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6th February 2015
Port Life
Tinnitus is a symptom, not its own disease
Making Sense of Medicine
Bob Keller
This noise in my ears is driving me to distraction! It seems never to end. It’s loud and soft, in one or both
ears, and it changes from ringing to clicking to hissing or buzzing, and even to roaring. It’s especially
annoying because nobody can hear it except me, even the doctor.
Sometimes it’s so bad I can’t focus on my work, and sleep is very unsatisfactory. What is going on?!
This symptom is generally called tinnitus, and every year about 25 million of us have an episode lasting at
least three months. This is not a disease in itself, but a symptom suggesting that something is amiss with
your hearing (auditory) system.
What is going on?
No one really knows the mechanism behind the experience of tinnitus, although there are some thoughts.
In my September column on vertigo, I described your auditory system in some detail.
Here, let me summarize the major transformations that happen when you perceive sound.
First, sound waves enter the part of your ear we can see and bump against the eardrum at a variety of
frequencies. The rather-complex middle ear uses an ingenious arrangement of small bones and
membranes to amplify the sound. Finally, a part of the inner ear called the cochlea contains many nerve
endings that transform their vibratory response to the sound waves into electrical nerve impulses. These
impulses are transmitted by the auditory nerve and interpreted by your brain to be sound.
It was long thought that the inner ear contained simply passive elements that resonate to the vibrations
caused by sound waves. However, relatively recent research has shown that in the cochlea is an active
biological amplifier.
This amplifier is known to be able to generate sounds that can be perceived with a very sensitive
microphone placed at the eardrum. It is now common practice to test newborns for congenital deafness by
presenting at the infant’s eardrum a tone or click, and monitoring the response from the cochlear amplifier.
It’s known also that the amplifier can spontaneously generate what are called cochlear microphonics,
especially in patients with certain pathologies, and that this is one source of tinnitus. Many cases of
tinnitus arise from other unknown causes.
What causes tinnitus?
There are a wide variety of conditions that can lead to tinnitus, but it is primarily long exposure to loud
sounds. As many as 90 percent of tinnitus sufferers have some hearing loss induced by prolonged noise.
The problem is that the noise permanently damages the cells of the cochlea.
Of course, one might expect this whether you play or listen to loud rock music, but many other professions
are in similar jeopardy: pilots, workers using jackhammers and landscapers, for examples. In fact, anyone
using chain saws, guns or other loud devices may be affected. Even a single sudden extremely loud noise
can bring on tinnitus.
Naturally, the best prevention of tinnitus is to avoid loud noises, especially if they are prolonged. This may
include wearing earplugs.
As to other causes, one must consider hundreds of prescription and nonprescription drugs. Principally
indicated in this group are aspirin, antibiotics, sedatives and antidepressants. You may experience tinnitus
as a result of an ear infection or a buildup of ear wax.
Age is a factor in that the cochlea and other parts of the ear may deteriorate with age. And diseases of the
middle and inner ear are possible causes.
Many medical conditions like high blood pressure and other cardiovascular disease, as well as anemia,
allergies, thyroid and diabetes, are related to tinnitus. It’s true, as well, that temporomandibular joint
disorder and injuries to the head and neck may cause tinnitus.
All of these are made worse by drinking alcohol or caffeine, and by being stressed and fatigued.
How can one treat tinnitus?
First, if tinnitus persists, please see your doctor. Tinnitus is a symptom of something, and your doctor is
probably the best prepared to help you figure out what that is. If tinnitus is the result of a treatable
condition, then your doctor can help with that.
If there is no obvious cause for the tinnitus, then there are many recommendations for living with it. These
include hearing aids, sound generators, neural stimulation or even a cochlear implant to bypass damaged
parts of the ear.
In my practice, using the gentle techniques of the myokinesthetic system, I have had some success in
relieving tinnitus using the same treatment I use for migraine headaches. What this does is help your
nervous system reorganize to minimize the effects of whatever is causing tinnitus. Interestingly, this is
similar to the goals of current research in this area.
And the future?
Current research seems not to have produced much in the way of practical solutions to tinnitus, but there
are some promising developments.
Some is focused on electrical or magnetic stimulation of the auditory parts of the brain. This approach is
similar to existing devices that reduce the tremor in Parkinson’s disease and reduce anxieties in an
obsessive-compulsive disorder.
Other approaches include deep brain stimulation and resetting the organization of that part of the brain
that responds to specific frequencies of sound.
For now, however, you are best prepared to prevent tinnitus by avoiding those activities and causes that
may result in tinnitus.
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Bob Keller is a certified pain relief practitioner and medical massage therapist in Newburyport. He can be
reached at 978-465-5111 or [email protected].