Tinnitus: The Silent Scream

Posted on April 14th, 2021 by

 

Tinnitus: The Silent Scream

Brooke Herman, Gretchen Van Ess, Ratana Chhang, Olivia Kunshier

Whether it is the screeching of a subway station, jamming out to your favorite song on the freeway, or testing the limits of your dorm room speakers, we all become exposed to loud noises at one point or another. Long-term exposure to high-decibel sounds like these can result in tinnitus, otherwise known as ringing, whooshing, buzzing, or clicking in the ears which can be loud or quiet (Mayo Clinic, 2021). Once tinnitus occurs, it often persists, making it difficult to reverse. Existing in the confines of one’s mind, tinnitus can feel isolating and incessant, resulting in distress, anxiety, and depression for those experiencing it. While a cure for tinnitus does not yet exist, various treatment options are available along with methods of prevention recommended to avoid its formation. Due to the lack of a clear manner to fully treat tinnitus, prevention methods are immensely important as the major causes of tinnitus, such as hearing damage, can be prevented. 

A symptom, as opposed to a disease, tinnitus, is frequently a warning that “something is wrong in the auditory system” (NIDCD, 2020). The auditory system consists of the ear, auditory nerve, inner ear, as well as parts of the brain that process sound. Anyone experiencing tinnitus is encouraged to consult with their doctors to check for possible underlying health factors such as obstructions in the middle ear, the formation of excessive ear wax, ear and sinus infections, and hormonal changes in women. In rarer cases, tinnitus can also be the result of diseases of the heart and blood vessels, joint disorders, or a brain tumor (NIDCD, 2020). Recent findings also suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil, Ibuprofen, and Motrin can increase the likelihood of tinnitus occurring (Risser, 2009). Research suggests that drugs like these over time can have a direct effect on the central nervous system, a system responsible for sending and receiving messages between the brain and the body.

This said, a vast majority of tinnitus cases are the result of noise-induced hearing loss, occurring most frequently in the adult population. In 2007, about 10% of the USA adults population, or about 25 million experienced tinnitus lasting a minimum of five minutes (NIDCD, 2021). By 2012, that percentage increased to around 15% according to the National Health and Nutritional Examinations Survey (ATA, 2016). Some of this increase can be related to the high percentage of adults who are a part of the “Baby Boomer” generation, considering the peak age range of those who experience tinnitus is ages 60 to 69 years old. Many of the older adults experiencing tinnitus reported regular exposure to very loud sounds in their environment as young adults (ATA, 2016). 

 In addition to being a warning sign for health issues within the auditory system, simply having tinnitus alone can decrease quality of life. Of 15% of people who reported in a 2011-2012 survey that they were experiencing tinnitus, 30% of them described it as a “‘moderate’ to ‘very big problem in their life” (ATA, 2016). The loneliness of experiencing an incessantly noisy world alone may lead to mental health concerns, hopelessness, and anxiety relating to tinnitus symptoms. As of 2018, estimates indicate that 48% to 78% of those experiencing severe tinnitus also “experience depression, anxiety or some other behavioral disorder” (ATA, 2018). On top of that, Henk M Konin’s study published in 2019 found that 66% to 76% of chronic tinnitus patients in the study have sleep disorders, with disturbances including “difficulty in falling asleep, difficulty in maintaining sleep, early-morning wakefulness, and non-restorative sleep with daytime sleepiness, and chronic fatigue” (Koning, 2019).

