SOMETIMES I hear birds chirping away outside, but it's usually at night time. Now and again, I register the "hum" the fridge makes, but I'm not always in the kitchen. After a long or stressful day, I might keep hearing what sounds like a very loud telephone dialling tone, even if my last phone call was made hours before, writes JOHN CRADDEN
Welcome to the world of tinnitus sufferers. Tinnitus is a condition where people experience sounds in their ears or head that have no external source. It can be hard to describe the sounds, but most sufferers would use words like ringing, humming, hissing, roaring, banging or clicking. The sounds can be heard in one or both ears or somewhere in the centre of your head.
As it happens, many of us will have experienced a ringing in our ears at some time or another – perhaps after a rock concert or from sitting too near a loudspeaker in a pub or club. The difference for people with tinnitus is that these sounds are heard almost continuously.
It’s also very common. As many as one in 10 of the population is estimated to have tinnitus to some degree, but only 1 to 2 per cent of those will find their tinnitus debilitating.
It’s not always clear what causes tinnitus. It is most commonly linked to constant or sudden exposure to loud noises or music, but also to ear infections, certain drugs or medications, and head injuries. For many sufferers, there seems to be no traceable reason for the onset.
My own tinnitus started when I was 14 during a football tackle, when someone’s foot ended up kicking my head rather than the ball, and these days only becomes temporarily noticeable if I accidentally bang my head hard on something.
There are many theories that try to explain the actual physiological mechanism of tinnitus. But it is generally agreed that it arises because the parts of the brain that deal with how we hear sound are registering some anomalous activity within the auditory system in our middle ears, and “misinterpreting” it as sound.
While no effective cure for it exists, the majority of tinnitus conditions are benign and pose no physical danger, and most tinnitus sufferers, myself included, simply get used to it and learn to live with it independently.
But the emotional response for some people with bad tinnitus is often panic and desperation for the noise to stop that can lead to depressive or even suicidal feelings.
A few months ago, my tinnitus became much worse after banging my head hard against an invisible glass partition in Dublin Zoo. Normally it lingers for about a month before fading away, but two months after this incident, it was still there. I found myself becoming more anxious about it, and so decided to look for some help or information. It’s not difficult to find information and research about the condition given how common it is, but very little of it comes across as conclusive or definitive.
“While there is a lot of research on tinnitus, there will be no single cure as there is no single cause and it affects different people in different ways,” says Dr Veronica Kennedy, a consultant audio-vestibular physician at the Royal National Throat, Nose and Ear Hospital in London.
Kennedy, a Cork native who studied medicine at Trinity College before moving to Britain in 1991, has been seeing people with tinnitus for 14 years.
Her approach to dealing with patients who seek help for their tinnitus is an almost entirely pragmatic one that involves counselling, and which seeks primarily to demystify the condition. “It must first be said that most people with tinnitus don’t seek treatment as, while they are aware of the tinnitus, it doesn’t trouble them,” she says. “Some who see their doctor about tinnitus just want an explanation.”
Thereafter, most people will simply get used to it and reach a point where their tinnitus is no longer consciously perceived, she says. “But if this doesn’t happen and the tinnitus becomes distressing, help is then often sought.”
One of the few definite conclusions from tinnitus research studies to date is the demonstrable link between the condition and sufferers’ responses to feelings of stress.
This is manifest in the many approaches to coping with tinnitus that focus on reducing anxiety and promoting relaxation, including various psychological therapies (counselling, cognitive behavioural therapy, tinnitus retraining therapy), self-help (relaxation techniques, exercise) and complementary therapies (acupuncture, yoga). There are also audiological therapies that merely aim to distract the sufferer (noise generators, hearing aids).
A while after my incident at Dublin Zoo, I tried out some of the better-known relaxation exercises, and also listened to some distracting “white noise” CDs. They helped a little bit.
Although Kennedy is open to any kind of treatment that works for the patient, she says the most successful therapy approaches involve managing the psychological aspects of tinnitus. A key element of these approaches is that they focus on dealing with the sufferer’s negative perceptions of, or reactions to, the condition.
Kennedy explains that the “natural course of tinnitus is to improve as long as there are no negative associations”, but if there are, that may well make the tinnitus seem worse to the sufferer.
“A therapeutic process should enable the person with troublesome tinnitus to develop a ‘neutral’ perception of the tinnitus which in turn allows habituation to it,” she says. “In other words, once the tinnitus ceases to be troublesome, the brain can then get on with not listening to it.”
For me, this immediately made a lot of sense. I remember thinking at the time I last banged my head, “Oh crap, my tinnitus is going to come back, big-time.” Sure enough it did and, fuelled by my growing anxiety, still showed no signs of fading away two months later.
Jean Scott, chairwoman of the Irish Tinnitus Association (ITA), who mans the association’s helpline every Thursday morning, says she encourages sufferers to think positively and realise they can take control. “If I find that the person takes a negative view of their tinnitus, I have to try to turn their thinking around, otherwise it’s the same kind of attitude that goes ‘I can’t go outside in the winter because my ears will get cold.’
“Very often callers will just want you to give them something that will help them straightaway, which we can’t really do,” she says.
For Kennedy, it’s clear that the hardest sufferers to help are those who dismiss the notion that they have any control over their tinnitus and ignore their internal resources.
“We do meet people who want someone to give them a cure and don’t accept that they can help themselves. Even after a lengthy visit with a detailed explanation of tinnitus mechanisms, approaches and strategies that they can use, they will stand up and say ‘so you can’t help me then’ and seek someone else for a cure.”
Kennedy has tinnitus herself, and while she doesn’t deny it can be annoying, she says she doesn’t let it take over her life. “Too often it is a downward spiral for some people with tinnitus feeding into a feeling of stress and stress feeding into tinnitus. Breaking this aspect is key to taking control of the tinnitus and living the life we want, rather than let the tinnitus take control of us and our lives.”
Having suffered bad tinnitus for about three months before I spoke to Kennedy and Scott, I found myself feeling more relaxed after chatting with them. Knowing that as long as you can learn not to focus on it or not see it as a threat, tinnitus can become much more manageable. A month later, my tinnitus subsided once again.
But this also means I find myself relieved to be quickly approaching the end of writing this article, because by having to consciously think about tinnitus, I’ve become more aware of its annoying presence again. Time for me to stop and go think about something else.
- For more information, contact the Irish Tinnitus Association on 01-8723800 or e-mail: ita@deafhear.ie. www.deafhear.ie