Dear readers,

Last night there was a show on TV with a subplot about one of the main characters having tinnitus (ear noise) and hyperacusis (exquisite sensitivity to sound). There were some mischaracterizations which I’d like to address.

Tinnitus (often called ‘ringing in the ears’) is the abnormal perception of sound that is not present in the environment. It can be perceived as a high-pitched whine, a loud hiss, a roar, clanging, crickets, or any other type of noise. The exact mechanism by which tinnitus occurs is not known, however, our theories in 2008 are significantly more scientifically exact than they were previously.

We know that our inner ears produce their own sounds. These ‘cochlear microphonics’ are used when we test newborn babies for hearing loss by measuring otoacoustic emissions. In general, our inner ear’s sounds are masked by environmental sounds and we do not perceive the cochlear microphonics. However, when a large group of young people were tested in a very quiet environment with no other stimuli, nearly all of them perceived their own tinnitus after a period of 30 to 45 minutes. Transient tinnitus is a frequent phenomenon and poses no danger.

Tinnitus becomes a problem when it is persistent or interferes with work or sleep. It is often perceived after there is some level of hearing loss, either through aging or noise trauma or other mechanism. The brain then picks up the cochlear microphonic and proceeds to perceive it as sound. Disabling tinnitus can result in severe depression and anxiety and must be attended to as aggressively as possible. It activates the limbic system in the brain, which is the ‘fight or flight’ response system, and that causes even more anxiety.

Hyperacusis is often considered the flip side of tinnitus, as the two often go together. In this condition, loud sounds are perceived as painful, and, in severe cases, even relatively soft sounds become intolerable.

Tinnitus is one of the top 3 problems affecting our returning soldiers from Iraq and Afghanistan.

Treatment of tinnitus and hyperacusis rests primarily with understanding the underlying process. This is of great help in alleviating the attendant anxiety and depression. Dietary modification is relatively easy and very effective. You should avoid drugs that constrict blood vessels, such as caffeine and nicotine. You should avoid dehydration by drinking enough water and minimizing alcohol intake. Emotional and muscular stress and tension will make your underlying tinnitus worse and should be minimized as much as possible. At bedtime, listening to white or pink noise or pleasant music can help mask the tinnitus. Hyperacusic patients often wear ear plugs or noise cancellation head phones, which are very effective.

There are several medications that have some degree of success in managing these conditions, and this avenue should be explored with your otologist if the above methods do not work. Tinnitus retraining treatment (TRT) has been used for years. It is effective in some people.

There are newer devices to counteract the limbic system effects. Some are implanted; others are not. I have a great deal of experience with the Neuromonics device, which initially masks the tinnitus but primarily works to alter the anxiety response to the tinnitus. It is very effective in both tinnitus alone as well as tinnitus with hyperacusis.

You will not go deaf from tinnitus or hyperacusis. Avoidance of noxious noise stimuli must be stressed. Please do not accept any ‘just live with it’ advice. Seek help from a qualified otolaryngologist or otologist/neurotologist. You’ll be happy that you did.

Sincerely,
Dr. Chandrasekhar