Tinnitus - Living with the RingingPeter Morgan

Muuramanzi Tlust, P.O. Box 4547, Auondale, Harare.

Tinnitus, or ringingin the ears, isa problem that most people haveexperienced for afew moments intheir lives. The sound originatesfrom within the ears themselvesand notfrom any external source,and usually takes the form ofhissing or ringing. Short termtinnitus may follow theoccurrence ofa loud bang or noiseor frorn a change in altitude. Formostpeople the experience passesvery quickly, perhaps in a fewseconds or minutes and isforgotten" For an unfortunate 57c

however, it may persist for lifeand can be extremely distressingsince only rarely can a cure befound. Most people rvho developtinnitus have no choice but tolearn to iive with it.

Tinnitus is a problem with manydifferent causes. Long periods ofI or.rd noise, inch.rding excessive useof the "walkman", damage theear, and catarrh or inflammationof the inner and middle ear mayalso ]ead to the onset of theringing. Several drugs areknownto produce tinnitus as a side effect.These include quinine and evenlarge doses ofaspirin and severaltypes of antibiotic in susceptiblepeople. Very often there may beno known cause and the ringingjust starts and never stops.

Surprisingly, public awarene ss ofthe problem is very low, possiblybecause no great medicaladvances have been made in*uring the aiiment, and there areno signs Lhat a medical solutionlr'i [] irr: found soon " Whilst certaindrugs are known to eliminai:e thefi*ig{isj th*y har,'e ma{ry Llrt-de"qirah l e :'i de etT'ects. and surgeryhelps in oliy an exbremei3r smalinurrber od'cases. Tinnitus is rareiyrelated to any iife-threatening

form of illness, and those whosuffer from it bear no physicalpain. The noises however affectthe ability to think and tocommunicate. In particular thesounds may strongly influence theability to sleep, since they aremost pronounced when othersounds are reduced to a bareminimum.

People react to tinnitus in manydifferent ways, and this maydepend on the psychologicalmakeup of the individual orindeed the type and loudness ofthe sound itself. Some people aredebiiitated by the problem, andmay eYen contemplate suicide,whilst a few actually enjoy thesounds. Others simply learn tolive with it, and rarely give it asecond thought - it becomes asmuch a part of their iives as thesound of their o.r,n breathing. Formost people there is a gradualchange fiom distress to toleranceand then to acceptance. Thisprocess, especially the achieve-ment ofthe state of tolerance andacceptance, is oftenhard won aftera very troubled period. Thedevelopment of tolerance oftentakes from between 3 to 18months.

The noises most present a problemwhen a person pays attention tothem because they are not

distracted in other ways. Twopeople who suffer from tinnitusmay talk to each other for a longperiod without noticing thesounds, that is until one of themmentions the problem inconversation. Then both becomeaware of the noises - immediately.As the conversation continues,the noises fade away from theconscious mind, but they are stillthere - unnoticed. Usually thesounds we hear as part of ournormal routine, the sound oftraffic, other people speaking,sounds within the workplace,house and garden ete., may divertthe attention of the tinnitussufferer, so that he may pass muchof the day withoub being aware ofthe noises. Because the elderlyare more prone to tinnitus, andalso sufferincreasingly from poorhearing, they may develop adouble handicap, since the"masking" effect of environmentalsounds is diminished and theeffect of the internal noise isaccentuated. Such developmentscan be very intrusive, and maywarrant the use nf a hearing aidto accentuate natural s'ound.

The sound and loudness oftinnitus varies considerably fromone person to another, and alsovaries during the day and fromday to day. A quiet tinnitus maybe tolerated for years, or evenunnoticed until it starts to getlouder, when it can cause trouble.In f,act sorne people piaced in asound proof booth and asked tocomment may actr"raily noticesounds f,rom their ears that theyhad never heard before. Theloudness s$erus to vary from theequivalent of a smaitr whisper tothe sound of,a low fiyingjet and isusuall"y jlrsi, helcrv that ofnorrnaiconversati*n. The a.pparent

