by Barbara Tabachnick Sanders, ATA Director of Education; Editor, Tinnitus Today Reprinted from Tinnitus Today, Sept. 2004, with permission from the American Tinnitus Association, P.O. Box 5, Portland, OR 97207, 800-634-8978, www.ata.org.
“What is tinnitus?” We answer that question all day long. And while it might seem like a simple one to tackle, our approach to answering it varies depending on a number of factors: how long the callers or letter writers have had tinnitus, what the likely cause of it was, how their doctors talked to them about it, even how much sleep they’ve had. (No one copes well who hasn’t slept well.)
What is the same for all who ask the question is that they need a really good answer. Here are our most common responses to your most common questions.
• A sound no one else hears
In almost every case, tinnitus is a totally subjective noise – one that only the person who has it can hear. In rare cases, when the tinnitus is caused by an abnormality in a vein or artery and is in rhythm with the heartbeat, the sound may be audible through a stethoscope placed on the neck or directly in the ear canal.
• A symptom
In and of itself, tinnitus is not a disease. It is like pain – a signal that something has gone wrong somewhere.
• A worry
Tinnitus can be very upsetting. In a way, that’s not surprising. Richard Salvi’s and Alan Lockwood’s brain imaging research in the late 1990s showed that in some subjects, tinnitus involves the limbic system – the brain’s emotional center. Our brains seem wired to interpret constant loud noise – chronic pain and vertigo too – as something to be upset about.
Since tinnitus is a symptom of something that has gone wrong, that something might need medical attention, such as an acoustic neuroma (a tumor on the auditory nerve). In those cases, the tinnitus is doing a job – that is, alerting the patient to a bigger problem. In most cases, though, the tinnitus trips that warning switch in error, and the person with tinnitus feels alarmed and anxious because of it.
An estimated 50 million Americans experience tinnitus. For most, it’s just a brief tone (called transient tinnitus) heard in the quiet of night right before bed, or perhaps heard for an hour after going to a concert without earplugs. For 12 million of those 50 million, the tinnitus is persistent and very often troubling.
• Better some days than other days
Even rough-and-tumble tinnitus can take a holiday now and then, to the relief and sometimes – believe it or not – to the dismay of those who get that once-in-while-good day. A few people think of the reprieve they get as a “tease” and are upset that the quiet doesn’t stay around. It sometimes helps if they remember that there are those who’d do almost anything for an occasional day or single moment of quiet.
• Continuous; Variable
For some people, tinnitus is a steady, unchanging noise every waking minute. For others, it is a sound that comes and goes, or a tone that changes pitch through the day. Some have tinnitus that’s “on” for three days and “off” for one day. The majority of people who contact us have constant, unvarying tinnitus.
At least it seems loud. For the majority (83.8%) of 1,422 patients at the Oregon Hearing Research Center, the tinnitus volume was 0-9 decibels above their hearing threshold. That’s very quiet. But if that “quiet” tinnitus is very high pitched, it might not be masked by lower-pitched sounds in the environment. That could make the tinnitus seem louder than the few decibels it really is.
This is the kind we hear about the most, which makes sense to us. People who aren’t terribly troubled by their tinnitus generally don’t call us for help. Constant, intrusive sound can disrupt sleep, family relationships, and one’s ability to work and concentrate. When tinnitus is at this level, medical and audiological care are probably in order. It is also imperative that people with tinnitus find a way to get restful sleep. It’s an important key in gaining control of the condition.
• Often louder after waking up
This is a very common experience, although researchers have not yet gotten to the root of it. We know that the brain is very active in a sleep state, not still at all. We also know that the brain experiences electrical and chemical changes during sleep that it doesn’t experience while awake. If you experience the phenomenon of temporarily elevated tinnitus following sleep, you are in good (although slightly perturbed) company.
• Misunderstood, dismissed
“Go home and learn to live with it.” I cringe at these words. And we know they’re being said with baffling regularity. Our battle cry to health professionals is this: NEVER tell patients to go home and learn to live with it – unless you tell them how to live with it. We now offer an educational course for health professionals that we hope will help turn that tide.
Men get it. Women get it. Even children get it. Education levels or income levels are not predictors. Excessive noise exposure is the most common tinnitus cause, but it doesn’t matter if the noise is from rock concerts, farm machinery, or artillery fire. Noise is noise; ears are ears. Those whose ears are susceptible to excessive noise are those most likely to be hurt by it.
ATA dedicates half a million dollars every year to tinnitus research. We’re able to do this for two reasons: 1) ATA members donate generously to our research program, and 2) brilliant and energetic scientists all over the world are dedicating their professional lives to the study of tinnitus. The number of tinnitus scientists increases every year, and the quality of research projects climbs proportionately. We are thrilled about this.
Tinnitus is caused by many things: ear-damaging drugs, jaw misalignment, Méniére’s disease, head injury, in rare cases a tumor on the auditory nerve. The most common culprit is excessive noise exposure. But regardless of its cause, tinnitus can be relieved – sometimes on the spot – by sound therapy. Here is the reason: A steady, low-level, broadband sound, like that of rainfall, can reduce the contrast between the patient’s internal noise and the sometimes too-quiet external world. Sound therapies, commonly called masking and tinnitus retraining therapy, can make tinnitus less noticeable and, for a lot of people, less troubling.
Other treatments, including medications, biofeedback, relaxation techniques, and a particular type of counseling called cognitive behavioral therapy, are helpful too.
Do you still have a question? If our excellent Web site (www.ata.org) doesn’t cover the material you need, if Tinnitus Today hasn’t addressed your topic, or if our brochures are too general to your specific situation, don’t fret. Just call or write us. It’s fine. We are, after all, in the answer business.
For more information regarding Tinnitus, please contact the American Tinnitus Association