Tinnitus lacks cure, but a few treatments can help

By Warren King
Seattle Times medical reporter

	MICHELLE KUMATA / THE SEATTLE TIMES
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"At the bad times, you can't do anything but feel pity for yourself," says Nguyen, 49, of Renton.

No one around Nguyen can hear what she hears. Her constant noise companion is from within, the result of a condition called tinnitus.

Experts estimate 50 million people in the United States alone suffer from tinnitus, commonly the result of damage to the hearing system. The sounds they hear are unmistakable and often unrelenting.

The most common is ringing. (Tinnitus is from "tinnire," Latin meaning "to ring.") Others include whooshing, roaring, clicking, buzzing, whistling, hissing, even melodies.

For more information: • American Tinnitus Association: 800-634-8978, www.ata.org. • American Academy of Otolaryngology — Head and Neck Surgery: 703-836-4444, www.entnet.org/healthinfo • National Institute on Deafness and Other CommunicationDisorders: www.nidcd.nih.gov • Self Help for Hard of Hearing People: 301-657-2248, www.shhh.org

In most cases, there is no cure for tinnitus. Most are associated with hearing loss, and the nerves of the ear and brain that form major components of the hearing system cannot be rewired. The vast majority of patients must simply learn to live with the condition.

"We tell patients that it's like an old tube radio where the tubes have gone bad," says Dr. Larry Duckert, University of Washington professor of otolaryngology. "The radio can't bring in the station anymore, and the tubes and intrinsic parts start to hum."

Damaged hair cells

Often the cause of tinnitus is related to damaged hair cells in the cochlea of the inner ear. When they're working properly, tiny hairlike structures on the cells' surface move with sound waves and the cells send electrical signals to the brain. When they're damaged, hearing is lost and the signals may produce random noise.

Common causes of hair-cell damage are age-related deterioration (called presbycusis) or loud noises — ranging from prolonged exposure to loud music or industrial noise to an explosion or other sudden, extreme sound.

Some drugs in the wrong doses also can damage the hearing system. Such was the case with Nguyen, who as a teenager living in Saigon had daily injections of the antibiotic streptomycin for about 10 months to treat tuberculosis.

The antibiotic damaged the hearing in her left ear and impaired her sense of balance by damaging part of her inner ear.

Over time, her hearing became worse and the tinnitus ensued. Dizziness also became a significant problem, and worrying that the problems would permanently interfere with her work as a software designer made everything worse.

"The stress made the sound louder," said Nguyen. "It was distracting. I still could do my work, but it did affect my productivity."

While overdoses of a powerful antibiotic caused Nguyen's tinnitus, many other drugs, including aspirin and other nonsteroidal anti-inflammatories (NSAIDs), can cause the disorder, especially with prolonged use or improper doses. More than 200 prescription and over-the-counter drugs have the potential to cause the problem, according to the American Tinnitus Association, an advocacy, education, support and research organization.

Many, many causes

Like the medications, other possible causes of tinnitus vary widely.

Coping with tinnitus Experts say there is no treatment for many of the estimated 50 million people with tinnitus. But there are things to avoid and ways to cope with the noise: • Avoid: Any type of loud noise, excessive use of alcohol, nicotine, caffeine, quinine (contained in tonic water), high doses of aspirin. All can increase the noise of tinnitus. • Ask your doctor about your medications: More than 200 prescription and over-the-counter drugs list tinnitus as a possible side effect. Too much aspirin or other products with acetylsalicylic acid could be a culprit. • Find ways to control stress and depression: Exercise, get plenty of sleep, eat properly, talk with a counselor or people in a tinnitus support group. • Mask the noise: Competing sounds at a constant low level can help. These could include radio static, soft music, recorded nature sounds such as running water or a fan. For some patients, physicians prescribe hearing aids, which amplify desired sounds, or maskers, devices that are worn like hearing aids and cover up the sound of tinnitus. Sources: American Tinnitus Association, National Institute on Deafness and Other Communication Disorders, the Mayo Clinic

Factors that can damage the hearing system, which includes the auditory nerves of the brain, include trauma to the head and neck, tumors on the hearing nerve, multiple sclerosis and strokes. Occasionally, but not often, the symptom of tinnitus points the way to a more serious, underlying problem, such as a head or neck tumor. Otosclerosis — deterioration of the sound-conducting bones of the middle ear — also can bring on tinnitus.

Sometimes, the hearing system itself is not damaged; the noise stems from another underlying problem. A buildup of ear wax or an infection — both treatable — can cause tinnitus. So can allergies; Ménière's disease, a disorder of the balance-portion of the inner ear; and an underactive thyroid.

