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Noise that can bring on a funk

The constant sounds that people with tinnitus hear can be distressing. Learning how to ignore them may be the best way to cope, experts say.

August 04, 2003|Valerie Ulene | Special to The Times

"I hear singing and there's no one there."

Change "singing" to "ringing" and that line, from the Irving Berlin song could be used to describe tinnitus. The name is derived from the Latin word tinnire, which means "to ring." But people who experience this problem, nearly 35 million of them in the United States, describe a wide variety of sounds that are not audible to anyone around them: from buzzing, humming and hissing to roaring, whistling, whooshing and clicking.

Some hear the sounds in only one ear, some in both; some say the noise seems to be coming from inside their heads, others cannot localize it.

The sound can come and go, or it can be continuous. The pitch can range from high to low and the volume from loud to soft.

Although the condition isn't dangerous or life-threatening, about 5% of those who have tinnitus say it is highly distressing and disrupts their normal life.

One man who has suffered from the problem for nearly 30 years put it this way, "It's hard to do anything or enjoy anything when you're constantly being assaulted by a screeching sound that no one else can hear."

The vast majority of people with tinnitus, however, don't find it particularly bothersome. Ironically, there is often no difference in the pitch or volume of the sound perceived by those individuals who are troubled by it and those who aren't. In fact, two people with similar descriptions of their tinnitus can be affected by it in dramatically different ways. That observation has led many experts to conclude that it's not the noise that causes distress, but one's reaction to it.

Some experts speculate that the "ringing" is caused by damage to nerve endings deep in the ear because tinnitus occurs more frequently in individuals who have some degree of hearing loss. However, this explanation cannot account for all cases of tinnitus because it can also occur in people with perfectly normal hearing.

"Tinnitus is a symptom, not a disease," stresses Dr. John House, an otolaryngologist at the House Ear Institute in Los Angeles. A variety of medical conditions -- high blood pressure, thyroid abnormalities, ear infections or simple buildup of wax -- can trigger the onset of tinnitus. Some drugs, including aspirin, other non-steroidal anti-inflammatory drugs and certain antibiotics, can also cause tinnitus, particularly when taken in high doses. In most cases, the noises disappear if the underlying problem is corrected. For example, if aspirin use is responsible, the tinnitus will resolve after the medication is stopped.

Frequently, however, no underlying trigger can be found, and the noise persists. In this situation, treatment is aimed at minimizing the distress it causes. "We try to get people to ignore the noise," House says. "Many times all it takes is reassurance ... telling patients that tinnitus is a symptom, not a disease, and having it doesn't mean that they're going to go deaf or develop a brain tumor." (Although the possibility of cancer is a common fear among tinnitus sufferers, tumors are a very uncommon cause.)

Some of the most effective therapies aren't trying to reduce or eliminate the noise but to make it less noticeable. For individuals with tinnitus who also have hearing loss, hearing aids often provide relief. The aids amplify background sounds, which helps "drown out" the sounds of tinnitus. People with normal hearing may benefit from the use of masking devices, which look like hearing aids, but create low-level sound that covers up the noise of the tinnitus.

Tinnitus retraining therapy takes the masking process one step further, combining low-level, steady background sounds with one-on-one counseling. The goal of retraining therapy: to draw people's attention away from their tinnitus and decrease their negative response to it. Anti-anxiety medications such as Xanax and antidepressants also provide relief for some people.

Anyone who notices the development of sounds that no one else can hear should see a physician promptly to determine if there is a correctable cause for the problem. Unlike the ailment Berlin was writing about -- love sickness -- some cases of tinnitus can be relieved immediately.



How to control effects of tinnitus

* Avoid loud noise. It can trigger or exacerbate existing tinnitus. (Transient tinnitus can develop after even a brief, one-time exposure.) Loud noise should be avoided whenever possible. When it can't be avoided, earplugs or another form of hearing protection should be worn.

* Be aware of side effects from medication for other diseases. Before starting any new medications (whether over-the-counter or prescribed by a doctor), talk to your physician or pharmacist to learn their potential side effects. If you already have tinnitus, don't start any new medication that has a high risk of aggravating it.

* Control stress and fatigue. For some people, these factors may aggravate tinnitus. Getting adequate amounts of sleep and managing stress can be helpful.


Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Our Health appears the first Monday of the month.

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