Getting Back to Sleep

Sleep continues to be a major problem for many people with tinnitus. The most common problem is that they wake during the night and then cannot get back to sleep, often blaming the tinnitus for initially waking them and then preventing them from getting back to sleep. Although tinnitus can cause a person to wake from sleep, there are many other more obvious factors that can cause this, such as irregular hours, having something on your mind, poor sleep habits, etc. To understand what is happening when we are awakened from sleep and how to get back to sleep, we must understand our bio-clock or "circadian rhythm".

Humans, like all other animals, are biologically programmed to follow a 24 hour cycle that is linked to sunlight and darkness. This rhythm regulates natural chemicals that rise and fall within our bodies throughout the 24 hour period, governing periods of alertness and sleep, as well as those states between the two.

Although humans have a circadian rhythm that dictates that we will be more alert during the day, and more likely to sleep during the hours of darkness, we all have minor variations that manifest themselves in some people being more a 'morning person' or a 'night owl', etc. These minor variations are not important. However, what is important, is maintaining a regular routine in our 24 hour period. If you regularly go to bed at 10.00pm each night, but decide to stay up until 3.00am for the next few nights, you are disturbing your natural rhythm and it is highly likely that you would not function at peak performance for the following few days. Part of any sleep management programme dictates that you should have a regular bedtime and get up at about the same time each day. This maintains your circadian rhythm.

Part of our circadian rhythm is that we have a wave cycle happening throughout the day and night that allows our body to have periods of less intense alertness during the day, and periods of deeper rest during the night. Without this natural cycle occurring, we would be like a motor that is running on full throttle all the time and would soon 'burn-out'. At night, this cycle continues, causing us to go from periods of rest to actually falling asleep. These cycles happen approximately every 90 to 120 minutes and can be likened to waves that form in the ocean: they arrive on the beach at more or less regular intervals, and, when the wave of deep rest arrives, we are more likely to fall asleep.

When some people wake during the night, they make a conscious effort to fall back to sleep immediately. When this does not happen, frustration and anxiety sets in and the more they try to get back to sleep, the more likely they are to toss and turn all night and NOT go back to sleep. The waves of deep rest that will lead to sleep will happen regularly throughout the night in the same way as waves reaching the beach. Surfboard riders can paddle as fast as they like between waves, but they will not go anywhere until a wave appears. In the same way, if you wake and your wave of deep rest in not upon you, you are better to physically and mentally relax, clear the mind and wait until the next wave of deep rest occurs, at which time you will most likely go to sleep.

If you can relate to waking during the night and having trouble getting back to sleep, recognize that your wave of deep rest may not be upon you yet. If you have been awake for 40 minutes or so and are experiencing anxiety in trying to sleep, get out bed and do something that will occupy your mind for half an hour, such as writing a list of things to do tomorrow, writing a letter or doing a crossword. These activities will stop your 'sleep anxiety' and allow you to return to your bed ready for sleep.

This article reproduced kindly with the permission of Tinnitus Association of Victoria.

 

 

 

 

The Downward Spiral

This article is written by Ross McKeown and Ian Paterson: counsellors with the Tinnitus Association of Victoria

I have received thousands of calls on the tinnitus advice line and counselling service over the last fourteen years, and that experience has enabled me to identify a range of types of callers.

The two most difficult types to help are those who suffered from depression and anxiety disorders before the onset of the tinnitus, and those who are determined to search for a cure or a treatment that will reduce the volume of the tinnitus. It is this latter group that I want to address in this article. 

A brief look at the internet under ‘tinnitus cures and treatment’ will quickly show that these people are in for a long journey that I believe will end in disappointment, great expense and a reduced ability to manage the tinnitus.

THE DOWNWARD SPIRAL:

When I first developed tinnitus just on twenty years ago, there was very little information available on how to successfully manage your tinnitus.  I received all sorts of well meaning advice from friends and health professionals about treatments I should consider, and so I began what turned into a devastating period of my life. 

Each treatment followed the same pattern. I would get my hopes up only to have them shattered when the treatment had no effect on my tinnitus. I fell into what I call the ‘downward spiral’.  Each successive failure made it more difficult to cope with my tinnitus and I became more depressed and anxious.

So when people tell me they intend to explore the range of purported cures and treatments believing it can`t do any harm, I tell them I believe such an approach is counter productive.

At this point in time, reputable tinnitus researchers and health professionals with an interest in tinnitus agree that there is no cure for tinnitus.  But unfortunately, many of them fail to tell you that it can be successfully managed.

Much ground-breaking research is being done on tinnitus, and our knowledge of the mechanisms and models of tinnitus generation is improving rapidly.  We know that tinnitus is not an ear problem, but a brain problem.  This knowledge has enabled tinnitus researchers to better focus their research projects, and some researchers are beginning to express optimism of a future cure for tinnitus.

However, living in hope of a cure for tinnitus is not helpful.  You must learn to manage it now.

MONITORING THE TINNITUS:

While undergoing alternative treatments for tinnitus you tend to continually monitor the tinnitus to determine whether the treatment is working, and consequently give the tinnitus a prominence it doesn't’t deserve.  And as we know, the more a person focuses on their tinnitus, the louder it will appear and the more distressed they will become.

The psychologist, author and tinnitus researcher Richard Hallam, describes it as the ‘Tinnitus Catch 22’, that is, the more attention you pay to your tinnitus and pursue ways of lessening its effect, the more you are likely to focus on it and treat it as significant.

MANAGING  YOUR TINNITUS:

The TAV believes there are four keys to successful tinnitus management:

1. The need to overcome any fears and worries about the tinnitus.

2. Changing one`s perception of the tinnitus.

3. Understanding the importance of focus.

4. Reducing the stress in one`s life, if necessary.

Successful tinnitus management in time will lead to habituation, where you no longer have a negative emotional response to the tinnitus.

As you become more relaxed about, and accepting of your tinnitus, the times when you are not focussing on your tinnitus becomes longer and more frequent.

In time you will find that your tinnitus has little effect on you quality of life.

In our seminar booklet we have a list of management strategies that I believe are worth printing again in this article. I hope you find them useful.

DON`T...

