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December 11, 2002

Hearing things

From: Independent, UK - 11 Dec 2002

Barbra Streisand, Steve Martin and Jimmy Savile all have it – as did Beethoven. But as the tinnitus-afflicted Michael Church has discovered, there is no need to suffer in silence

11 December 2002

Famously deaf, Beethoven was also a famous tinnitus sufferer. The great composer, who was driven mad by "rushing and roaring sounds" in his head, has become a stock image of this notorious complaint. More recently we have the example of Pete Townshend, who blamed his creative silence on the internal ringing which plagues him like a permanent after-echo of his guitar. "I've shot my hearing," he grimly declared. Meanwhile Barbra Streisand has ascribed her volatile temperament to the tinnitus from which she has suffered since she was seven. Stories abound of people being driven into depression – even to suicide – by this aural torture.

Torture? Well, comedian Steve Martin used no such term to dramatise the tinnitus he acquired while filming a pistol-shooting scene in 1986. "You just get used to it," was his typically stoical comment. Jimmy Savile, who collected an aural hiss from a lifetime spent among 10-foot speakers, was even more upbeat. "It doesn't bother me in the slightest," he told me. "It reminds me of all the girls I've known, and all the discos. I'm very happily ensconced with this friend inside my head." You'd hardly think they were talking about the same complaint.

I acquired my own tinnitus in the stupidest possible way: on the rifle range at Catterick army camp, while training as an officer cadet. St Albans School in the late Fifties was a grotesquely spartan place, where ear-defenders were unheard of (my fellow victim Stephen Hawking improvised earplugs from blotting paper, and the doctor had to dig them out). After a noisy afternoon with a Bren firing 12 inches from my left ear, I returned home deafened, and though my hearing eventually returned (minus the high frequencies), I was left with a loud hiss. (Yes, I should have sued both the school and the MoD, but 16-year-olds don't have time for such niceties.)

Over the years, I got used to that hiss, and for much of the time didn't notice it, but at a period of occupational stress in my early forties it suddenly seemed to intensify. I also began to suffer from "hyperacusis", excessive sensitivity of the ear, so routine household or street noises caused considerable discomfort. I hit a crisis when I unwisely went to a rock musical without earplugs, after which I spent the next few days with my head full of whines, bleeps and hisses. Desperation drove me first to seek the help of a friendly acupuncturist, and then – when that did no good – to ring the ear-sufferers' Samaritans, the Tinnitus Helpline, after which point things began to improve.

I got myself referred by my GP to the Royal National Throat, Nose, and Ear Hospital in King's Cross, and there, over four months of fortnightly sessions, I was put through a course of cognitive therapy. This worked no miracles, but did the trick: rather than lining up with Beethoven, I now lined up with Jimmy and Steve, and learned to live amicably with my hiss.

But I also helped myself by seeking out and interviewing fellow sufferers: that old adage about "a trouble shared" is particularly true with this private, invisible affliction. I met a BBC music producer whose tinnitus had been triggered when a whistle was blown in his ear during a demonstration. His doctor told him he had irreversible ear damage, and that he might one day go deaf, which put him into a suicidal spin; the ENT doctor he subsequently saw told him he should regard his tinnitus in the same light as he would a severe, chronic back pain. Referred onwards to an "audio therapist", he had his ears filled with needles, and was finally told to pull himself together. Next he tried hypnotherapy, then acupuncture – by this time his hyperacusis was so severe that some days he could hardly bear the rustle as he read his newspaper.

Eventually he registered at a private clinic for "positive counselling" – akin to my cognitive therapy – and he realised that this, together with using a white-noise generator which he was advised to wear for six hours a day, was what he should have done at the outset. He doubts if he will ever hear total silence again, but he's reached the point where he seldom hears his internal noise. He's left the Beethoven camp for good.

But this man has no hearing loss: if anything, partly as a result of his fine-tuned work, his hearing is better than average. Tinnitus is full of such paradoxes. Another is that people with the worst hearing loss often don't suffer from tinnitus at all. Yet another is that most of those who do have it – one person in 10, to some degree – are not bothered by it. Only one in 100 find it severely affects their life. But since that includes 400,000 people in Britain alone, it's a problem worth taking seriously.