The Zimbabwe Science News Vo1.28 Nos 4112 April/December 1994 11

loudness may also be affected bY

a persons mood. PeoPle who are

annoyed or distressed maY rePorta loud tinnitus; certainly tinnitusis capable of Producing the mostextreme state of desPair'

Loud tinnitus is obviouslY morenoticeable than quiet tinnitus and

remains more dominant even

during normal daY to daYactivities. In such cases itmaYbedifFrcult for sPeech to be under-stood, especiallY in busY Places'Listening, as oPPosed to hearing,is a mental activitY, whichbecomes less efficient when a

person's attention is distractedby irrelevant noises. The abilitYto think whilst reading or Per-forming other mental tasks maY

be internrPtedbY attention to thenoises. The overall effect is thatthe person with tinnitus maY often

appear to be distant.

The sound itself varies from a

hiss, ringing, squeak, or whistlein the higher range, to drones,rumbles and hums in the lowerrange. Some tinnitus is a mixtureof the two. The hiss of a badlY

tuned radio station is the sound

that many PeoPle maY hear' As

the non-tinnitus sufferer can

imagine, this can be extremelYannoying!

Insomnia

For most PeoPle the ringing inthe ears is most distre ssing duringthe times of sleeP when there are

few if any distracting sounds and

other activities to divert attention'Tinnitus can delaY the onset ofsleep and can also induce earlY

waking. Such effects reduce thelength of healthY sleeP with the

"orri"qo"ttt effects on overall

daytime activitY and generalhealth.

Living with the Problem

Since there may be no knowncure, most PeoPle who develoP

tinnitus have no alternative butto adjust and live with theirproblem. Very fortunatelY most

people go through several stages

of tol"rtt "u

which can actuallYbe documented. Stage one istypifi edby a Persistent awareness

ofthe noises excePt during sleeP

and by masking bY louder and

distracting noises' WorrY and

depression set in and concen-

tration on mental tasks is dfficult'Insomnia may be severe. Stage

two is reached when momentsoccur when the noises are not

noticed and other activities and

sounds divert attention from the

tinnitus more easilY. Thebeginnings of emotional acceP-

tancebegin, andthere is agradualreturn to normal sleeP. Stage

three is reached when awareness

is reduced even furtherto Periodsof quiet, stress and tiredness. The

noises become less distressing'Finally stage four is reached when

attention is Paid to the noises

only when theY are louder thannormal or duringPeriods of quiet

when theY m aY attr act attention'The noises no longer intrude intonormal activities and a state ofemotional accePtance has been

achieved. These stages maY takeup to 18 months to achieve.

Masking the sound ofTinnitus

Many externallY generatedenvironmental sounds mask theinternal ringing in the ears and

thus divert attention awaY fromthe tinnitus. On daYs of loudtinnitus, environmental noises

may provide onlY Partial masking,whilst on daYs of quiet tinnitusthe same external noises maY

provide comPlete masking. [t isiasy to visualise how a loudersound covers uP the quieterinternal sound simPlYbecause ofits volume. However there is a farmore interesting and subtle effectwhen the external sound success-

fully masks the tinnitus withoutbeing louder. Thus the tYPe ofsound is also imPortant as well as

its loudness.

The masking effecthas led to the

development of a range of Portablemasking devises which look like

hearing aids and are fitted to theear. Most Produce a meaninglessshushing or hissing sound, orspecially prePared music whichr.tui., more of the higher Pitchedsounds. Sea sounds are also used'

Personal ExPeriences

My own interest in tinnitus began

over two and a half Years ago

when ahigh Pitched ringing sound

started in mY right ear. Since

that time, the ringing has been

continuous. I can confirm theinitial state of desPair, followedby the slow accePtance of thepioblem, as outlined earlier inlhis article. SleeP was almostimpossible for several weeks, butthe accidental discoverY ofaverYeffective masking technique hasprovided considerable cornfort,especially at night.

