It is often reported there is little hope of a cure for tinnitus sufferers. But specialists at Beaumont Hospital are achieving considerable success with a retraining therapy. Nuala Macklin reports.
Tinnitus is characterised by a continuous buzzing, ringing or hissing sound in the head. According to Rory McConn Walsh, ears, nose and throat (ENT) consultant at Beaumont Hospital in Dublin, 7 per cent of the adult population have been to see their family doctor about tinnitus.
He says: "About 35 per cent of people experience tinnitus of some type, at some time in their life. Of adults who suffer from ear complaints, over one-third of those are due to tinnitus. Some 0.5 per cent experience tinnitus to such a severe extent that it interferes very seriously with their ability to lead a normal life."
When we hear, the sound travels up along the nerve of hearing which runs along the auditory canal, and is then matched with other sound patterns already stored in the hearing memory which is in the auditory cortex. Sometimes, a foreign or new sound pattern is introduced. Because it is unfamiliar, it can dominate and occupy the attention of the sufferer to a greater or lesser degree. Tinnitus is not a disease, rather the ability to hear sounds generated by the auditory system. The problem is the distress created - not the type of sound.
McConn Walsh says: "There is still a view that tinnitus is caused by ear damage and that it is untreatable and often patients are told to learn to live with it.
"This is incorrect as there is help available. It's important to be positive with patients and to give them hope. I tell them that in the majority of cases, tinnitus will improve although it may never go away completely.
"Tinnitus can be caused by wax, acute middle ear infection, chronic inner ear infection, glue ear, trauma [such as loud noise] or inner ear disease such as Meuniere's disease. It can be drug related or congenital. It could be an acoustic neuroma [small benign growth on the nerve of hearing], although this is very rare."
In some cases, where a patient feels they can't live with tinnitus, the ENT surgeon will refer them to a tinnitus retraining therapist.
McConn Walsh says: "I reserve a certain category of patient for TRT, ie those who are very seriously affected. In the past year, I've seen a couple of patients who were suicidal, such was the level of their distress."
The big breakthrough in tinnitus came in the late 1980s.
Pawel J Jastreboff, professor of otolaryngology at Emory University in Atlanta, developed a totally new treatment for tinnitus that results in significant improvement for more than a reported 80 per cent of patients.
Kay Walsh, hearing therapist at Beaumont Hospital, explained how tinnitus retraining therapy (TRT) uses a combination of low level, white noise and counselling to achieve the taming of tinnitus.
She says: "I would see a tinnitus sufferer after they've been investigated by the ENT surgeon. Sometimes, they will say that they're being woken up by it at night and can't get back to sleep.
"Their quality of life will have begun to suffer badly at that stage. They may have been worrying that they had a tumour and fearing the worst. Because the hearing system is connected to the nervous system, their distress will have triggered high anxiety and tension in the body.
"The first thing I try to get across is that their thinking needs to change, and that there's a lot which can be done if they are prepared to come to grips with it. I review their lifestyle with them, and sometimes discover that there may have been a bereavement or a divorce which will have caused severe distress. They will consequently have intensely negative associations with the tinnitus sound.
"For some, the prospect of living with this condition for the rest of their lives can lead to anxiety and a feeling of isolation and hopelessness. The more distressed they are about it, the louder the sound appears to become. Probably because they focus more intently upon it."
TRT teaches the patient how to relax and to develop a more positive attitude to the sound.
Walsh says: "It takes time and there's no quick fix. In time, they learn to associate the tinnitus sound as they would a sound they like.
"In addition to counselling, they are treated with a white noise generator that is worn for eight continuous hours each day. It contains all of the frequencies that we have and produces a sound that is slightly lower than, and effectively tames, the sound. Reports indicate that it is very successful.
"There is a strong emotional link between tinnitus and the level of the tinnitus sound. Relaxation has a fundamental role in its successful treatment.
"As part of the positive attitude training, I point out that tinnitus can be a help, or watershed in your life. It may be telling you that you need to change your lifestyle. I encourage the practice of yoga, breathing techniques and exercise. The golden rule is to avoid total silence. While children sometimes develop tinnitus, they don't seem to be as bothered by it.
"The key requirement is the commitment of the patient if they are to succeed in incorporating the sound as part of their life."