Tinnitus: The noise that annoys
Ringing, buzzing and humming in the ears can be torture for tinnitus sufferers like me, writes Enjoli Liston. But at last there's hope of a cure
Tuesday 13 October 2009
Eeeeeeeeee. Eee, eee, eee. Hmmmm. Ssssssss. Or maybe even whoooooosh. Irritating, aren't they? These are just some of the kinds of invasive noises experienced by people living with tinnitus, a condition characterised by ringing, buzzing, humming or whistling noises heard in one or both ears without any external source.
For the 2.3 million people in the UK who have tinnitus, including myself, very little currently can be done to silence the noises that experts now know are not generated in our ears, but in our brains. However, the results of a new study announced this week by scientists in the US have shown that the areas of the brain which are activated when tinnitus is experienced can now be pinpointed. And as a result, more effective targeted treatments – and perhaps even a cure – may be closer than ever.
For most people, the peaceful night-time quiet just before sleep is the perfect antidote to the stresses of the day. But for me and so many other people, the nights are often the worst – because they are rarely ever quiet. For two years, I have experienced a high-pitched ringing in both ears, as if someone decided to plant a TV, switched on but muted, in my brain. There is a history of tinnitus in my family, which I have made worse by standing too close to speakers at too many concerts (more on that later). I have always been told there was nothing doctors could do about it. However, although there is currently no cure, there are a few treatments that have found some success. I have learnt to ignore tinnitus as my way of living with it, but my constant companion is not loud enough to be seriously intrusive. I'm one of the lucky ones.
Rachael Nugent is not so lucky. Although tinnitus is often typecast as an affliction of old age, Rachael, a 32-year-old personal assistant from Manchester, has lived with the condition for more than eight years. She has pulsatile tinnitus, which means the "noise" she experiences beats in time with her heart. "At first, I only noticed it at night time as a quiet noise. But suddenly, without warning, I started to hear it all day, every day." Rachael went for tests and even an MRI scan to rule out the more serious conditions tinnitus can occasionally be associated with, such as thyroid dysfunction, diabetes and a benign tumour on the auditory nerve known as acoustic neuroma.
When these conditions were eliminated and doctors diagnosed tinnitus, they could offer no help. "When they told me there was no more that they could do for me, all hope went and I just, well, had a meltdown I suppose ... I felt like no one was taking me seriously," says Rachael. "I dealt with it really badly and became very angry." She paid privately for a year of counselling to help her cope with this anger, but has found that the most successful way of dealing with the noise itself, is distraction. Rachael has moved from a quiet office to a noisy, bustling fashion company, in order to prevent herself dwelling on that fact that she can "hear the blood rushing through" her ears.
Although the exact causes of tinnitus are still relatively unknown, it is most commonly linked to prolonged exposure to loud noise (which was probably the trigger for my own condition). Despite this, noise is also one of the most effective treatments. Paul O'Flynn, a consultant ear, nose and throat surgeon, says: "It's important to try and reassure people that most cases of tinnitus are not sinister or progressive, and encourage them, conceptually, to think of it as the internal equivalent of background noise, like air conditioning or traffic. When people notice this noise, they focus on it and it enters their consciousness. It can become an aggravation. But you can train the mind away. During quiet periods, listen to the radio – focus on other things."
For many, this is easier said than done. Daniel Campbell, a 22-year-old lance corporal in the Royal Engineers, found his tinnitus impossible to ignore until he began using a noise generator, a small device tucked behind his ear emitting a constant but adjustable level of noise. Daniel developed tinnitus in his right ear after his ear defender fell out during a training mission in Belize and suffered sleepless nights for more than two years because of it. Initially, Daniel didn't know what he was experiencing was a recognised condition and his doctors said there was nothing they could do to help. "I thought, that's great, I've got to live with this ringing in my ear for the rest of my life." But the noise generator has proved a comfort, emitting noise that keeps the ringing from becoming progressively worse throughout the day, so that when night falls, it remains bearable.
But noise and distraction doesn't always work. Although some have found comfort in complementary therapies such as yoga, Alexander technique, relaxation meditation, hypnosis and acupuncture, the success of these treatments depends on personality, as each person's tinnitus is as unique as the person themselves.
And for a small proportion of people, their tinnitus is so severe that it becomes torture. The actor William Shatner developed tinnitus after an explosion on the set of Star Trek, and admitted earlier this year that he has even contemplated killing himself because of the unbearable level of noise he experiences.
It is for this small proportion of people that the new study developed by scientists at Henry Ford Hospital in Detroit offers renewed hope. The team scanned 17 patients with tinnitus and 10 without, using a technique called magnetoencephalography or MEG, to measure the magnetic fields generated by electrical currents in the brain's neuron cells.
Tinnitus patients with ringing in one ear had the most activity in the auditory cortex on the side of the brain opposing the ear with tinnitus. And patients with ringing in both ears showed activity in both hemispheres of the brain, with greater activity in the opposite side of the brain to the side with the loudest tinnitus. However, those without tinnitus had a few small active areas in the brain, but none that showed particular consistency.
The scanning techniques previously used to detect this kind of activity are less precise. "MEG, however, is a much more sophisticated machine," says Dr Michael Seidman, director of neurology at Henry Ford Hospital and lead researcher on the study. "It can identify a specific tone or topic point, so only a small area in the brain lights up. It's like having the lights on in only the city of Detroit, compared to having the lights on in the entire state of Michigan."
Treatments using a magnetic field to reduce neural activity around the auditory cortex of the brain have already proved successful in Germany, and several promising drug trials are under way – but by narrowing down the target area of the brain, they may prove more effective.
David Baguley, consultant clinical scientist at Cambridge University Hospital, says this research shows "exquisite detail" of the areas of the brain involved in tinnitus, and as such, offers "a first step" towards the effective treatment of severe cases. He also believes tinnitus researchers may be as little as 10 years away from this goal. "It's all at a very exciting stage where treatments are actually being tried on people, rather than just being talked about," says Baguley. "People should no longer be told there's nothing that can be done."
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