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You Rang?

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Photo by Towfiqu barbhuiya.

In medieval Britain you might have been advised to take a freshly baked and piping hot loaf of bread from the oven, tear it in half and hold an end up to each ear as long as you could stand it to remedy this condition. In ancient Egypt you might have been treated for this ailment by the insertion into the outer ear of a reed filled with oil infused with frankincense, tree sap, herbs, and soil. Even earlier, the Mesopotamians documented rituals and chants to the god of water that they used to rid a person of this suffering caused by “whispering” or “singing” in the ears.

The enigma of tinnitus

Tinnitus, aka “ringing in the ears” is not all that much better understood today.

If these therapies sound a little primitive or superstitious, it might surprise you to know that tinnitus, aka “ringing in the ears” is not all that much better understood today. Almost 5000 years later, modern medicine has not yet figured out a way to assess the phenomenon of a sound that can only be heard by the one person in whose head it is happening.

We can be glad that the Renaissance practice of surgically perforating the mastoid (bony ledge that can be felt behind the earlobe) in order to quell the whistling wind thought to cause tinnitus has been abandoned.

By the 19th century, tinnitus began to be correctly associated with hearing loss, but to this day, many cases remain untreatable because it can be impossible to learn the origin of the condition. In the majority of cases, when a cause cannot be found, modern patients are sent home with the frustrating advice to “learn to live with it” from a stumped provider.

Affecting as many as 45 million Americans in a mild way, and up to 10 million in more severe ways, the sound one hears in one or both ears is often described as ringing, but can also sound like buzzing, roaring, clicking, hissing or humming. These subjective sounds cannot be measured or detected by anyone other than the person experiencing them, and can often be so loud as to interfere with everyday life. Indeed some of the most severe symptoms of tinnitus can be the anxiety and depression caused by the long term auditory and psychological disturbance. Even many patients with mild cases, end up in treatment for the psychological side effects. Treatment in these cases may never resolve the tinnitus, but may provide helpful coping strategies.

Understanding the causes

Construction workers and musicians suffer disproportionately from the condition.

Most often the cause of tinnitus is age-related hearing loss. The tiny hairs inside the ear called cochlea deteriorate with age and sometimes from cumulative or sudden exposure to loud noises. They transmit unusual electrical impulses when damaged which cause the sounds we call tinnitus.

Blockages or fluid build-up in the ear canal can cause pressure changes bringing about tinnitus. While recovering from a cold or other virus, you may experience temporary tinnitus.

Medications of many types can cause tinnitus, with greater doses generally causing more challenging symptoms. Anti-inflammatories, antidepressants, cancer drugs, diuretics, and others have been shown to cause tinnitus. Usually, the symptoms stop when the medication is stopped.

A host of other chronic and temporary health issues can cause tinnitus, and you should see your provider to rule out any serious conditions and perhaps get a referral to an audiologist who may have remedies for those whose tinnitus cannot be explained or attributed to an otherwise solvable problem. Apart from aging, risk factors include exposure to constant or sudden loud noises. Construction workers and musicians suffer disproportionately from the condition.

The brain’s role

One of the chief advances of the past few decades is that tinnitus is now understood to be sourced at least partly in the brain rather than the ear. A 1981 study showed that tinnitus did not stop when patients had their auditory nerves severed. Forty five per cent of people in the study had an improvement, but 55% reported the sound worsened. Jinsheg Zhang, professor of otolaryngology and communication science at Wayne State University says that when the cochlea are damaged and can’t send a comprehensible signal to the brain, there is still activity in the brain’s hearing region and tinnitus is the resulting untranslatable “sound”. A voice or a violin still stimulates the damaged cochlea, but the brain doesn’t know what to do with the faulty signal and instead “hears” the incomprehensible sounds of tinnitus.

Because other parts of the brain involved with attention and emotions also show activity around tinnitus, there is often a strong psychological factor in how people deal with it, although it is not well understood why tinnitus can drive some people round the bend while others barely notice it.

From ancient rituals to contemporary solutions

Advances in masking, or drowning out the sound, have been very helpful.

Treatment plans today are often focused as much on the emotional and psychological effects of tinnitus as they are on eliminating the actual sound in cases where no underlying health issues are shown to be the cause.

Advances in masking, or drowning out the sound, have been very helpful, and masking has in fact been a known remedy since Greco-Roman times. Modern technology has found ways to mask the offending sound with a hearing aid that produces white noise. In cases where the tinnitus is related to hearing loss, this type of device is a multi-tasker, boosting hearing as well as covering up the annoying sounds.

Other forms of “sound therapy” can also help, whether it be listening to soothing music or rushing water, or any other pleasant sound that masks the tinnitus. Relaxation techniques are often added. Based on the most recent knowledge, docs are no longer telling people just to learn to live with a condition that has plagued humans for millennia.

But if you are still on a sourdough kick that may have started about four years ago, and you’ve got an annoying ringing in your ears when your next loaf comes out of the oven, rip it in half and cover each ear with an heel. Let us know if it works. And then pass the butter.

Ann Constantino, submitted on behalf of the SoHum Health’s Outreach department.