1. Continually monitor the level of your tinnitus.

2. Work through an endless range of `cures`.

3. Live in hope of a miracle cure.

4. Talk about it constantly with family and friends

5. Remain angry about this unfair intrusion.

6. Spend frequent periods listening to your tinnitus.

7. Remain anxious and depressed about your tinnitus.

8. Feel guilty about not coping.

1. Overcome your fear of the tinnitus.

2. Accept your tinnitus as a normal part of your life.

3. Stop worrying about it.

4. Keep busy focusing on stimulating and enjoyable activities.

5. Surround yourself with ambient and environmental sounds.

6. Gain strength from others who successfully manage their tinnitus.

7. Employ relaxation and stress management strategies that work for you.

8. Learn to accept the fluctuations of your tinnitus.

DO NOT LET YOUR TINNITUS MANAGE YOU, YOU MUST MANAGE IT!!

TINNITUS MANAGEMENT SEMINARS : 2010

The dates for the first three seminars for 2010 are: March 14th and May 9th.

Please note that we are changing the seminar day from a Saturday to a SUNDAY for a trial period which will be reviewed in June.

CONTACT DETAILS:            

Tinnitus Association of Victoria

PO Box 731

Woodend  Vic  3442

Phone (BH) 9770 6075

Web Site: www.tinnitus.org.au

 

 

 

 

 

Ear Syringing

Our bodies are confined by skin which is waterproof and an effective barrier to most harmful external agents. The ear canal is lined with skin, which unlike skin elsewhere, cannot be reached with a finger. When it is dirty it cannot be washed, when it is wet it cannot be dried, When it itches it cannot be scratched by finger nails and when it is sore it cannot be soothed.

The lining of the skin of the ear canal grows upward from its deepest layer of cells. Older cells are pushed towards the surface eventually forming a layer of dead cells. Scales of these dead skin cells, similar to those rubbed or washed off elsewhere on the body, accumulate in the ear canal. At the same time glands within the skin of the ear produce a waxy secretion which mixes with the dead cells. It is this mixture that we call ear wax. It may be soft, even runny, if the secretion predominates; or firm and hard if it is mainly composed of dead cells.

While the skin is growing from the deepest layers to the surface, it also grows sideways and migrates out of the ear canal. This has been illustrated by placing a drop of Indian ink on the ear drum. If inspected daily over a period of weeks, it appears to move along a spiral path and eventually drops out of the ear. This process, unimpeded,  normally keeps the ear clean by carrying away any dirt or wax on the surface of the skin as it migrates. If this self-cleaning system fails for any reason, or if the wax is pushed back into the canal by over-enthusiastic cleaning, the wax collects and may block the canal. This commonly occurs without any problems and, therefore, needs no action.

However, occasionally wax does produce problems. The commonest is a slight degree of deafness. In people with troublesome  tinnitus, this deafness may be sufficient to increase the apparent loudness of the tinnitus, which is often masked during the day by background sounds. In some individuals the presence of wax covers the masking effect of the background noise.

The tinnitus is brought to the subject’s attention by the wax. Some will lose the sensation after syringing, but a few will continue to be aware of the sound and be concerned about it enough to make the symptom into a medical complaint. Someone with troublesome tinnitus, whose ears are blocked by wax may, therefore, benefit from having it removed.

People who have eczema or dermatitis of the ear are likely to have a reaction to some of the additives, resulting in itching, pain or discharge from the ears. For this reason ear drops should only be used when there is a good reason for removing the wax and only if there is no known tendency to skin problems. Even if the drops are used, they do not always clear the wax.

The common alternative is syringing. Water, at body temperature, is injected through the nozzle of a syringe into the ear canal. Under the gentle force of the syringe, it runs into the deepest part of the canal where it forms eddies which dislodge the wax. The wax is carried out of the canal by the continuous flow of water for as long as the syringing continues. If the wax seems hard, it is best to soften it by the use of drops for one or two days prior to the syringing.

In competent hands and with a relaxed subject, the procedure is usually painless and effective. Considering the vast numbers who have their ears syringed each year (perhaps a million in the UK) the numbers of serious complications are small. However, there seems to be a very small number of cases where the procedure coincides with the onset or aggravation of tinnitus.

The reason for this is not clear. Pain in the outer ear canal should not “cause” tinnitus which is quite a different sensation. The noise of syringing has been measured and it does not seem to be very loud, certainly not loud enough to cause noise induced damage. It has been suggested that there may be nervous reflexes, perhaps to the temperature of the water used, either too warm or too cold, but there is no proof, so this remains a theoretical possibility only.

Perhaps the most likely explanation is that syringing, especially if unpleasant for any reason, can act as a trigger to bring the patient’s attention to nervous activities which are already present, but hidden within the auditory pathways of the nervous system. The emotional response to pain or anxiety which can accompany syringing may be sufficient to make the hearing mechanism more sensitive, enough to detect and amplify these faint auditory signals, which once heard, become established in the consciousness as tinnitus.

If the tinnitus is seen as a result of damage caused by syringing, understandable but perhaps misplaced anger will ensue. This may prevent habituation (the process by which we cease to listen to boring background noise of no significance), and the tinnitus will become more intrusive and persistent. It could be a combination of some of the factors mentioned which links syringing with tinnitus, or there could be other mechanisms of which we are, at present, unaware.

In some cases it may even be coincidence. There are syringing alternatives available to be administered by a Medical Practitioner. Wax can be removed with a metal probe or hook. In skilled hands, this is easy and effective, but likely to be more painful. It is used far less than syringing, and it too may sometimes be associated with the onset of tinnitus. Suction, through a narrow tube, is another method used in ENT departments to clean ears. This is much noisier. It sucks cold air into the ear and can be painful if the skin is sensitive or inflamed. Like the other method it too has been associated with tinnitus.

To summarize:

• If the wax is not a problem, it is best left alone;
• If removal is justified for medical reasons, ears drops should be tried;
• For those few people for whom drops are inadvisable, or where drops have been tried and failed, or where immediate removal of wax is necessary for some reason, careful syringing by someone who has been properly instructed in the technique is the best option.

This information is not a substitute for medical advice. You should always see your GP / medical professional.

This article reproduced kindly with the permission of Tinnitus Association Victoria.

