Stop that damned ringing

How tinnitus can drive you crazy, and how it can be cured.

Published May 6, 1999 4:00PM (EDT)

In parts of rural India people believe that if your ears are ringing, you
are hearing the voice of God. If this is so, then "God" is no longer
speaking to William Shatner. For a while there, God wouldn't shut
up. God's voice made William Shatner go very nearly mad. William Shatner
was ready to do anything to rid himself of the Lord's reverberations. Even
kill himself. But in 1996, before he could be driven to suicide, William Shatner met Dr. Pawel J. Jastreboff.

Jastreboff cast the Lord out of William Shatner's ears.

Audiologists have a specific term for Shatner's affliction: tinnitus.
Pronounced tin-NIGHT-us or TIN-it-us, the term refers to ringing or other noises in the ears or head. Tinnitus is one of the most widespread
disorders of the auditory system -- and with a battery of recent studies
demonstrating that our aging ears are paying the price for noisy lives in a world that keeps getting noisier, tinnitus is on the increase.
According to the American Tinnitus
50 million Americans
suffer from "annoying" tinnitus. Of these, 12 million find their tinnitus
so distressing that they seek medical intervention.

You probably have tinnitus. More than 90 percent of us have some level of it. If you put yourself in a very quiet place (Jastreboff would recommend an anechoic chamber, but a closet full of coats will do) and concentrate, you will likely detect a high-pitched whine, a soft seashell roar or perhaps chirping crickets. Unless you're one of the 50 million people for whom it reaches the level of annoyance, however, the white noise of everyday life is probably enough to mask your tinnitus. The trouble begins when this threshold shifts. We've all been to a loud concert or ballgame and left with our ears ringing. Now imagine if that sound never left, and kept intensifying. A relentless little demon, tinnitus announces itself in the ears but frequently extends its residence to the spirit, where it can have debilitating emotional
effects. It can, quite literally, drive you crazy.

"It just takes over your life," says Patsy Clark, a 52-year-old piano
teacher from Bowling Green, Ky., who was forced to resign her position as church
organist last year when tinnitus made it impossible for her to hear the
music she was playing. "It makes you feel desperate and frustrated, and
your whole outlook is bleak. Sometimes I couldn't eat." Frustrated after fruitless trips to medical doctors, Clark found a librarian who put her in touch with the ATA, who in turn put her in contact with Dr. Jay Hall, an audiologist and director of the
Vanderbilt Balance and Hearing Center in Nashville, where Clark is currently
under treatment.

Both Shatner and Clark found relief through tinnitus retraining therapy (TRT), a technique pioneered in the early 1990s by Jastreboff, a
tinnitus expert and researcher at Emory University. TRT is attracting
widespread attention both for its success and its attention to the emotional
aspects of tinnitus. Through a combination of counseling and a
sound-generating device that "retrains" the brain, TRT essentially provides
the patient with the ability to unconsciously tune out tinnitus -- to ignore,
if not escape, the demon.

But how can a little ringing in the ears drive you to depression? Why can
some people ignore it, while others obsess over it? According to
Jastreboff, we are just beginning to understand these things. "If I believe
my own theories," says Jastreboff, tinnitus "is happening on a dynamic
balance scenario." In other words, what goes in your ear can come out your
psyche. It's not as far-fetched as it sounds. Studies using positron
emission topography to chart brain activity have recently confirmed
what researchers have long suspected: In certain people, tinnitus activates
both the auditory and limbic (emotional) centers of the brain. Tinnitus can
raise your blood pressure, induce anxiety, unleash feelings of guilt, loose
the bats in your belfry. "Sounds can trigger all kinds of emotions," says
Hall. "That's why music is so powerful. You can hear one song and not
even know it's there, or you can hear another and be moved to tears -- and
it's just sound. So the emotional response to sound can be very, very
dramatic. Tinnitus should be in a neutral category. It should be like Muzak
in an elevator -- you shouldn't even notice it. Unfortunately, with certain
people, it generates profound negative emotions."

Operating on the psychological principle that known, even unpleasant,
phenomena are less frightening than the unknown, directive counseling
centers around "demystifying" tinnitus by teaching the patient about its
mechanisms and its dynamic association with emotion.

Habituation begins with the attachment of a noise generator the size of a
hearing aid that makes a low-level sound just below the volume of the
individual's tinnitus. The device is worn eight to 10 hours a day for
18 to 24 months. During that time, according to Jastreboff, the brain
undergoes "plastic" changes, reprogramming itself to tune out the sound; in
the process, the tinnitus is "tuned out" as well. If treatment is
successful, the tinnitus remains, but the patient is no longer aware of it.

TRT is riding a wave of unprecedented research on tinnitus and its
treatments. Publications like Tinnitus Today and the International Tinnitus
Journal Online describe
ranging from acupuncture to implanted
tinnitus suppressors. Relatively unheard of 10 years ago, international,
multidisciplinary tinnitus conferences are now common.

As with any hot area of research, competing camps of thought have begun to
emerge. "For many years, few people were interested because it seemed
little could be done," says Hall. "We're just now going through that
transition where people are learning more about it, and some battle lines
have formed around professions -- the audiologists vs. the psychologists
vs. the ear surgeons -- but this is a complex problem that is bigger
than any one profession. In many cases no one professional can evaluate it.
[In the future], I'm optimistic you will have a lot of multidisciplinary cooperation."

Tinnitus is not a disease; it is a symptom. Because it can be caused by an
underlying medical condition or drug reaction,the ATA recommends that anyone seeking treatment for tinnitus begin with a medical evaluation, preferably by an ear, nose and throat specialist.

It is possible to have tinnitus and still have normal hearing. In more than
90 percent of cases, however, it is accompanied by hearing loss. While many
severe tinnitus sufferers peg their troubles to a single intense incident,
the intrusion of clinically significant tinnitus is generally cumulative
and gradual, and long-term noise exposure is the No. 1 cause. "In most cases, tinnitus has probably been present, but not noticed," says Hall. "But then an event will come along -- they'll go to a loud concert or shoot a gun, or they may experience an emotional event such as an illness or the death of a spouse -- and that's when they start to notice the tinnitus." In
other words, something happens to our ears or our emotions that nudges
tinnitus over the hump from intermittent distraction to disturbing nuisance.

Not everyone gets a bad vibe from all the noise. In remote regions of
China, tinnitus is welcomed as a sign of wisdom. In parts of Turkey, it
portends good luck. And, according to Jastreboff, certain religious
sects in India feel that tinnitus is an intimate message from the very voice
of God. William Shatner, who is not from India, sought out
Jastreboff. "He came in very discouraged," says Jastreboff. "He was very
close to a suicidal state. He blames the breakup of his second marriage to
tinnitus -- I'm not sure about that, but he was in very, very bad shape
indeed. He went through my treatment, and he's fine now."

By Mike Perry

Mike Perry is a registered nurse who has written for Esquire, Newsweek and the New York Times Magazine. He lives in Wisconsin.

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