The resulting stress and anxiety can often worsen tinnitus symptoms as a result of a constant activation of the body’s natural fight or flight response (Hear, 2017). Usually regulated by the body’s emotional filter, the limbic system’s uninhibited release of natural stress chemicals like cortisol can constrict blood flow and quite literally throw the brain, body, and inner ear into a state of chaos. In this way, treatments for tinnitus frequently focus on reducing the body’s overall state of stress with the most effective treatments for tinnitus including Cognitive Behavioral Therapy (CBT), Biofeedback, Tinnitus Retraining Therapy (TRT), and masking (Harvard, 2011). Out of these options, CBT is shown to be effective for over 60 percent of individuals seeking to improve their outlook on life, in addition to stress reduction (Harvard, 2011). For someone with tinnitus, unexpected or persistent ringing can often create distress when attempting to perform daily tasks, something which CBT and Biofeedback attempt to directly address. By placing electrodes on the skin, patients engaged in Biofeedback treatment are guided using CBT stress reduction techniques and learn to monitor their muscle tension to achieve relaxation. In controlled trials, biofeedback is shown to be an effective and reliable treatment option for tinnitus (Weise, 2008).

TRT, a newer method of tinnitus treatment, is another option for those in search of mental solitude. The American Tinnitus Association (ATA, 2018) explains TRT as following a series of mechanisms with the sole focus on minimizing the recognition of ringing. These mechanisms include 1) masking, or exposing the client to a sound louder than their tinnitus, 2) distraction, or shifting the client’s attention away from the sound,  3) habituation, or leading the client to recognize the sound as unimportant and regular, and 4) neuromodulation, or the introduction of a specific sound helping the client to achieve a reduction in brain activity associated with tinnitus. It should be noted, however, that when compared to long-term patient satisfaction with other tinnitus treatments such as cochlear implants, TRT is shown to be only 30 percent effective (Pienkowski, 2019).

Masking devices are another form of treatment related to the first mechanism of TRT. These devices are typically cost-effective and can provide immediate relief, making them the most common form of treatment for those with moderate to occasional tinnitus episodes. These devices include hearing aids and sound modulators that offer specific tones, some of which can be provided using sleep apps such as myNoise or NatureSpace, and are available on most smart devices. By covering or altering the sound in the surrounding environment, the devices mask or distract the sufferer from the ringing they experience, providing a significant amount of relief (ATA, 2018). Overall, while masking, TRT, and CBT may offer relief, the limited effectiveness and ability to fully treat tinnitus symptoms illustrates the importance of preventing or reducing tinnitus before it becomes a serious problem. 

Because tinnitus is frequently the result of inner-ear damage, avoiding harm to the ear and surrounding areas is critical. This, however, is easier said than done. Michele Abrams, a clinical audiologist at Southern Connecticut State University, explains that although volume and decibel levels are important, exposure to loud noises over time can have additive effect damage to the inner ear. This type of sound exposure is also referred to as the intensity-time tradeoff. As Michele explains, “We know that 85 db is a critical level. Eighty-five db, eight hours a day, that’s your maximum. If it’s 90 db — five db greater — you have to cut your time in half” (Mack, 2016). To put that into context, city traffic is around 85db while the average conversation operates at a decibel rate of between 60-75db (Yale, 2015). 

The British Tinnitus Association suggests a few additional methods to reduce the possibility of tinnitus formation. These include but are not limited to: making sure to clean ear devices to prevent wax build-up and infection, taking regular breaks from loud environments, avoiding loudspeakers or concerts without ear protection such as earplugs, taking advantage of noise-canceling capabilities, and lowering the volume on personal listening devices (BTA, 2021). Other recommendations include making sure that your headphones or earplugs have a snug fit to reduce the amount of ambient noise. This is important as it can reduce the perceived need to increase volume past a safe decibel range, something that can also be controlled by visiting the volume limit on most apple devices (Mack, 2016). 

Tinnitus is a condition that can cause high levels of distress, ranging from mild annoyance to severe anxiety. Understanding the causes of tinnitus and raising awareness of viable treatment and prevention methods allows people to avoid developing this usually permanent symptom, with the most effective prevention is protecting the ears from loud noises. These precautions may include wearing earplugs in loud environments such as concerts, keeping headphone and radio volume low, and wearing protection in gun ranges or while performing music. While tinnitus cannot be cured, treatments can work to offset its debilitating nature for those who experience it (Harvard, 2011). Requiring further investigation and research, tinnitus requires increased public awareness to prevent the likelihood of its occurrence and to help those in search of a solution. 

 

References

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