This past week, I was hanging out at a café with my good friend Molly doing what I do best: complaining. Because Molly happens to be a doctor of audiology, I decided to customize my generic and drawn-out rants to the matters of the ear.
Teary-eyed and full of self-pity, I explained to her that for the past five years, I have been suffering from a high-pitched ringing in my ears. I told her I've been to a few docs, but they were quick to either brush the ear ringing off as inconsequential or put me through a myriad of tests to ensure that there was no associated hearing loss. Not one offered treatment, a follow-up, or any type of reassurance.
Being the ever-so-snarky lady that she is, Molly simply replied, "You have tinnitus and are going about it all wrong." She then pointed to my extra-large iced coffee, my sleep-deprived baggy eyes, and my shameful breakfast spread (think a smorgasbord of salt, cholesterol, and saturated fat). "These need to change."
I asked her to start from the beginning. Here's how it went down.
Molly: Yes. So fundamentally what you have going on is the perception of sound within your ear. This sound could manifest in many forms: humming, ringing, roaring, etc.
Let's start with the basics. The cochlea, which is your primary organ of hearing, is lined with thousands of tiny hair cells. These cells are very frequency specific. Over time these cells become damaged from many factors such as genetics, environment, noise, and even the natural aging process. When this happens, the damaged cells are not sending along the same message to the auditory portion of the brain that they once were, putting the whole auditory system into disarray.
Unfortunately for humans, we are unable to just "shut off" our ears, even when sleeping. The brain is always searching for sounds. And it just so happens that these damaged hair cells contribute in creating the perception of aural sounds, commonly in the form of high-pitched ringing.
Brian: Why did this happen?
Molly: Tinnitus is somewhat of a mystery. We aren't totally sure why some people get it and some don't. As annoying as it is to both practitioners and patients, we don't have a perfect model for tinnitus or else we could figure out exactly what the cause is, who has it and be able to treat it. What we do know is that absolutely anyone can get tinnitus.
Hearing loss is the most common cause of tinnitus. Because the elderly population has a higher incidence of hearing loss than other demographics, tinnitus is a very common geriatric complaint. But, in the case of younger patients as yourself, noise exposure and tinnitus often go hand-in-hand.
I guarantee most people have experienced tinnitus at some point in their lives. I know I have lain in bed with my ears screaming at me after going to a loud club or concert.
Yes, even audiologists forget to bring ear plugs.
Brian: Let's bring this back to me. What can I do to keep my tinnitus in line?
Molly: Remember, tinnitus is a symptom, not a disease. So treating tinnitus is in the form of symptom management.
But the fact that you saw an otolaryngologist (ear, nose, and throat doctor) was a good move. The first step to treating tinnitus is to ensure that there is not underlying treatable etiology. Just having the reassurance that your tinnitus is an isolated symptom as opposed to a sign of underlying disease can help assuage the ringing.
Next, it's important to identify triggers of your tinnitus. Commonly, stress, anxiety, lack of sleep, and loud noises are classic instigators of tinnitus. Certain diets are also frequently associated with worsening ear ringing. Ordinarily I would advise you to eliminate caffeine and high salt intake, as they are shown to exacerbate tinnitus. But we both know you are incapable of this.
The worst thing you can do when you have tinnitus is to focus on it in a negative way. If you give it tons of attention and form negative reactions to it, you will hear it more often. Behavioral counseling offers coping mechanisms for this issue and has been shown to be an effective treatment. Anti-depression or anti-anxiety medications can also help with the negative feelings associated with tinnitus.
Be aware that many different medications could actually be causing or worsening your tinnitus. Make sure your meds don't have this side effect.
Brian: Duly noted. I'm assuming these behavioral changes take time to start treating my tinnitus. What can I do in the meantime?
The most common method of treatment involves learning to "tune out" your tinnitus by using some other type of sound therapy to reduce your brain's perception of these unwanted sounds. This is a broad category and can include anything from using a white noise machine at night to ear-level sound generators that one can wear all day.
For those with hearing loss, hearing aids are actually a great help for tinnitus patients. The key is to enrich your sound environment so that you never have to deal with the bane of tinnitus sufferers: total silence.
Molly: You will live to see another day.
Special thanks to my friend Molly Adler, Au.D. for helping me write this week's piece. Please note that the aforementioned treatments are discussed in very general terms and are the tip of the iceberg of a wide array of available therapy. If you suffer from tinnitus, go see your local audiologist to discuss them in more detail.
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