Tinnitus is not a disease: it's a real auditory sensation independent of any external sound. Ageing is the most frequent cause; diseases of the middle ear may bring it as a side effect. Noise damage – from explosions, amplified music, pneumatic drills – is a common cause too. Some experts describe it as a phantom sensation, like pain in a phantom limb. The ear, they say, normally receives a constant stream of nerve impulses which it "translates" as silence. If part of that pattern – normal "silence" – is missing, the brain interprets that abnormally as sound. But it's a very small sound: the usual analogy is with a baby crying at night, or a party going on next door. The actual level may be low, but its connotations make it irritating.

Some therapists put this idea in an evolutionary context, and liken tinnitus to a survival reflex for detecting predators in the wild. Hence their strategy of "retraining" the brain to reinterpret the messages it receives. The therapy I received at the Throat, Nose and Ear hospital was based on a similar idea.

My psychologist's strategy was to peel away the neurotic emotion from the physical symptom, so as to leave it in a proper perspective. And I found her diagnosis of my case illuminating. The gunfire had left me with high-frequency deafness: the "void" thus created was being invaded by the "normal" noise inside my head. That may be a metaphorical way of explaining the situation, rather than a medical one, but it certainly helped damp my irrational fears. You need a psychologist – or a "how to" book – to start you on this road to recovery, but the beauty of it is that you finish the job yourself, which is precisely why it works.

According to Laurence McKenna, the psychologist who heads the clinic at King's Cross, irrational fears are in many ways the root of the trouble. "The stock image of tinnitus is a problem in itself," he says. "People have read terrible things about it – scare stories that are intensified by illustrations such as Edvard Munch's The Scream. But people who have no prior knowledge of tinnitus, and who may initially even think it's the noise of the central heating, are easier for us to treat, because they aren't panicked. If you can't hold out the hope of being able to deal with it, there would be no point in therapy at all. People do manage to live in equilibrium with their tinnitus – their lives can be made perfectly liveable. That is our goal."

McKenna spends a lot of his time scotching myths: for example, the notion that tinnitus disturbs sleep. "Some people say they can't sleep for tinnitus; others find sleep a blessed relief." It's a myth, he says, that sufferers are already predisposed to tinnitus because they are neurotic. "Some people are harsh on themselves, and say 'I ought not to suffer from this.' But it's absolutely not the preserve of the neurotic – though the negative counselling which some GPs give is quite enough to make people neurotic." He spends a lot of time teaching people how to relax: he doesn't prescribe the "sound generators" which my BBC producer friend used. But he does concede that, through giving people control over their perception of their tinnitus, such machines can be of major help.

Over the past 10 years, McKenna and his colleagues have become increasingly optimistic about this perennial problem: research is now going on into the production of an anti-tinnitus pill. But the biggest obstacle is the most intractable: there are only a handful of clinics in Britain where cognitive therapy is on offer, and there are not even two dozen psychologists specialising in it.

Meanwhile, though researchers into cognitive therapy report high success rates, McKenna is not so arrogant as to claim that this is the only method that works. There are dozens of potential palliatives, and each individual case is different. All that can be reliably said is that there's no need to panic, because with time – and a modicum of persistence – we can all induce our internal noise to abate.

The British Tinnitus Association publishes a quarterly journal, full of reassuring information, called 'Quiet' (0114-250 9933). The association also has a helpline on 0800 018 0527

Tinnitus - some facts and figures

Tinnitus is a condition whereby you "hear" or perceive noises that are unrelated to actual external sound. Around 10 per cent of people experience tinnitus in some form. The sound may be heard in one or both ears and is most commonly described as ringing, though it may also consist of whistling, buzzing or humming. The tone of the noise may vary and it may be consistent, though for some people it comes and goes.

The precise cause of tinnitus is not fully understood, but it may sometimes be triggered by exposure to loud noise. Tinnitus is rarely a sign of a serious disorder, but you should consult your doctor if you think you have it.

© 2002 Independent Digital (UK) Ltd