 

 

 

 

Ensemble Spontaneous Activity in Tinnitus

By Daniel Stolzberg, ATA Student Research Grant Recipient

Neurons (nerve cells that send and receive electrical signals in the body) in specialized regions of the brain are responsible for our ability to hear. However, in order to interpret both simple and complex sounds, such as speech or a note on a piano, a subset of these neurons must respond in synchrony (occur at the same time) with the temporal rhythms and oscillations (repeating fluctuations of brain activity.

By analogy, in an orchestra comprised of millions of musical neurons, the music of Beethoven will only emerge from the neural activity when all the members of the “orchestra” follow the tempo of the musical passage.  Individual members of the orchestra must carefully listen to the ever-evolving musical theme and react appropriately to maintain the melody.

The role of brain rhythms

For more than a century, researchers have been recording brain rhythms in an attempt to understand how the brain processes sensory information. They have segregated the rhythms of the brain into several classes by the frequency with which they occur. Some frequency bands are associated with specific activities. For example, when you close your eyes, an alpha rhythm (10 Hz) will be generated from the visual processing areas of your brain located at the back of your head. The alpha rhythm seems to be important for maintaining order over large areas of the auditory, visual and somatosensory cortex. Gamma rhythms, which occur at higher frequencies (30-60 Hz), typically develop when a new sensory signal (sound, sight or touch) arrives at the cortex. The strength of these bands is constantly changing as we attend to, or ignore, the sensory signals coming in from the environment.The relative strengths of alpha and gamma band brain waves can tell us much about what the brain is processing or attending to.

BRAIN RHYTHMS AND TINNITUS:

Within the past few years, researchers studying tinnitus have noticed that even in quiet, the brain areas that process sound in people who suffer from persistent tinnitus have proportionally less strength in the alpha rhythm and more in the gamma rhythm than those who do not suffer from tinnitus. This pattern of activity is very similar to those that occur when your brain receives a sound from the environment. In our research using animals with noise-induced tinnitus, we noticed a pattern very similar to that recorded from humans suffering from tinnitus.  The broad goal of this research project is to understand how small groups of neurons, as well as individual neurons (the individual musicians) change their interpretation of the entire orchestral piece to give to tinnitus.

WHY RHYTHMS MAY CHANGE:

One possible reason why these rhythms change their pattern of communication during tinnitus may be a loss of normal sound input due to noise trauma, drug toxicity or age-related hearing loss. When the brain loses normal input from the ear, the brain tends to adjust to make it better able to detect any input that may still be available. In doing so, individual neurons may receive messages from other neurons they normally would ignore.

AWAKE AND ALERT:

An important aspect of my research is obtaining measurements related to tinnitus rats that are awake and conscious.  During sleep or anaesthesia, we do not normally perceive sounds  from  the environment or the internal phantoms sound of tinnitus.  Therefore, I obtain all of my measurements of brain rhythms, before and during tinnitus, from conscious animals.

Over the past few years, I have developed the techniques to record from unanaesthetized rats for up to several months. Although technically challenging, my results are likely to provide a better understanding of how changes in brain rhythms contribute to the perception of tinnitus and what brain regions may be involved.  A major component of my efforts during the past year has been developed custom computer software to pick out the activity of single neurons from the cacophony of activity from thousands of other surrounding neurons and to relate the neural activity to changes in the brains rhythm.

ASPIRIN AND NEURONAL CHANGES:

I present here some of the first new data to come from this project.  We gave an awake rat a high dose of aspirin, a drug known to reliably induce tinnitus.  A small group of neurons responded in the rat’s auditory cortex before (left) and one hour after (right) inducing tinnitus.  These figures represent the ongoing rhythmic activity in the rat’s auditory cortex that occurred just before (-1 to 0 seconds) and just after (0 to 1 seconds) the neuronal response.

In an animal without tinnitus, energy in the alpha band (8-12Hz) decreased during the neuronal event (occurring at 0 on the bottom axis), while other frequency bands, such as theta (4-7 Hz), increased.  During the neuronal event the energy in the alpha band decreased. Other frequency bands, such as gamma (30-60 Hz) and beta (12-30 Hz), seemed to increase. 

Thanks to the generous support of ATA, I now have the technology, tools and experience to better study the neural underpinnings of tinnitus in awake animals.  In addition, this research will allow us to test the efficacy of drugs and other forms of treatment to alleviate tinnitus.

 

 

 

 

Questions and Facts about Tinnitus

WHAT IS IT?

Tinnitus is a subjective experience of hearing a sound, a ringing, or a noise when no such external physical sound is present. Some call it "head noises", "ringing", or other similar things.

WHAT DOES "TINNITUS" MEAN?

There are many causes: indeed almost everything that can go wrong with the ear has tinnitus associated with it as a symptom. Things as simple as wax against the ear drum to very serious items as tumors on the Vill nerve can produce tinnitus. Otosclerosis (fixation of the bones in the middle ear) can produce tinnitus. Ménière's disease has tinnitus associated with it. One of the most common causes of tinnitus is exposure to excessively loud sounds such as shooting, chain saws, rock concerts, and other loud sounds. Other known causes of tinnitus result from infections, allergies and circulatory disturbances producing changes within the ear.

DO MANY PEOPLE SUFFER FROM TINNITUS?

Yes, in its severe form tinnitus is the third worst thing that can happen to mankind. The worst is severe unrelievable pain, the second worst is severe, unrelievable dizziness, and the third worst is severe unrelievable tinnitus.

DO WE KNOW WHAT TINNITUS IS?

No, the actual thing or event or mechanism of tinnitus is not known. We know it is real; something has gone wrong in the auditory system, but we do not know what that something is. We do know that it is not the patient's imagination; it is a physiological or neurological event that is real.

DOES TINNITUS MEAN THAT ONE IS GOING DEAF?

No, tinnitus is an indication that some kind of damaging agent has attacked the hearing mechanism, but its presence does not mean that the patient will become deaf.

WHAT MAKES TINNITUS WORSE?

