The Noise in Your Head

Persistent ringing, buzzing or clicking can signal the presence of tinnitus.

by Rosie Williams

September 2016

Melanie West has heard ringing in her ears for most of her life. When she went to doctors, though, she was told there was nothing wrong.

“That was devastating as a young person. I figured out how to live with it on my own,” says West, 64, who lives in the Phoenix metro area.

Persistent ringing in the ears, called tinnitus (TIN-ni-tus or tin-NI-tus), suffered by an estimated 45 million Americans, is not an ear problem but a neurological issue. Described as “the perception of sound when no actual external noise is present,” it can cause sounds such as ringing, whooshing, clicking or buzzing.

There are two types. The rare objective tinnitus, audible to other people as well as the patient, usually originates in the circulatory or musculoskeletal system. However, 99% of cases involve subjective tinnitus, in which only the patient perceives the sounds.

Possible causes of tinnitus include occupational noise, medication, head or neck injury, blast trauma or tumors; even loud MRIs can trigger it. (Actor William Shatner has suffered with tinnitus since he was exposed to a special effects explosion.) Hypertension, diabetes, anxiety and depression are also common factors. “Tinnitus is not a disease. It is just a symptom of an underlying problem,” explains Michael J.A. Robb, MD, founder of the Robb Oto-Neuro Clinic in Phoenix.

Tinnitus is similar to the type of disruption in the brain that happens when someone feels a limb after it has been amputated. “If there is an abnormality in the hearing, then there are changes in the hearing nerve, which we call synchronous firing or hyper-excitable nerve signals,” Robb says. What’s more, “there are a lot of areas of the brain talking to each other, and there are areas trying to remap and reorganize because of a mild hearing loss at the level of the ear. So the problem may start at the level of the ear, but then it quickly becomes a centralized brain problem.”

“We have to decide what neuro-pathways are responsible for the problem,” says Jinsheng Zhang, PhD, of the Laboratory of Tinnitus and Auditory Neuroscience Research at the Wayne State University School of Medicine. “Then we might be able to reset and rebalance the processes to mitigate and eliminate the sound.”

Robb says dealing with tinnitus requires being proactive. “Have a hearing test done on an annual basis, and have ear plugs readily available,” he advises, either those sold over the counter or custom-made models for “a high fidelity experience that is quieter. We don’t want people to become reclusive and refrain from the passions they have in life.” Earplugs can protect against external sounds; however, they often exacerbate the tinnitus itself.

Although there is no proven cure, there are methods that help alleviate tinnitus. The American Tinnitus Association lists possible treatments that are often combined including noise masking, biofeedback, diet and exercise, sound pillows and hypnosis. Zhang’s team is currently researching a tinnitus-suppressing implant.

In 2008, Melanie West called the ATA and found a support group. “That helped tremendously, because I found there were other people that were going through the same kinds of problems, such as lack of sleep,” she says. “Sleep becomes very difficult, and it affects quality of life.”

The support group directed West to Robb. “We suspect that it was [childhood] ear infections and antibiotics that brought on the tinnitus. It took Dr. Robb almost a year to talk me into wearing hearing aids.”

The result was life-changing, says West, who now works for Robb and is executive director of the ATA. “I have had them on ever since. I have around 30% to 50% of the perceived volume. The process of wearing sound generators or hearing aids over a period of time can retrain the neurons of the brain not to listen to the tinnitus.

Having good health and healthy habits, however, can improve one’s quality of life and ability to manage their tinnitus.”

“There are many strategies to help tinnitus patients so that it doesn’t drive anxiety, depression or sleeplessness,” says Robb. “They can reclaim their lives.”

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