Understanding tinnitus

Imagine the sound of a jet engine permanently in your ear… that’s what some tinnitus sufferers have to put up with. Read on to discover why there is new hope for this distressing condition

Don’t Lose The Music, the current RNID (Royal National Institute for Deaf People) campaign, is designed to encourage people to protect their hearing while enjoying music and raise awareness of the dangers of regular exposure to loud noise – for this can lead to premature hearing loss and tinnitus.
Tinnitus is a term used to describe a noise that people can hear in one or both ears – usually a humming, whistling or a ‘pulse’ sound. While there are a number of high profile tinnitus sufferers in the music industry, including Sting, Eric Clapton and Cher, the condition is certainly not restricted to musicians and pop stars. In the region of four per cent of UK adults, that’s 2.4 million people, experience tinnitus to ‘severely or moderately annoying’ levels. For 242,000 people in the UK, the condition ‘severely affects’ their ability to lead a normal life, according to Deafness Research UK.

Sound of silence
Tinnitus, which means ringing in Latin, is experienced by everyone at some time. If you sit in ‘silence’ and tune into your internal sounds, you will gradually start to hear your pulse or a ringing or whistling sound. It also manifests itself momentarily if you’ve been exposed to loud noises, such as after attending a concert or listening to loud music.
So while it’s thought that everyone has experienced momentary tinnitus, some people are tuned into this internal perception of sound, interfering with their everyday activity. Sometimes people with tinnitus also experience depression or insomnia and these conditions feed upon each other making each condition more severe. Patients with severe tinnitus describe it as being as loud as a jet engine, ruining their lives. However, when testing loudness of tinnitus in severe cases, it is often only slightly louder than the quietest sound that can be detected, leading to the conclusion that tinnitus is a disorder of perception.
Normally, the brain deals automatically with standard internal bodily sounds such as the sound of our pulse, via auditory filters that prevent unwanted internal noise coming to our attention in the same way that they filter out unwanted external sounds. For example, if you buy a new fridge you will hear it buzzing at first, but after a few days the noise no longer comes to your attention. When these filters don’t work so well, tinnitus sounds can be perceived.
Tinnitus is therefore related to internal noise that is there all the time, but which you are attending to rather than ignoring. The more you pick up on it, the more your body works to bring it to your attention. It’s a vicious circle.

Fight or flight
Anyone can suffer from tinnitus, although some people are more susceptible. For example, people who are consistently exposed to loud noise, such as musicians; older people with hearing loss; and people who suffer from stress and anxiety all tend to be more prone. Musicians are a common group of sufferers because their job is to listen to sounds – all day, every day – and this makes them susceptible to hearing their own internal tinnitus sounds.
This is because loss of detection in the sensory structures of the ear causes the brain to strain to hear, prompting the internal amplifiers to be turned up in order for people to detect speech. This amplifies internal sounds.
Stress can also be a tinnitus trigger. When the fight or flight mechanism kicks in, the body is ready to react quickly to any perceived threat. This state stops the filtering out of even small sounds in order to allow you to attend quickly to really minor danger signals, meaning you suffer from tinnitus because of heightened perception.

Getting help
While everybody experiences momentary tinnitus to a greater or lesser extent at times during their lives, the time to seek help is when it starts to have a debilitating effect. For example, if you are having difficulty sleeping, or it affects your mood or relationships. The more you understand it, the easier it is to get on with your life. In many cases it is worsened by stress or anxiety and once general wellbeing is improved, symptoms may lessen. There is no simple test for tinnitus so you will need to describe to your GP what you are experiencing. They may then refer you to an audiologist, a tinnitus clinic or an Ear Nose and Throat (ENT) doctor.

What’s the treatment?
Common ways of treating tinnitus centre around ‘retraining’ the brain to filter out internal sounds. Cognitive Behavioural Therapy (CBT) is a talking therapy that encourages sufferers to see themselves or their condition in a different way. CBT is often offered over a minimum of four or five sessions and the process trains the brain to turn down the mechanisms which affect the filters and amplifiers.
I have also been doing some new research into using a type of hearing aid called a Receiver In The Canal (RITC). It works for people who suffer from tinnitus and have hearing loss by putting back the sound they’re missing without blocking up the ear. Results so far show RITC aids reduced tinnitus annoyance in 73 per cent of hearing impaired patients, with 30 per cent reporting complete resolution of their tinnitus.
For other sufferers, sound enrichment – playing background sounds such as a babbling brook from a CD at a low level – helps stop tinnitus sufferers from perceiving their own internal sound.
Treating stress can also be very effective in reducing tinnitus. Counselling, exercise and acupuncture can all be effective as can supplements such as St John’s wort, which is a natural mood enhancer and anti-depressant; B vitamins, which help boost production of the ‘happy’ brain chemical serotonin; and potassium, which helps soothe feelings of anxiety. Chamomile tea is believed to reduce stress by relaxing the smooth muscles lining the stomach and intestine.
For years tinnitus sufferers were told nothing could be done, but as understanding grows, more people are able to manage, overcome and – crucially – understand the condition,and find much needed relief.

Cut your risk
The main action you can take to minimise your risk of tinnitus is to avoid exposing yourself to high levels of noise. The RNID campaign states that continued exposure to noise at or above 85 decibels (the measurement for sound), over time can cause hearing loss: at nightclubs and pop concerts levels can exceed 110, while iPods can reach over 100.
A helpful rule of thumb is that, if the background noise is so loud that you can’t talk to someone two metres away without shouting, the noise level could be damaging. Trying to avoid stress and anxiety and maintaining good all-round health and wellbeing is also important in minimising risk.

The expert: Andy Phillips
Andy Phillips is head of audiology services for the Royal Berkshire NHS Foundation Trust in Reading. He has been involved in audiology for over 20 years and is currently working to understand the mechanism of tinnitus perception and to try to find effective treatments.

Compiled: Nicola Smith