• Loud Sounds. This is the key thing. Tinnitus patients must avoid loud sounds. If they use chain saws or shot guns or ride loud motorcycles or use outboard engines, etc., they must wear ear protection, either ear plugs or ear muffs, or both. Tinnitus patients are encouraged to do an overkill in protecting their ears from loud sounds.

• Nicotine. We ask all tinnitus patients to give up smoking because of the vascular effects of nicotine.

• Caffeine. We ask all tinnitus patients to give up all forms of caffeine for a one-month period to determine whether or not caffeine has an adverse effect on their tinnitus. Caffeine is found in coffee, tea, all cola drinks such as Coca-Cola and chocolate.

• Excessive Use of Alcohol. Almost all tinnitus patients find that following states of intoxication, their tinnitus is worse.

• Marijuana. All tinnitus patients are urged to avoid marijuana in all forms.

• Stress or Fatigue. These do tend to aggravate tinnitus whatever the cause. Many things can help to refresh and relax you, e. g. getting enough rest, controlling stress, etc.

• Medications (for other illnesses) which makes the tinnitus louder must be reported to your doctor - an alternative should be obtained. Avoid aspirin if possible.

• Weather Change. For quite a few tinnitus patients, a change in atmospheric pressure can either reduce or worsen their tinnitus temporarily.

• Attention. Concentrating on the sound can make it louder.

IS IT ASSOCIATED WITH HEARING LOSS?

In most cases, tinnitus is associated with some hearing loss. For example, those who have been exposed to excessively loud sounds will have a hearing loss for the high-pitched tones. Usually their tinnitus will be located as a high-pitched tone in the region of the hearing loss. In some cases, tinnitus is present where there is no hearing loss and for no discernible reason.

WHAT CAN BE DONE ABOUT TINNITUS?

The first step is to consult your doctor who may refer you to an Ear, Noise and Throat specialist to investigate the cause.

WHAT TREATMENTS ARE AVAILABLE FOR TINNITUS?

Wearing a Hearing Aid

If a hearing impairment accompanies your tinnitus, then wearing a hearing aid may help. A hearing aid amplifies conversation and environmental sounds which will often mask tinnitus. Concentrating on outside sounds tends to reduce awareness of 'internal' sounds.

Stress Management

Stress has a significant impact on the perception of the tinnitus as it leads to the heightened sensitivity of the brain to all sounds. It is worth evaluating your lifestyle so it includes enjoyable and relaxing activities. Become passionate about a sport, a hobby, further education, or something to concentrate on when the tinnitus is annoying you.

Listening to Other Sounds

Some environmental sounds can mask tinnitus, e. g. the sound of the sea, rain, the noise of a fan or air conditioner, engine noise, the ticking of a loud clock, the radio, music, etc. and it can be especially helpful to listen to sounds late at night as it is likely you will be most aware of your 'sound' at that time. If necessary, you can listen to the radio through a 'pillow speaker', so that others cannot hear it. Some find that the static noise produced by a radio, tuned slightly off-station, can also drown out tinnitus. Sleeping with your head on extra high pillows may alleviate tinnitus as it sometimes relieves congestion.

 

 

 

 

International Seminar

The most up to date information on Tinnitus research and treatment comes out of the 8th International Tinnitus Seminar held at Pay, France from 6th to 10 September 2005.

Dr. Ross Dineen and Myriam Westcott of Myriam Dineen of Dineen-Westcott Audiology, Heidelberg in Melbourne, attended this conference.

Sue and I attended the annual meeting of the Victorian Tinnitus Association where Ross and Myriam presented their report on the conference.

I also had a quick catch-up with them and introduced myself again as a member of our wonderful Wimmera Hearing Society Inc. team.

A copy of the six page report is available at our office or ring or email us for a posted or faxed copy or check the Victorian Tinnitus Association web site.

These were prevalent in recent tinnitus research:

• the Physiological Mechanism of Tinnitus (the brain’s physical mechanisms which cause tinnitus).

• the Hastreboff Neurophysiological Model of tinnitus and tinnitus retraining therapy (how can we train or trick our brain into coping with or eliminating tinnitus).

• the psychological implications and treatment of Tinnitus (how our mind and emotions and thought processes react to tinnitus).

  I found the physiological research very interesting and encouraging. This is a promising area in which many new experiments lie ahead before treatment at cerebral cortex level (brain stem) will be possible.

  While the papers are very technical, those of you who are really nterested would appreciate being kept up to date on the latest research.

 

 

 

 

Guess What?

Young women seem more likely to get tinnitus than young men. The National Study of Hearing reports that young women get tinnitus eight per cent more frequently than men.

Tinnitus used to be called boilermaker’s ear, because shop floor workers in heavy industry often complained about it.

Reports suggest that blue-eyed people are statistically more likely to suffer from tinnitus. Blue-eyed people have less of the pigment melanin than brown-eyed people and melanin is thought to offer some protection. 

Studies show that tinnitus affects the left hear more commonly than the right.

In 1801 Dr Grapengiesser, a physician from Berlin, reported treating tinnitus with Volta’s column of silver and zinc plates. Developed on year earlier, this was actually the first battery!  For people without tinnitus, the electric current would actually bring tinnitus on; but for people with tinnitus, the device woud help suppress it.

Believing that tinnitus might be relieved by inhaling the vapours of chloroform and prussic acid, ear specialist Joseph Toynbee (1815-1866) subjected himself to the ‘cure’ - with fatal consequences.

There is a theory that Vincent Van Gogh cut off his own ear because he had Meniere’s Disease (which includes tinnitus). But please, don’t try this at home!

The English word “tinnitus” comes from the latin word “tinnire”, which means to ring or tinkle.

Noise pollution isn’t a new problem. As early as 720BC, authorities in the Italian City of Sybaris introduced ‘noise zoning’ into local planning laws.

The Annamite tribe in eastern India believed that the ear is inhabited by a small animal whose function is to protect the ear.  If it starts fighting with similar animals, or is disturbed by a foreign body, tinnitus results.

Reprinted from RNID’s One in Seven magazine supplement.

 

 

 

 

Tinnitus and Hearing Loss

Hearing Aids by Ross Dineen and Myriam Westcott (Dineen & Westcott Audiologist).

