When Justus Bennet, now 57, developed facial paralysis – probably brought on by stress – his doctors sent him to hospital for tests, concerned he might have a brain tumour. There medics piped different sounds into his ears as they measured his brain’s responses. The test found no abnormalities, but something strange occurred.
“One frequency sounded like a hammer bashing steel,” Justus recalls. Immediately, his left ear began to ache. Then came a shrill tone, so loud it sounded to him like a scream. But it hadn’t come through the earphones. There was no identifiable source.
That was in 1998. The noise-from-nowhere was tinnitus. Its din hasn’t stopped for more than a few hours since.
A surprisingly large number of people around the globe (including me) experience ringing, chirping, clicking, buzzing or other noises with no external source. Tinnitus affects over 300 million people worldwide, with around 10% of the population having it to some degree, and 2% being affected in a debilitating way. And the older you get, the more likely you are to be affected.
Tinnitus can be intermittent or constant; soft or loud. And when it makes it difficult to understand a conversation, or follow a programme on TV, tinnitus can drive you a little batty. Dr Michael Seidman, director of Otologic and Neurotologic Surgery at Henry Ford Hospital in Detroit, Michigan, says he sees some patients who have been divorced, “who can’t work, who are just debilitated by it”.
What’s behind this infernal, internal racket – and how do you mute the volume?
“Tinnitus is not a disease,” explains Deborah Hall, professor of Hearing Science at the University of Nottingham, UK. “It’s a symptom that can follow from a range of different medical conditions.”
The known causes vary: loud noises; hearing loss; physical injury; Meuniere’s disease; certain medications; genetics – even ear wax. Sometimes, the cause can’t be pinned down.
At a tinnitus clinic in Portland, Oregon, more than 90% of patients were found to have some degree of hearing impairment, even if mild enough to go unnoticed. “The exact pitch where you have your hearing loss is often also where you have your tinnitus,” says neuroscientist Professor Berthold Langguth of the University of Regensburg, Germany.
Because there is no single cause, “That probably means there’s no one single intervention that is going to work for all people,” says Professor Hall. But it might also mean that, for people with tinnitus caused by a particular injury or condition, there could be more effective treatments than the overall statistics suggest.
Dr Seidman advises people who have been told there’s no way to quiet the cacophony to go back to the doctor and ask again. “There are no cures, but there are things we can do to help manage the problem.” He recommends that sufferers start with the simplest approaches and only move on to more complex ones if those fail. Here are several useful treatments available now:
“There was a study that showed more people with tinnitus had a B12 deficiency, for example, and some of those patients got better when they supplemented with the B12,” says Dr Seidman. Other studies suggest that zinc deficiencies can contribute to tinnitus. People with such deficiencies, when given zinc supplements, often report some relief. Adding zinc won’t help, however, if blood levels are already at normal levels. The herb gingko biloba, while often prescribed, performed no better than placebo in several studies.
Quiet the Phantom Sound
One of the more dramatic reductions in tinnitus demonstrated in a clinical trial was achieved in the early 1990s with alprazolam (aka Xanax, Xanar or Zopax). The small study found alprazolam reduced tinnitus loudness in 76% of sufferers versus 5% on placebo.
“Smart people ask, ‘does it actually turn down the volume of my tinnitus or does it turn down my annoyance?’” says Dr Seidman. Probably a bit of both, is his conclusion. The neurotransmitter that’s associated with anxiety is also the one “that take[s] sound from your ear to your brain,” he explains. Because alprazolam influences this neurotransmitter, “we do think it does turn down the volume.”
Two similar drugs, clonazepam and oxazepam have also been reported to help some tinnitus sufferers.
Gabapentin, a drug that is typically prescribed for control of epilepsy, lowered the volume of tinnitus in people who have inner ear damage caused by exposure to loud noises, reported a study in 2006, but not in those with tinnitus due to other causes.
For those people with the dual diagnoses of major depression and tinnitus, two studies found that the anti-depressants sertraline and nortriptyline can sometimes lower tinnitus volume and annoyance. Researchers caution, however, against prescribing anti-depressants for non-depressed people.
Increase Normal Sound Volume
Because hearing loss so often accompanies tinnitus and vice-versa, among the primary treatments are hearing aids. These don’t eliminate tinnitus, but make it easier for some to hear despite it – and they sometimes make the chirping, whistling, whirring and ringing easier to ignore. But because hearing aids can’t eliminate the phantom sound itself, many people need a more comprehensive approach.
Add Another Sound
Masking therapy pipes a pleasant tone (music or the sound of water, for example) into the ear through a device that may or may not include a hearing aid. It works by distracting from the phantom noise. The greatest successes with masking, according to a study published in 2003, are achieved by matching the pitch of the tinnitus with that of the new sound.
Trick the Brain’s Noise-Maker
A paper published in 2013 points to several new masking-type devices that pipe specific tones into the tinnitus-affected ear, to try to reset the brain so it stops producing that phantom racket. Preliminary studies conducted by the device manufacturers show promise.
According to Professor Hall, there is a host of potentially better treatments that may bring the sounds of silence – just around the corner.
Many experts are excited by the potential of a new drug, AM-101, now in clinical trials. One early study “showed that tinnitus loudness significantly decreased with a high dose of AM-101,” says Dr Seidman, who is involved with the trials. It won’t work for everyone. But if proven safe and effective, it might be the magic bullet for some.
A second drug, AUT00063, is in very preliminary trials. “They’re looking to change the way that the brain deals with sound information at a stage higher up than the ear,” says Professor Hall. Early experiments yielded positive findings.
Vagal Nerve Stimulation
The brain deciphers what the ear has heard – but sometimes, as in tinnitus, it fills in the blanks if it doesn’t get enough input. Because the vagus nerve delivers the actual signals from the ear to the brain, researchers hope to use that connection to retrain the brain about what’s real and what’s not.
A small vagal nerve stimulation (VNS) device is surgically implanted in the tinnitus sufferer’s chest and wired to the vagus nerve, a large nerve that runs from the body through the neck to the head. As different tones within the wearer’s actual hearing range are played through headphones, the VNS sends mild electrical signals to the brain. Over time, the hope is that the brain will rewire itself to distinguish real sounds from the fake pitches generated by tinnitus. Clinical trials are in progress. Reports say that preliminary research is promising.
Magnets To Reprogram the Brain
The theory behind low-frequency transcranial magnetic stimulation (TMS) is much like the one behind the VNS device. Guided by brain scan images, large magnetic devices are positioned at specific points on the head to reprogram the way the brain processes phantom sound. And when it works, TMS works amazingly well. “Most of the people who had some response, still reported improvement two to four years later,” says Professor Langguth. But only about 10% of all treated patients reported good improvement. Another 30-40% had slight improvements. Professor Langguth and others are working to make it more effective.
Justus Bennet, meanwhile, like too many others, although prescribed hearing aids for hearing loss in both ears, was offered no treatment at all specifically for tinnitus.
But it might not need to be that way for him or for others with this annoying affliction. If your doctor tells you nothing can be done for your tinnitus, don’t give up. You might even give that doctor a copy of this article.