Tinnitus--when the ringing won\'t quit

by Rick Alan

Anyone who has watched cartoons knows the sight gag whereby an extremely loud noise causes one of the character's ears to turn into a ringing bell. In real life, though, it's not funny. Tinnitus--chronic ringing of the ears--affects more than 40 million Americans. For some it is just a nuisance; for others it is a stressful, life-altering condition.

Chronic ringing of the ears, known as tinnitus (tin`-i -tis), presents as a continuous ringing, hissing, roaring, clicking, or whining sound in one or both ears. It is best defined as "the perception of sound when no external sound is present." The sound can be intermittent or constant, with single or multiple tones; it can be subtle or at an ear-shattering level. It can strike people of all ages and, for most, it is difficult to treat.

Approximately 17% of the general population (about 40-50 million Americans) suffer from the condition, though it's much more prevalent among the elderly (approximately 33%). For most, the condition is simply annoying. However, as Dr. David Vernick, assistant professor of otolaryngology at Harvard Medical School notes, "For a small percentage of sufferers, perhaps 5%, tinnitus can be so severe that they can hardly hear anything else."

Though not a form of hearing loss per se (although most people who have severe tinnitus have a hearing loss problem as well), tinnitus is usually caused by many of the same things that cause hearing loss. These include:

• Obstruction of the outer ear from wax buildup, swelling, or foreign matter that puts pressure on the eardrum.
• Mechanical defects in the middle ear caused by injury, inflammation, infection or growth.
• Problems with the inner ear related to nerve damage or dysfunction. Such damage or dysfunction can be caused by exposure to loud noise (especially over an extended period of time), concussion and other head injuries, and the side effects of various medications, including aspirin.
• Tinnitus also may be a side effect of certain medical conditions. These include hardening of the arteries to the ear, some allergies, high blood pressure, diabetes and thyroid problems.

These four causes of tinnitus, which are by far the most common causes, are what is often referred to as "subjective tinnitus," whereby the ringing in the ear is not caused by an outside source but rather by the auditory system itself. In addition, a small number of people suffer from "objective tinnitus," whereby the sufferer hears a sound actually caused by another part of the body which may be audible to others, generally via a stethoscope. Such sounds can, for example, be caused by blood vessels, which produce a throbbing noise, or a problem with the jaw, causing a clicking sound.

As with hearing loss, the specific treatment for tinnitus will depend on its underlying cause. If the problem relates to an obstruction of the outer ear, removal of the obstruction (wax or foreign matter) or treatment of the obstruction (swelling) usually will solve the problem. When an infection, inflammation or growth in the middle ear is the cause, treatment or removal often can solve the problem. If the cause is an underlying medical condition, treatment of that condition can alleviate the tinnitus. If medication is the cause, eliminating, changing or lessening the amount can solve the problem, but only if doing so will not exacerbate the condition for which the medication is being taken.

Unfortunately, in many cases, especially when the problem results from inner ear nerve damage or dysfunction related to hearing loss, there is no "cure" for tinnitus. In these cases, "masking" of the tinnitus "noise" with other sounds can help. In some instances, especially in cases of mild tinnitus, background noise (such as music, CDs and tapes, or small machines that generate "white noise") may be sufficient to mask tinnitus. Dr. Vernick notes that "even the static between stations on your radio," may be a good masking device. In more severe cases, a small device worn like a hearing aid inside the ear and which generates a masking noise will help the problem. And for those who suffer from both hearing loss and tinnitus, either a hearing aid alone or a single device that combines hearing aid and tinnitus masking will help the problem.

In addition, removing a number of factors that don't necessarily cause but often exacerbate tinnitus can be helpful. Your doctor may recommend that you eliminate or reduce stress through stress management courses and biofeedback. Or she may recommend that you restrict or exclude alcohol, especially red wine and grain-based liquors, as well as caffeinated foods and beverages.

In general, the steps you should take to help protect against tinnitus are the same steps you should take to prevent against hearing loss.

Protect yourself against loud noises. Keep your TV, radio and stereo at low to moderate levels, especially when you're listening through headphones. Wear ear plugs or protective ear covering whenever you may be subjected to noise from construction work, heavy machinery, hunting or target shooting, loud stereo equipment, or playing in a band, to name just a few.

Prevent ear wax build up, but only by using eardrops or ear wash. Never try to remove wax with cotton swabs.

Have regular hearing check-ups annually. However, if you suffer from persistent tinnitus, or you experience any signs of hearing loss, consult with a hearing professional before your yearly check-up.

You should be concerned about hearing loss if you have any of the following symptoms:

• Constantly asking others to repeat themselves
• Difficulty hearing conversations, especially in crowded areas with a lot of background noise
• The need to play your TV, radio or stereo at high volume
• Difficulty hearing at movies, the theater, speeches or religious sermons