I noted that certain naturalsounds aPPeared to mask theinternal ringing sound quiteeffectively. These sounds includedthe rustling of Palm leaves,running water and also the shrillchirp of criekets atnight. Walkingfrom the house into the garden atnight aPParentlY made thetinnitus go away. Of course thesounds continued, but theY were

effectively masked bY the sounds

ofthe crickets. Listeningto musicwas quite ineffective atmasking'Since I had no intention ofsleeping for the rest of mY life inthe garden, the sounds had to be

copied and rePlaYed in the-

bedroom. I found the sounds ofcrickets could best be mimickedby recording the sounds on taPe,

and replayingthem on a walkman

28The Zimbabwe Science News Vol'28 Nos 4!12 Apil/December 1994

through high quality walkmanearpieces - used as speakers.Using this technique the basesounds which were also recordedon the tape were not audible, andthe naturalhigh pitched sound oferickets was almost perfectlyreproduced. The greatest comfortwas achieved, not by playing suchrecordings directly into the ears,but the setting the earpieces afew metres away and playing therecording as if the crickets wereactually in the bedroom. Thedegree of masking could beadjusted by varying the volumethe recording. Complete maskingcouldbe achieved, by turningthevolume up, and partial maskingby turning the volum e down. Thissimple device, poweredthrough atime clock and transformer topower an auto reverse walkmanhas worked almost continuously(6.5 hours per night) for nearlytwo and a half Jrears, and hasprovided considerable comfort tome during that time.

E:planations

Why should the sounds of cricketsappear to mask the annoyingringing within the ears? Thereare several explanations. The fi rstis known as habituation ofattention. In this case the brainfinds it easier to ignore soundsthat are constant and meaning-less compared to more complexand variable sounds or soundswhich are useful. Forinstance wetend to ignore sounds of a tickingclock, breathing and even thekitchen refrigeratorbecause theseare constant, and concentrate onother sounds that are either usefulto us or catch the attention forother reasons. During the daymany sounds we hearmay attractour attention and a certainproportion of these are vital toour daily routine. During thesilence of the night the brain has

almost nothing on which toconcentrate apart from thetinnitus. Under these conditionsthe shrill and pointed cricketsound appears not only to disguise(mask) fhe constant hiss oftinnitus, but also to attract thebrain's attention more. I am surethat as tlle mind begins to focuson other things, consciousattention to the tinnitus is lostfirst followed by consciousattention to the cricket sound. Ihave found the sound of cricketsfarmore acceptable to thehissingof tinnitus, partly because theyoriginatefrom anatural source ofsound and partly because theycan be explained and controlled.Indeed the background soundthey offer is comforting comparedto the hissing of tinnitus -something I would not haveimagined years ago.

I also think it is important thatthe sound which masks thetinnitus originates outside thebody, as this in itself drawsattention awayfrom the internalsound and the sense ofconfi nement which this produce s.

However the masking effect ofcrickets alsp occurs throughwearing a pair of headphones,but ofcourse the sound appearsto come once again from withinthe brain itself and notfrom someother place. Under theseconditions the body only senses apartial relief.

Residual inhibition

In a very small proportion ofpeople the effects of maskingpersists a{ter the masking soundhas been turned off. Completedisappearance oftinnitus is rare(79o of users in one study), but apartial quieting of the noise ismore common,but sadly onlylastsfor a short time. However thisappears to be a promising field ofwork for the future.

Since the conceptofmaskingis soimportant it is vital that the earsare allowed to function at theirbest. This may mean clearingblocked wax which producespartial deafness by reducing theamount of ambient sound thatcan be heard, and thus allows thenoises to dominate. The generalcondition of the ears may reflectthe general condition of the bodyitself. Turning to a fresh whole-food diet, exercising a little andfrnding time for sufficient restand relaxation has been knownto help. Homeopathic remediessuch as pulsatilla (the pasqueflower) can relieve fluid in theinner ear, and acupuncture is alsoknown to improve the conditionin some cases - although notmine!

Beferenees

Ilallam, R. (1989). Liuing withTinnitus, Wellingborough, U. I{. :

Thorsons Publishers Ltd. 128pp.

sEk#*; 6uee -B.P\-

The Zinoabwe Science News Vol.28 Nos 4lll ApiDecember 1994 29

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