People with a hearing loss often blame their tinnitus for their hearing problems, particularly when communicating in groups and in background noise. The tinnitus is a symptom of a hearing loss, not a cause. If you have hearing loss, then hearing aids will be effective in both the management of your hearing loss and your tinnitus.

Hearing aids, by amplifying external sounds around you, will result in your internal noise, or tinnitus, becomes less noticeable. To be effective in managing both the hearing loss and the tinnitus, hearing aids need to be worn for most of the day. 

The effort of straining to hear a conversation and resultant communication difficulties frequently lead to frustration, fatigue and stress. These are all major aggravating factors in the tinnitus awareness and annoyance. Once you have adapted to the amplifications provided by your hearing aids, you can expect a significant reduction in stress and fatigue.

Because your hearing loss is likely to have developed over some time, your concept of what is “normal” hearing has also slowly changed. When hearing aids are fitted for the first time, and sounds are boosted to the level they should  be heard, your concept of what is “normal” hearing will need to be adjusted. Many sounds will seem unnaturally prominent or noticeable for the first few weeks, as it takes time for the brain to relearn these sounds. This adaptation or adjustment period may last up to several months. For this process of adaptation to occur, it is advisable to use your hearing aids for most of the day. 

Your hearing aid may be less effective as a tinnitus management tool when you are in a quiet environment. Sounds enrichment is required, using the strategies previously outlined. It is important to remember, however, that most people with a hearing loss will have a reduced ability to hear a voice through background noise. Digital signal processing hearing aids are now available with multiple channels, twin microphones and noise suppression features to assist communication in background noise. Conventional hearing aids do not have these features. 

When you remove your hearing aids, you may notice your tinnitus appears more prominent. Don’t be concerned about this; it is simply due to the lack of amplification of environmental sounds making your tinnitus seem louder by contrast. Try not to remove your hearing aids in a quiet environment; increasing the volume of environmental sounds will help.

Genes that cause age related hearing loss
Breakthrough in Search for Genes that Cause Age- Related Hearing Loss scientists funded by RNID, the national charity for deaf and hard of hearing people, have discovered evidence of a gene that contributes to age related hearing loss.

The research, just published in the journal ‘Human Mutation’ could eventually lead to treatments being developed to prevent age related hearing loss, they believe. Hearing loss is the most common sensory impairment among older people, affecting around 6.5 million people aged over 60 in the UK. Hearing loss erodes the quality of life for many making it difficult for them to communicate with their family and friends, which can lead to increasing isolation. Currently, there is no way of identifying those risks or preventing the onset of hearing loss

 

The RNID-funded project, led by Professor Guy Van Camp at the University in Antwerp, tested the hearing of 645 people aged 40 and 80. Genetic analysis of a gene called KCNQ4 showed significant differences in its sequence between those with a hearing loss and those without, which was confirmed in a separate study of a further 664 people. The findings indicated that KCNQ4, gene known to function in the ear, contributed to age related hearing loss. To confirm this, additional research needs to be carried out to identify the sequence changes that alter the way the gene works. 

Dr Ralph Holmes, RNID’s Biomedical Research Manager, says: “ Many people consider hearing loss as an integral part of ageing, rather than a potential preventable condition. This research provides another important piece of the jigsaw in highlighting a gene associated with age-related hearing loss, It offers real hope that treatments will be found and we are optimistic that in the future people will no longer face the prospects of losing their hearing as they age.” 

Professor Van Camp headed the research at the University of Antwerp and the findings are published in the Journal ‘Human Mutation’ (Vol.28. August, 2006) at: www.wiley.com/humanmutation.

Hearing isn’t just about ears: Age-related hearing loss is not just a case of the ear losing the hearing function. The ability of the brain to process sound is weakened as well. Modern digital hearing aids with directional microphones may solve some of these problems. The ears are still crucial for hearing, but preliminary studies in mice indicate that a decrease in certain processes in the brain may make it harder to filter out unimportant sounds.

‘Traditionally, scientist studying hearing problems started looking at the ear. But we are finding patients with normal ears who still have trouble understanding a conversation. There are many people who have good inner ears who just don’t hear well. That’s because their brains are ageing.’ said Dr. Robert D Frisina of the University of Rochester Medical Centre.

Failure of the Brain
'The preliminary research result, published at the annual meeting of the Association for Research in Otolaryngology, pointed towards a decreasing ability of the brain, as it ages, to sort and filter out the many sounds channelled in through the ear every day. This indicated that the so-called feedback of the brain to the ears no longer function fully, causing many to find that they have trouble discriminating between the sounds around them and focus. For many people, even if they can hear sounds as they get older, they still lose the ability to understand speech, because of these brain problems’. Frisina said.

People with these problems may find a partial solution in modern digital hearing aids with directional microphones, which can filter out some background noise. For many people, the decline begins when they reach their 40’s or 50’s. 

New Medication
The scientists hope that their research, in time, will make it possible to develop new medication which may alleviate the problem of the brain, just like the current medications alleviate other neurological conditions. 

Sporting Danger
Exciting matches, animated discussions, deafening goal celebrations, the World Cup was more than just a fest for Ballack, Ronaldinho and other scoring predators, it was a test for the fans, as well. Those who joined the throngs of the spectators flocking the game in Germany, took with them their fans paraphernalia, but they should also have taken earplugs for their own good. ‘The noise in a football stadium can be a serious threat to your hearing’, said Burkhard Mathiak, a spokesman for the German Schalke 04 Bundesliga team who recorded noise levels during the game. ‘The intensity and noise levels following a goal compare to the noise from a jet at take off’, said Mathiak.

‘The noise level is comparable to that in a night club, reaching 110dB. The blaring of horns can reach levels as high as 130dB and although these horns are illegal, they are still brought into the stands by football fans, and they constitute an imminent danger to the hearing of the people around them. The same is true for other noise making devices, such as whistles, smoke bombs and megaphones that can cause instant permanent hearing damage.

Not regulated 
Unlike the work environment, sports events are not subject to noise regulations and when we leave the workplace we often expose ourselves to extremely high levels of noise without giving it proper thought. Some people even find extreme noise level exhilarating.

Tinnitus articles reprinted with compliments of Tinnitus Association of Victoria.

