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February 9, 2006

When noise plagues you

From: Louisville Courier-Journal, KY - Feb 9, 2006

By Darla Carter
The Courier-Journal

Voluntarily pumping sound into one's ears has become commonplace among music lovers in this iPod nation. But imagine walking around with an irritating noise in your ears for 24 hours a day, without being able to shut it off.

Such is the plight of people with tinnitus.

It's often described as ringing in the ears, but tinnitus also can manifest as hissing, sizzling or cricketlike chirping, said Ingrid Edwards, an audiologist at The Heuser Hearing Institute in Louisville.

The problem may be temporary, such as the ringing that anyone might experience after a loud concert, or it may be chronic.

For Melanie Magruder, 61, of Louisville, the noise started as buzzing at age 20 and went on to take various forms for the next four decades.

"I heard bacon frying all the time," she said.

At other times, the sound would be "like you're hearing a 747 take off at the airport, like you're standing right next to it -- louder and louder and louder and then softer like the plane is gone," she said. Also, "I would hear like Chinese gongs, and that would wake me up at night."

But the worst noise, she said, was a whining sound that would build to a crescendo "as intense as I could stand it."

Although many people who have lingering tinnitus learn to ignore it, the problem bears investigating because it could be a sign of a medical condition that needs treating.

"We really view tinnitus as a red-flag condition that deserves attention and evaluation to rule out any of the significant causes, and that's even more so if it's only in one ear or if it sounds different between the two ears," said Ian Windmill, an associate professor and director of audiology at the University of Louisville. "Some people just tolerate it like pain when it's a sign of a problem, and the problem needs to be identified."

Tinnitus is often a sign of damage to the inner ear, and many people who have it, including Magruder, also have some degree of hearing loss.

"It's not really a disease; it's a symptom," Edwards said of tinnitus. "It's a result typically of ear-related damage of some sort."

Noise damage

Dr. Burton Cohen, a Louisville physician, said many tinnitus patients have a high-frequency hearing loss from some source of excessive noise, which people can reduce their exposure to by wearing earplugs or earmuffs.

"The most common cause I've seen has been shooting shotguns," he said. "They'll tell me that they shot shotguns when they were 15," which might have been 55 years ago.

IPods and similar devices also can impact hearing, said Edwards, who stressed the need to keep the volume at a reasonable level.

"We used to use headphones," she said. "Now, we shove them down in our ears. That's making a difference" since the sound is intensified.

Other problems that can lead to tinnitus range from earwax to aneurysms, said Cohen, who practices at Heuser and Kentuckiana Ear, Nose and Throat.

There "could be something wrong with their heart, something wrong with the blood vessels in their neck, (an) aneurysm" or another serious problem that needs urgent attention, he said. "You could have a brain tumor."

If people have a pulsating noise or washing machine noise in their ear, getting a doctor to "listen to their heart and their neck, (and) get X-rays … may save their life," he said.

Many medications, including certain antibiotics, aspirin and similar drugs can affect hearing and lead to tinnitus, Cohen said.

Someone taking ibuprofen for three weeks for knee pain might develop ringing in the ears, Edwards said.

Other reasons for tinnitus include:

* Ear or sinus infections.

* Problems with the temporomandibular joint in the jaw area.

* High blood pressure.

* Stroke.

* Nerve degeneration.

* Multiple sclerosis, Meniere's disease, thyroid disease, diabetes.

See a doctor

Windmill said it's crucial to see a doctor when tinnitus is accompanied by additional symptoms, such as dizziness or changes in taste or smell.

A primary care physician is usually the first person to see the patient, then can make a referral to a specialist, he said.

Tinnitus patients generally are given an audiological assessment to check their hearing, and while they're in the booth wearing headphones, sounds are played to try to match the tinnitus sound in their head, Edwards said. They also can be tested for damage to their cochlea.

Since tinnitus can have a major psychological impact on someone's life, it's also important for professionals to try to determine what emotional effect the tinnitus is having on patients, she said.

The impact ranges from minor to "people who cannot function or are at risk of losing their jobs because the ringing is bothering them that much," she said. Sometimes it becomes "a huge deal and almost the only thing they can pay attention to."

Cohen said, "I've seen one suicide; some of these are very depressed, unhappy" people.

Treatments vary

It's hard to predict what treatment will help a given patient, Windmill said.

For many people, all that is needed is a little reassurance. If you deal with tinnitus on a regular basis, "70 percent of your patients only need to hear that medically there is nothing wrong with them," Edwards said.

Treating the underlying condition, such as prescribing diuretics for someone with Meniere's disease, may be all a patient needs, Cohen said.

If there is a hearing loss, a hearing aid is often one of the first things tried, said Lata Krishnan, an audiology clinic director at Purdue University in West Lafayette, Ind.

"It's not that the hearing aid makes the tinnitus go away," she said. "It's just that the person now is hearing other noises and sounds from the environment, and therefore, the tinnitus is less noticeable."

Another tool is called a masker and produces sound in the person's ear that is sometimes described as "white noise" to cover the tinnitus.

It can be helpful in that the patient knows the noise is coming from an external source as opposed to some mysterious place inside the head, Krishnan said.

Adding to the mix

Another tinnitus tool is called a noise generator. It mixes or changes the sound the person is hearing and is designed to be used for a two- to three-year period until the person no longer notices his or her tinnitus or can tolerate it, Edwards said.

Neither noise generators nor maskers are guaranteed to work and can cost a couple of thousand dollars.

Yet another option is Tinnitus Retraining Therapy, which is a combination of counseling and low-level noise. It's designed to teach patients how to deal with the tinnitus and accept it instead of having an emotional or stressful reaction to it, Krishnan said.

Many other things have been tried to varying degrees of success, including biofeedback, herbal remedies and medications, such as certain antidepressants, Windmill said.

"They all have a fairly low success rate, and that's probably due to the fact that each person's tinnitus is different and generated in a different way and probably comes from a different part of the auditory pathway," he said.

Cohen said he has seen biofeedback work well in tough cases. "I find that to be one of the best methods for uncontrollable tinnitus is biofeedback," he said.

Finding relief

Cohen has tinnitus himself but just tolerates it. "It'll fluctuate with fatigue and with stress," he said, but it doesn't keep him up at night.

For tinnitus sufferers who do have trouble sleeping, it can be helpful to leave something on in the house, such as the radio, a fan or tapes of ocean waves, Cohen and Krishnan said.

And some people find that their tinnitus goes away for a short time when they take off their hearing aid or masker, allowing them to sleep comfortably at night.

Ed Schickel, 58, of Bardstown, Ky., said hearing aids have helped him to cope with his tinnitus, which ranges from the sound of crickets to a running fan and can make it difficult for him to understand people.

For Magruder, relief came in the form of a cochlear implant, which she received in August to compensate for hearing loss that occurred after a bout with measles and a high fever at age 6.

"I have no tinnitus whatsoever when I'm wearing the cochlear implant," she said, referring to the external portion of the device. "So it's only at night that I have it now, and I'm used to it, so I'm really happy about that."

Up until then, she said she tolerated the tinnitus noise because she was skeptical about whether a masker would help. "I didn't think introducing sound into my ear would make me feel any better."

Reporter Darla Carter can be reached at (502) 582-7068.

Copyright 2005 The Courier-Journal.