The latest buzz on tinnitus

Tinnitus is often described as “ringing in the ears” (the term is derived from tinnire, Latin for “to ring”). It really is a phantom noise nobody else hears and can take many different forms — ringing, clanging, whistling, humming, hissing, machine-like noise, and even roaring.

It is estimated that roughly one in three people, ages 55 and over, suffer from tinnitus. For many, tinnitus is just a nuisance. But others find it debilitating. For some people, it never goes away; for others it is temporary or intermittent. Some people, by a great effort, learn to ignore or tolerate the noise, but for others, it may result in depression and an inability to work, sleep, or function.

Causes

Tinnitus arises from a malfunction in the ear, the auditory nerve (which transmits sound signals), or the brain. Some researchers think that the noise comes from the brain itself — that the brain is ringing, not the ears. It is almost always accompanied by hearing loss, which is usually age-related and/or caused by repeated exposure to loud noises.

It may also be triggered or worsened by other conditions, including Meniere’s disease (an inner ear disorder), ear wax buildup, infection, hypertension, diabetes, or a head or neck injury. Aspirin, certain beta-blockers (hypertension drugs), antidepressants, and antibiotics can bring it on or make it worse. To some extent, it is an occupational hazard. For instance, working around heavy machinery or in the construction industry increases the risk.

Treatments

If you have tinnitus, you will probably be referred to an ear, nose, and throat specialist (an otolaryngologist) and audiologist, who will test your hearing. Sometimes the ringing can be silenced by treating an underlying condition — for example, by curing an ear infection, removing ear wax, or switching medications.

Tinnitus, however, has many causes, and no single treatment will work for everyone. But a review by the Cochrane Collaboration (an international group that reviews and analyzes medical research) suggests that cognitive behavioral therapy (CBT) can help improve the quality of life for many who have the condition. CBT is a form of psychotherapy that focuses on making changes in the patterns of thinking in order to alter responses to troubling thoughts, feelings, or behavior.

The Cochrane review, published in 2007, analyzed six small but well-designed randomized controlled trials that tested the value of CBT as a treatment for tinnitus in 285 participants. The Cochrane reviewers concluded that CBT improved the patients’ quality of life and reduced the overall severity of their tinnitus, compared to a similar group that did not receive CBT. But the therapy didn’t make the sounds seem less loud, and it had little effect on tinnitus-related depression.

The authors caution that none of the studies in their review had sufficient follow-up to allow any conclusions about CBT’s long-term efficacy for tinnitus. Still, the findings offer hope for the many who struggle with this interior cacophony.

Probably the most common treatment is to mask the internal noise with external noise. Oftentimes people are only bothered by tinnitus when it’s quiet — at bedtime, for instance. They might find relief from the noise of a fan or an air conditioner, or tuning the radio between stations and turning up the volume. Headphones can also help mask tinnitus with soothing sounds, music, or white noise.

 Maskers can be built into hearing aids, though people with tinnitus and hearing loss often find that their tinnitus improves with a hearing aid alone. Simple modifications to your hearing aid can help in the same way that maskers do. For instance, if you have a high-pitched ringing in your ears, your audiologists could boost lower frequencies. Tinnitus Retraining Therapy (TRT) combines ear devices that emit low-volume sounds with active counseling about tinnitus. The aim is to retrain the brain to turn tinnitus into background noise. TRT is expensive and can take up to two years to produce a somewhat satisfactory result.

In small clinical trials, patients with tinnitus have also found relief with tricyclics, an older class of antidepressants. Less commonly, doctors prescribe anti-seizure drugs, sleeping pills, muscle relaxants, or benzodiazepenes like diazepam (Valium). Experts, however, advise patients and their physicians to consider the possible side effects of these medications in addition to their potential benefit.

Simple Ways Of Management

Most patients, though, simply have to find some way to live with it — to make the sounds less noticeable. Here are some simple, practical ways to manage tinnitus. Some may work better than others.

• To prevent tinnitus or keep it from getting worse, avoid exposure to loud noises. Wear hearing protection (earplugs or ear muffs) at sporting events and loud concerts and while blow-drying your hair, mowing the lawn, traveling by air, and using power tools. If you use headphones, don’t blast the volume or wear them for long periods of time.

• Some people find they are helped by reducing sodium, giving up caffeine or alcohol, or exercising regularly. Quitting smoking may also help.

• There are no medications approved specifically for tinnitus but anti-anxiety drugs, antidepressants, and other medications sometimes help combat the emotional stress.

•   A hearing aid may help increase the sounds you want to hear and drown out those you don’t. Some hearing aids also have built-in sound generators.

• Mask the noise by increasing background sounds — turn on a radio, television, or fan. For tinnitus that keeps you awake, use a bedside audio unit or sound machine.

• In-ear masking devices are available which produce “white noise” that can reduce or eliminate the perception of tinnitus. Even after the device is removed, the effect may last hours or even a few days.

By the way: Ginkgo biloba, B vitamins, zinc, magnesium, magnets, hypnosis, and acupuncture are just some of the many remedies that have been suggested for tinnitus. None have been shown to be effective.

New Therapy

Early studies on a new therapy called transcranial magnetic stimulation (TMS), which sends an electric current into the brain, are encouraging and clinical trials are underway. Some tinnitus patients have benefited from electrical cortical stimulation (ECS), which makes use of pacemaker-like implants to deliver electrical impulses. Electrical neurostimulation is noninvasive and also has a few side effects. But more research is needed, and currently TMS and ECS aren’t available outside clinical trials.

If you have tinnitus, it’s important to talk to your doctor. As scientists explore new forms of treatment, your best bet is to try different approaches.

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For more information, log on to the American Tinnitus Association website at www.ata.org.