 

 

 

 

Research Gives Hope for Cure

Areas of the brain responsible for tinnitus, which cause constant roaring and ringing in the ears, have been isolated for the first time by doctors in America.

The discovery could lead to a cure for the condition, which is linked to deafness. Researchers from the University of New York and the United States Veterans Affairs Department Medical Centre in Buffalo, New York realised that some patients could control loudness of the noises by clenching and unclenching their jaws. Using position emission tomography, or PET scanning, they were able to trace blood flow in the brains of tinnitus patients.

When they made their tinnitus louder, there was a corresponding increase in activity in small areas of the temporal lobe, opposite the affected ear. The results were compared with other tinnitus patients who did not manipulate the noise and with people who did not suffer from tinnitus. Dr. Alan Lockwood of the State University of New York in Buffalo, who headed the study, said "By identifying the sites in the brain that mediate tinnitus, we have taken a critical step down the road toward a cure for this disabling condition".

Other findings, never before observed, included an abnormal link in tinnitus patients between the area of the brain responsible for hearing and the limbic system, the brain wiring responsible for emotions, which may explain why tinnitus can be emotionally crippling.

The study was reported in the Medical Journal of Neurology.

By Celia Hall, Medical Editor, HEARNET.

Article reprinted with permission from the HEARNET website.

 

 

 

 

Low-pitch Treatment alleviates Ringer Sound of Tinnitus

This article has been taken from the March 2007 edition of Tinnitus Talk It is an interesting article and may be a cheap and practical idea to try.

For those who pumped up the volume one too many times, UC Irvine researchers may have found a treatment for the hearing damage loud music can cause.

Fan-Gang Zeng and colleagues have identified an effective way to treat the symptoms of tinnitus. A low pitched sound, the researchers discovered, applied by simple MP3 player suppressed and provided temporary relief from the high pitch ringing tone associated with the disorder. Some treatments exist, but none are consistently effective.

Zeng presented his study on Feb 13 at the Middle Winter Research Conference for Otolaryngology in Denver.

“Tinnitus is one of the most common hearing disorders in the world, but very little is understood about why it occurs or how to treat it,” said Zeng, a professor of otolaryngology, biomedical engineering, cognitive sciences, and anatomy and neurobiology. “We are very pleased and surprised by the success of this therapy, and hopefully with further testing it will provide needed relief to the millions who suffer from tinnitus.”

As director of the speech and hearing lab at UCI, Zeng and his team made their discovery while addressing the severe tinnitus as a research subject. The patient uses a cochlear implant to address a constant mid-range pitched sound in his injured right ear accented by periodic piercing of a high pitched ringing sound ranging between 4.00 and 8,000 hertz in frequency.

At first, Zeng thought of treating the tinnitus with a high –pitched sound, a method called masking that is sometimes used in tinnitus therapy attempts. But he ruled out the option because of the severity of the patient’s tinnitus, so an opposite approach was explored, which provided unexpectedly effective results.

After making many adjustments, the researchers created a low-pitch pulsing sound  - described as a “calming, pleasant tone” of 40 to 100 hertz frequency—which, when applied to the patient through a regular MP3 player, suppressed the high pitched ringing after about 90 seconds and provided what the patient described as  a high –level for continued relief.

Zeng’s patient, programs the low-pitched sound through his cochlear implant, and Zeng is currently studying how to apply this treatment for people who do not use any hearing –aid devices. Since a cochlear implant replaces the damaged mechanism in the ear that stimulates the auditory nerve, Zeng believes that a properly pitched acoustic sound will have the same effect on tinnitus for someone who does not use a hearing device. Dr. Hamid Djalilian, a UCI physician who treats hearing disorders, points out that a custom sound can be created for the patients, who then can download it into their personal MP3 player and use if when they need relief.

“the treatment , though, does not represent a cure,” Zeng said “this low –pitched therapeutic approach is only effective while being applied to the ear, after which the ringing can return. But it underscores the need to customize stimulation for tinnitus suppression and suggests that balanced stimulation, rather than masking, is the brain mechanism underlying this surprising finding.‘

 

PSYCHOTHERAPY QUIETS CONCERNS OVER RINGING IN THE EARS

Psychotherapy may help tinnitus sufferers cope with the life disturbances that sometimes accompany their condition, according to the new review of studies. A counselling method called cognitive behavioural therapy or CBT seems to amplify patients’ quality of life, even when the volume of the noise remains the same.

“It’s a way of working on beliefs and changing psychological responses to tinnitus,” said lead reviewer Pablo Martinez-Devesa. “usually you’d assess the patients to change the attitudes of patients toward the tinnitus, then introduce education on the possible causes, then, though several sessions, you would try to change the attitudes of patients towards the tinnitus.’

The review of six small randomized controlled trials gathered data on 285 patients.

The vast majority of people with the condition do not seek treatment but cope with the noise inside their head on their own.

But between 0.5 percent and 3 percent of adults with tinnitus have a chronic condition severe enough to impinge on their life. Among these sufferers, sleep disturbances, anxiety and depression are common.

After participating in CBT, tinnitus suffers reported greater overall satisfaction with their life, compared to a similar group of patients who did not receive CBT treatment, the Cochrane review found.

Tinnitus researcher Robert Folmer said how people react or deal with the perception of sound is what separates a sufferer from someone who is little bothered by tinnitus. Folmer, an associate Professor of Otolaryngology at Oregon Health and Science University, was not on the Cochrane review team.

Cognitive behavioural therapy, which helps people with life and coping skills, is widely available throughout the United States, but Folmer suspects that few American practitioners are using CBT to treat tinnitus.

“We refer a lot of people for psychological counselling, including CBT, but the problem is we never know what they are going to get when they go there.” Folmer said. “When I say CBT that means something different to everyone . There's a wide range of what that could be.”

Martinez-Devesa says standard cognitive behavioural therapy would include patient education about the condition. But Folmer said that even  without specific knowledge about tinnitus, a CBT provider can still be helpful.

“Even though a therapist doesn’t know anything about tinnitus, if  they help the patient with co-symptoms, our studies have shown that the severity of tinnitus goes down, if these other factors improve.” he said.

