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Ears, Nose, Throat and Health

Tinnitus, excessive noise

THE RINGING IS DRIVING ME MAD

By Dr. W. Gifford Jones

December 4, 1988

N.W. McLachlan wrote in 1935, "Noise is any undesired sound. Noise is sound at the wrong time and in the wrong place." Many people who complain that a constant noise in the ears is driving them mad would say,"Amen " to that definition. What causes "tinnitus" a ringing in the ears? And what can relieve this unrelenting annoyance?

Tinnitus means different things to different people. Davidah Wolf, chief audiologist at St.Michael's Hospital in Toronto writing in the journal ,"Diagnosis", says this malady has existed since ancient times. That once treatment consisted of fumigating the ear with smoke from the burning skins of nonpoisonous snakes. Or the administration of various herbal medicines to the ear.

There are two kinds of tinnitus. Most patients can only hear the noise themselves. But on rare occasions the noise is due to vascular disease and can be heard by others. Sometimes the sound is due to blood being forced through a narrowed carotid artery in the neck. At other times the din is produced by blood swirling around a venous aneurysm.

Tinnitus is more often seen in elderly patients. Or those who have been exposed to excessive noise for long periods. It's hard to estimate how many people suffer from this trouble. Wolf reports the U.S. National Health Survey in 1962 showed that 16 per cent of people between 18 and 79 years of age complained of tinnitus. Another British study seeking this problem generated 9,000 positive responses.

Dr. David Charles, a prominent otologist at The Toronto Western Hospital, suggests age is not the only factor that predisposes to tinnitus. Rather, the degree of tinnitus is often associated with the severity of hearing loss. And that the great majority of patients complaining of tinnitus have suffered hearing loss, but may not be aware of it.

There are multiple causes of tinnitus. In some cases it's due to obstruction of the auditory canal or eustachian tube, dental disorders, reactions to drugs , hypertension and atherosclerosis. Infections of the external or middle ear, allergies, migraine and epilepsy are also precursors. Less common causes are multiple sclerosis, temporomandibular joint problems, whiplash and tumours of the acoustic nerve.

What makes the noise is the $64.00 question. Most otologists believe there's more than one cause. And that damage can occur at various parts of the auditory pathway. For instance, patients with a diagnosis of acoustic neuroma who have the nerve severed during surgery may still complain of tinnitus. As one authority said, "The more you know about this problem the less you know."

Why does tinnitus drive some people up the wall while others find it a minor annoyance? It's often dependant on the person's personality. Perfectionists are more likely to find it disturbing. Or those who worry that the incessant ringing is related to serious disease.

Dr. Ron Fenton ,Professor of Otolaryngology, at the University of Toronto, says that severe, incapacitating tinnitus is often associated with depression. And that patients who are stressed, and run down, are more likely to suffer from this condition.

How tinnitus is treated depends on the cause. Syringing an ear plugged with wax may provide a quick cure. Antibiotics can bring an infection under control. And acoustic nerve tumours must be removed.

For the majority of sufferers no specific cause can be found. Reassurance that the symptom is not life-threatening enables many people to live with the annoyance. Patients who are depressed may be helped by tricyclic antidepressants.

Davidah Wolf offers other practical suggestions. Wolf says a tinnitus masker can be useful in some patients. It's a small device that sits behind the ear like a hearing aid. It produces a "shushing" or "whooshing" noise. The audiologist attempts to zero in on the frequency of the tinnitus and provide the patient with an appropriate masker. In essence this external noise counteracts the internal noise. Treatment hinges on the fact that psychologically patients can more readily accept external noise.

Some patients don't like external noise any better, as it further decreases the ability to hear normal conversation. This further complicates the picture for those who already suffer hearing loss. For these patients a hearing aid is the preferred treatment as it too can increase background noise.

Simple distraction can be helpful. Turn on the radio, TV or use a Walkman cassette recorder. If all else fails, people with spots before their eyes and noise in their ears must learn to make such annoyances their friends.


W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: Docgiff.com

My book, �90 + How I Got There� can be obtained by sending $19.95 to:

Giff Holdings, 525 Balliol St, Unit # 6,Toronto, Ontario, M4S 1E1

Pre-2008 articles by Gifford Jones
Canada Free Press, CFP Editor Judi McLeod