Do you ever, in the still of the night, get unexplained ringing or buzzing in the ears which not only annoys you but comes in the way of your falling asleep? If the answer is “yes” remember that you are not alone in your predicament. There are over 48 million people in India who suffer from what is called “tinnitus” (tin-NY-tus).
Tinnitus is a medical term used to describe the perception of noise either in one or both ears when there is no corresponding external sound. It is largely a mystery, a phantom sound heard in the absence of actual sound.
When patients approach us for advice our usual response is, “I know there is nothing you can do about it; you just have to learn to live with it”. It is frustrating to hear this remark time after time, because – contrary to general opinion – it’s not true. Although our knowledge and understanding of tinnitus still has a long way to go, in the last few years research has improved its grasp on tinnitus, and as such we are heading in a more positive direction for sufferers.
When we suffer from this malady, it is normal for us to want to know what the cause is. Like many other health issues the answer to this is never simple. There are many different trigger factors for tinnitus other than the “Noise Exposure” which is a modern-day scourge; age, ear disease, head and neck disorders, circulation issues, certain medications, and even stress can also act as triggers.
In today’s world we are constantly exposed to dangerous noise levels above the manageable 80 decibels. Whereas a relatively quiet city street noise is rated as 60 decibels, a pneumatic drill provides 90, a nightclub 100, a gig 110 and a jet taking off 120 db. There are many theories that explain tinnitus, one of the newest is that “our brain has lost its normal ability to block or tune out a negative sensory signal”. There is a linked network of brain structures that is involved in emotion, behaviour, and long-term memory acting as a gatekeeper to keep the tinnitus signal from reaching the auditory part of the brain. Put simply, damage to this system probably affects the perception of sensory signals in such a way that tinnitus can develop and carry on in a self-perpetuating loop. The various effects tinnitus has on people include: a) Poor concentration, b) Disrupted sleep patterns, c) Frustration and anger, d) Depression and suicidal tendency.
There are several treatments that may give you some relief: 1) “Masking”: It involves using external noise to cover the tinnitus noise in the ear. Tinnitus is usually more disturbing in quiet surroundings. Another constant sound at a low level, such as a ticking clock or radio static (white noise), may mask the tinnitus and make it less noticeable. 2) “Medicine or drug therapy”: Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success but have troublesome side-effects. Alprazolam may help reduce tinnitus symptoms, but it is habit-forming. 3) “Hearing Aids”: Many people with tinnitus also have a hearing loss. Wearing a hearing aid makes it easier for some people to hear the sounds they need to hear by making them louder. The better you hear other people talking or the music you like, the less you notice your tinnitus. 4) “Tinnitus maskers”: Some people sleep better when they listen to constant sound at a low volume on the radio or use bedside maskers. These are devices you can put by your bed instead of behind your ear. They can help you ignore your tinnitus and fall asleep. 5) “Relaxing”: Learning how to relax is very helpful if the noise in your ears frustrates you. Stress makes tinnitus seem worse. There’s little evidence that alternative medicine treatments work for tinnitus.
There are other drug treatments being tested in clinical trials. However, as tinnitus is so complex in its origin and system involvement it is unlikely that we will find a single drug cure. But there is a global research effort involving investigators from several Universities. They have made a major breakthrough that provides new insights into how tinnitus occurs. The results of the study, published in a recent edition of “eLife”, suggest the neural network responsible is more wide-ranging than previously thought. Having thus conceptualised a broader, more comprehensive neural network, the researchers hope to eventually test the model by “deactivating specific segments of the neural network”. By a process of elimination they would learn if shutting down one part of that network relieves tinnitus. Some specialized centres use “neuromodulation” with transcranial magnetic stimulation (TMS), a painless, noninvasive therapy that has been successful in reducing tinnitus symptoms.
With all this in mind if we ourselves suffer from tinnitus or are dealing with a tinnitus sufferer it is important not to say ‘nothing can be done’ because that’s just not true. Our negative talk makes the journey back for the tinnitus sufferer more difficult and longer. Instead, there is need to reassure tinnitus victims that help and advice is out there, and that in time we can even learn to live with the condition – if not to eliminate it altogether.
(Dr Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa)