Often, doctors are at a loss for ways to effectively treat chronic tinnitus. In those cases, helping someone with related conditions like anxiety or sleeping problems becomes the best solution, Folmer said.

Martinez-Devesa P, al. Cognitive behavioural therapy to tinnitus Review. Cochran Database of Systematic Review 2007, Issues 1.  Ear, Nose & Throat News (Health Behaviour News)

This article has been taken from Tinnitus Talk March 2007 edition.

 

 

 

 

 

 

 

 

 

Muscle Relaxation Techniques

These exercises can be carried out during the day, before going to bed or actually in bed.  The important thing to remember is that you are in a quiet surroundings.  If necessary, switch off the telephone.  When commencing  the exercises, close your eyes and try to relax your body and mind.  After each step in the routine, repeat to yourself the words relax, relax, relax.

Turn your toes under: count to five, take a deep breath and release the tension in your toes.  And breathe out, relax, relax ,relax.

Turn your toes towards your face: count to five: take a deep breath and release the tension in your toes. And breathe out.  Relax, relax, relax, relax.

Try to push your buttocks through the chair or bed: count to five and take a deep breath, breathe out and relax your buttocks.  Relax, relax, relax.

Stretch your right arm out in front of you, be sure it is still and tight at the elbow: count to five and take a deep breath, then SLOWLY lower your arm and breathe out.  Relax, relax, relax.  Repeat with the left arm.

Next, place your palms in front of your chest, as if you were praying: press them tightly together as you count to five, breathing in at the same time.  SLOWLY bring your arms down and breathe out.  Relax, relax, relax.

Rest your chin on your chest:  press down hard.  Breathe in as you count to five.  SLOWLY raise your chin and breathe out.  Relax ,relax, relax.

Tip your head back so that your neck is stretched.  Count to five as you breathe in.  SLOWLY bring your head to the upright position as you breathe out.  Relax, relax, relax, relax.

Try to raise your shoulders to touch your ears.  Hold that position  while breathing in and counting  to five. Lower your shoulders as far as you can and breathe out.  Relax, relax, relax.

Screw your eyes shut very tightly: count to five while breathing in.  Release your breath and relax the muscles around your eyes, your face and your mouth.  Relax, relax, relax.

Open your mouth and eyes as widely as you can.  Take a deep breath.  Now close your mouth as you breathe out and open your  eyes, and  just relax.

Become aware of the whole of your body.  Shift your body around until you are really comfortable, with good posture. If you are sitting in a chair, place your feet flat on the floor on a cushion, with your ankles together.  Do not cross your legs.

After you have finished those exercises, continue with this simple breathing technique.

Breathe gently: do not force your breath. Keep your eyes closed. As you breathe out, say the word ‘one’ to yourself. This is ‘mindless’ and does not require much thought. Keep saying it each time you breathe out. If it is a long drawn-out breath then let the Word ‘one’ follow its length. If it is a short breath then it is a short ‘one’. Follow the word as if is flowing through your blood stream – from your neck down – and through your arms or legs or wherever your mind takes it. Your mind may wander onto more mundane thoughts, such as the family or things you could be doing, but discipline your mind to refocus on your breathing and that word ‘one’. Do this for 20 minutes. You may check the time but do not set your alarm clock. Carry out this breathing technique for the full 20 minutes or more. If you are in bed then in all probability you will already be asleep! Take your time getting out of your chair.

THE FOLLOWING EXERCISES WILL HELP TO RELAX THE AREAS AROUND YOUR BACK, NECK AND SHOULDERS.

Sitting upright in a chair, very slowly - to the count of five - bring your chin down to your chest.  Hold that position for a count of five.  Now slowly, to the count of five, bring your head back to the upright position.

Now - very slowly to the count of five - tilt your head back and hold it in that position.  Then slowly, to a count of five, raise your head to the upright position.

Keeping your head straight, move it to the right side (do not lean forward as you carry out the exercise).  Count to five and slowly bring your head back to the upright position.  Repeat the exercise to the left.

Next, cross your arms by having the right hand clutch the right shoulder and the left hand clutching the right shoulder.  Really stretch both arms.  Very slowly return to an upright position.

Now, bring both your elbows back until there is a ‘crease’ between your shoulder blades.  Hold that position as long as you can, then return to the upright position.

When you feel tense, carry out these exercises and your tension will reduce.

Remember to stay calm and relaxed, so allowing smooth transmission of chemical and electrical messages throughout the limbic system and connected parts of the brain, thence to your body.  This will result in a healthier body and mind.

 

 

 

 

 

The Power of Perception

Stephen Nagler from the Alliance and Hearing Centre, Atlanta, Georgia U. S. A. presented a paper at the 7th International Tinnitus Seminar in Fremantle, Western Australia in March. Titled "The Key to Success in Tinnitus Therapy", it contained the following two wonderful analogies that demonstrate the importance of perception when learning to cope with tinnitus.

You're travelling in a jam-packed subway car with hundreds of other commuters, hardly room to breathe. Some fellow starts repeatedly poking you in the back - very firmly - with the tip of an umbrella.

What happens? Well, if you're normal, you would probably get angry. Your face would turn red, your pulse would go up, and your blood pressure would begin to rise. These are readily measurable physical changes, no psychology about it, right? So you turn around to tell this inconsiderate jerk to stop poking you with the umbrella.

And upon turning around, you discover that it is not an umbrella at all; it's a gun! Again, palpable physical changes. All due exclusively to how you thing about the same stimulus - a poke in the back. So you reach into your pocket to give the crook your wallet.

And when you look again, you discover that you are again mistaken; it's a blind lady inadvertently poking you with her cane as she tries to maintain her balance in the crowed train. The colour returns to your face. A shudder of compassion overcomes you, and your eyes may even become a bit moist, as you gently escort the lady to a safe spot in the train. Again, measurable physical changes brought about solely by your thoughts regarding same stimulus - a poke in the back.

The Importance of Perception

There was a travelling salesman making several stops during a cold winter. He is chilly, tired and hungry, but he has forgotten to make a motel reservation. He sees a motel by the side of the road - one level. Park right outside your room. Vacancy light flashing. The manager says that there is one room left, but unfortunately the steam radiator has a small crack in it; there is a consistent 'hssss' sound as steam escapes.

