that almost 40 million people currently suffer with it, it is an important health topic. There are cases reported in almost all age groups, and the list of famous “victims” is large and impressive and includes Howard Hughes, David Letterman, Beethoven, and Bono. In fact, many famous and not-so-famous musicians experience tinnitus (pronounced TIN-it-tus or tin-EYE-tus)—chronic exposure to loud noises is felt to be one of the major causes of this affliction.
Tinnitus is an all-encompassing diagnosis that has many different manifestations. Some people experience a constant hum, others perceive a rhythmic hissing comparable to the drone of cicadas, and still others hear a high-pitched trill, and so on. Occasionally this abnormal sound perception takes the form of recognizable tunes, a phenomenon called musical hallucinations. The symptoms may be intermittent or constant, barely noticeable or loud and distracting. Researchers work with patients to try and scientifically quantify what they are experiencing in the hopes that better understanding will lead to successful treatment strategies. They are able to quantify the precise sound reported by the tinnitus sufferer by identifying the external tone that when played, matches and therefore masks the inwardly experienced sound! It is a laborious effort requiring extensive trial and error attempts, and unfortunately no concrete advances or correlations have yet been achieved.
The most important division of tinnitus is that of objective vs. subjective. Objective tinnitus is when a physician can also discern the sound that the patient complains of! While relatively rare, objective tinnitus is the type more likely to be associated with a physical problem or irregularity, and it is also the type most likely to be amenable to medical intervention. Sometimes muscular dysfunction is the source, such as when deterioration of the tiny middle ear muscle, the stapedius, is weakened by an illness such as A.L.S. (Lou Gehrig disease). The weakened stapedius flutters rather than maintaining even tension, and these vibrations can be heard by a nearby person listening carefully at the patient’s ear lobe. Severing the stapedius reliably cures this tinnitus. Similarly, some neuromuscular diseases like multiple sclerosis cause repetitive quivering of the soft palate muscles and this internal loud whirring can be heard by a carefully listening examiner. Botulism toxin, more commonly known as botox, injected directly into the spasming muscle will stop the tinnitus. And irregular blood flow to or in the cranium caused by partially blocked or tortuous arteries, may create a characteristic type of tinnitus that physicians can identify via stethoscope. Diagnosing this process may lead to vascular surgery that mitigates the tinnitus symptoms. Determining if one’s own case of tinnitus is objective or not is therefore an important first step in work-up of this troublesome malady.
Subjective tinnitus differs from objective tinnitus in that ONLY the afflicted individual senses the sound. By far, exposure to loud noise seems to be the most common cause. The noises can be sudden, such as a gunshot, or prolonged such as a musical concert. While there seems to be some correlation between the decibel level and the duration of exposure to the likelihood of developing tinnitus, there are cases where a single, brief sound blast yielded lifelong suffering. Thus Ear, Nose & Throat specialists routinely advise wearing hearing protection devices when significant noise exposure is anticipated. Note that tinnitus is an occupational hazard of carpenters, factory workers, tree workers, soldiers, musicians, and lawn maintenance personnel. In these professions ear plugs or noise blocking headphones should be considered essential gear!
Medication is another commonly identified provoker of subjective tinnitus. While most culprits are prescription concoctions and include antibiotics, chemotherapy agents, and diuretics; over-the–counter medicines such as aspirin and ibuprofen are also to be blamed. The only chance of curing or reducing drug-induced ear ringing is to stop the offending medication, so it is important to report this symptom to your physician so this possibility may be fully explored. There are other causes of tinnitus, as well, such as thyroid imbalance, vitamin B12 deficiency, syphilis, small tumors, and Lyme disease. These require medical treatment; doctor evaluation of tinnitus includes testing for these issues.
While the sound-sources in cases of objective tinnitus are well understood, there are several different theories as to the cause of subjective tinnitus. Most scientists believe that hearing loss is the root of the problem; when the auditory/sound receiving part of the brain does NOT get regular stimulation from the hearing organ in the ear (the cochlea), these under-stimulated brain cells begin to fire spontaneously on their own, thus causing a brain perception of sound that has no external source. Hearing evaluation and correction is therefore felt to be a critical component in the prevention of new tinnitus cases, and may help improve those in whom it has already developed.
So, ear protection, physician examination, judicious use of medication, and hearing evaluation and correction are the key elements to tinnitus diagnosis and treatment. Other moieties, such as the herbal supplements, melatonin, and lipoflavanoids, as well as low doses of the sedative valium, are occasionally but not universally helpful. Ultimately, for many sufferers the most important aspect of treatment is to develop and nurture the ability to ignore it. Those that fail to achieve this experience increased risks of anxiety and depression. Yes, the good news about tinnitus is that you can live with it forever. The bad news is that you might have to! So turn down the iPods, folks, and put on ear gear when you mow the grass! Your otic and mental health may depend on it.