A disturbance in blood flow also can cause internal noise. The narrowing and stiffening of an artery from atherosclerosis or a malformation of blood vessels in the brain can cause the beats of the heart to become audible. High blood pressure can make the noise of tinnitus louder.

Still, doctors are unable to find a cause for many cases of tinnitus. Many patients have no hearing damage and there is nothing else that would explain the noise.

'Very frustrating'

Physicians freely admit they do not fully understand the mechanism of tinnitus. It is one of the least understood conditions in medicine, they say. And very often they are unable to provide any relief.

"It's a very frustrating condition for the patient. All cope differently with it. And it's extremely frustrating for the physician because we can't always fix it. It's frustrating for everybody," says Dr. Doug Backous, medical director for the Listen for Life Center at Virginia Mason Medical Center.

Heidi Nguyen knows frustration in abundance.

Last summer, she finally left a stressful job to return to school, studying to become a certified database administrator. It was important to remain productive, she said, despite her increasing problems with tinnitus and dizziness.

The dizziness, however, soon became so difficult that she underwent a procedure by Duckert to destroy the vestibular organ of her left ear — the damaged portion of her inner ear that so impaired her balance.

The surgery eliminated her dizziness, but the noise in her ear continued. Nguyen sank further into a depression that had been building. She wondered if she would be able to continue her studies, or even be able to work again.

"It turned my life upside down. It was a tsunami for me. ... Never in my life did I think I would have to face a disability like this," said Nguyen, whose family gave her great support and tried to reassure her during those dark days.

Last fall, Nguyen returned to Duckert seeking help for her depression and the noise that still plagued her life. His prescription of an antidepressant helped significantly, and she is now on a much more even keel. She is better able to cope with the tinnitus that continues in varying intensity, depending mostly on her level of stress.

"It's like being a fisherman," she says. "On a good day, when you have good weather, you can go all day. On a bad day, when there is bad weather, you work to a minimum and know it will go away."

Ways to cope

Antidepressants have helped many people with tinnitus, according to Backous and Duckert. Physicians also can treat some underlying problems, such as switching from a medication causing a problem, removing ear wax, or treating an infection or underlying vascular problem that causes turbulent blood flow.

Otherwise, relatively few treatments are available for tinnitus caused by permanent damage to the hearing system. Some of the treatments used by those who are unable to find a way of coping with tinnitus include:

• Hearing aids: For people with hearing loss, hearing aids amplify the sounds they want to hear, making it easier to tune out the sound of tinnitus.

• Maskers: Worn like hearing aids, these devices produce a sound that masks the noise of tinnitus. A combination hearing aid and masker also is available for those with hearing loss. To mask tinnitus noise, some people use audio tapes, bedside maskers that are outside the ear or radio static. Backous had one patient who found the perfect masker in a TV set tuned between channels.

• Tinnitus retraining therapy: This treatment combines use of a masker and counseling. It helps patients learn how to ignore their tinnitus.

• Biofeedback and relaxation: Patients monitor body indicators such as blood pressure and muscle tension and learn how to change them through relaxation techniques.

Things to avoid

Aside from treatment, physicians say, patients can stay away from a variety of things that increase the noise of tinnitus. These include: loud noise, drinking too much alcohol, recreational drugs, caffeine, smoking, fatigue and stress.

"If you have tinnitus," says Backous, "you have to understand where it's the worst. And you have to learn how to adapt to it."

Nguyen has worked hard at adapting to tinnitus. With the help of a counselor, she has put her condition in perspective and learned important ways to keep the noise to a minimum. During the best times, it sounds like the whistle of a gentle wind blowing through a crack.

Most important, she says, is to get plenty of rest. At night, when she is growing tired from studying, she puts her books aside, confident she can return to them in the morning. She avoids loud noise. She avoids a lot of movement, such as driving, which seems to make the noise worse. And she has learned to focus on other things in her life, rather than worrying that tinnitus might seriously impair her.

"I feel less and less fear about it. ... Nowadays I feel like I live more of a normal life," says Nguyen.

The experience of tinnitus also has given her insight about her life. She appreciates her abilities and material possessions more. She is confident she will be able to enjoy her work and remain productive. And she has more compassion for others.

"This illness has made me be a more thoughtful person, more considering," Nguyen says. "Now I see someone with an illness, and I truly feel for them."

Warren King: 206-464-2247 or wking@seattletimes.com

Copyright © 2004 The Seattle Times Company