The salesman is cold, tired and hungry and takes the room gratefully. He enters the room, notices the quiet 'hssss' sound and puts down his bags, eats a sandwich, brushes his teeth, takes a nice hot shower, puts on his pajamas, pulls back the fresh linen on the bed, crawls in and falls asleep.

The next morning he awakes refreshed and goes on his way. Six weeks later, he finds himself in the same situation. Same town. Cold, tired, hungry. No reservation. He remembers the motel. The manager says 'I have one room left. It's the same room you had six weeks ago and I apologize; I have not yet the chance to fix the steam radiator'. The salesman say 'No problem. I slept just great six weeks ago. I'll take it'.

As he is walking down towards the room, the manager yells to him 'Oh yes, one other thing. A couple of days ago a travelling circus came trough our small town here, and two cobras escaped from the snake charmer. They caught one of them right here - about twenty metres up the street. And they expect to catch the other one any time now. Thought you'd like to know. Have a good night's sleep'.

The salesman enters his room. He hears it. 'Hssss, he looks carefully behind the curtain. Then he gets ready for that nice hot shower, but he slowly peeks into the shower before take .... a quick shower. He then gets ready for bed. He looks under the bed first. He pulls down those fresh sheets .... rather cautiously ... before he slides in .... somewhat tentatively.

Do you think he sleeps? Not a wink! He tosses and turns all night, cannot wait to leave at daybreak, even before. As he leaves the motel, the manager see him. 'Hi. Glad I caught you. I got a phone call around 2am. An eighteen wheeler ran over the second cobra about two kilometres up the road. Just thought you'd like to know'.

Six weeks ago. this 'hssss' of the cracked steam radiator was a meaningless neutral background sound, which quickly faded away and afforded the salesman a pleasant restful sleep. Now, the exact same sound - same frequency, same intensity, same character - was the most intrusive, most annoying sound imaginable - only because it had taken on a new meaning. But was it really louder? It certainly seemed so to the salesman - even though the reading on a decibel metre placed in the room would have been identical. And since people who are afflicted with (subjective) tinnitus are the people who can hear their tinnitus - perceived loudness is the only loudness that counts. Perceived loudness is a function of two variable - the magnitude of the signal and the meaning assigned to that signal.

Article republished with permission from Ross M^cKeown, Tinnitus Association of Victoria.

 

 

 

 

Along the Road to Relief: Medication

Professor Ewart Davies of the Department of Pharmacology at the University of Birmingham UK has an encouraging message.

He believes it won't be long until medication provides effective treatments for most cases of tinnitus, despite the vagaries of individual response. The dual nature of tinnitus and its interpretation has naturally influenced the direction of the search for a medical remedy.

Most trials have been directed by ear specialists and have aimed primarily at modifying or abolishing the sounds themselves. Among others, diuretics, anti-spasmodic and lidocaine have been investigated. Some have had a modest success. But none are ideal for the extended use that people with persistent tinnitus often need. Diuretics flush nutrients from the system, which then must be replaced; anti-convulsives may cause problems, lidocaine must be delivered intravenously and its effects appear short-lived.

In real life, these are significant drawbacks. For one thing, many doctors will be reluctant to prescribe them. (The eventual best use of these medicines may be to interrupt erroneous nerve signals when they first appear, to prevent them becoming chronic). New anti-convulsives like topiramate and oxcarbazine are less likely to cause problems.

A slightly different psychosomatic approach deals with the problem indirectly, aiming to reduce the symptoms that make tinnitus a burden: sleep disturbance, difficult concentrating and feelings of anxiety. This makes sense because we all know that some people have tinnitus but are not really bothered by it. They can sleep well, have sufficient energy and are often unaware of the sounds.

Trends in the medical treatment of tinnitus:

• The number of medications that can modify neurotransmitter disorders is growing, improving the chances of finding one that helps, while having minimal side-effects;

• Family doctors are increasingly aware of the presence of anxiety or depressive states in patients and are more familiar with medications that may relieve these conditions;

• The increased ability of psychiatrists, and general practitioners as well, to safely combine psychoactive medications of different types for cases that resist a single drug, an indication that the right receptors on nerve cells haven't been activated. Examples are Zyprexa and Prosac.

Most often prescribed for tinnitus-related problems are:

• Tricyclics - amitriptyline, doxepin, nortriptyline

• SSRI's - Celexa, Paxil

• SNRI's - Effexor, Zyprexa

 

 

 

 

Acknowledging the Presence of Tinnitus

The first step to accepting tinnitus is to acknowledge its presence, to stop avoiding or denying that it is present, and to acknowledge that it probably won’t go away. Unfortunately for most people who have had tinnitus for more than six months it is unlikely that it will go away completely. So, one of the first steps in coming to terms with tinnitus is to admit to yourself that the tinnitus does exist and that it will probably be part of you for the rest of your life.

The importance of getting informed

When you first become aware of your tinnitus you may find yourself constantly thinking about it, worrying about it. Why is it there? What has caused it? Does it mean I’ve got a brain tumor, that I’m going crazy, and that I’m going to go profoundly deaf? Will it ever go away? How can I ever learn to live with this thing? It will drive me crazy! The more you worry about tinnitus, the more overwhelming it seems.

Everyone asks these questions. These are a normal reaction and an important part of coming to terms with tinnitus. What is not reasonable is to constantly ask these same questions over and over again, without actively setting out to find the answers to the questions above.

Focusing on tinnitus

By constantly worrying about the significance of the tinnitus you keep it at the forefront of your attention, giving the tinnitus a significance in your health and well-being which is most likely unwarranted. This is an essential part of becoming a “tinnitus sufferer”.

By making tinnitus a focus of your attention you can highlight its persistence and amplify your sense of being plagued by the tinnitus. The more you listen to, or attend to your tinnitus, the louder and more overwhelming it seems to become

Attention and tinnitus

The process of attending to the tinnitus highlights it in relation toe environmental sounds.

We all live in a world full of noise. In most situations we are surrounded by a range of different noises and sounds that we can selectively listen to or ignore depending on the situation we are in at the time, the nature of the activity we are engaged in, and our level if emotional excitation or arousal.

We listen to all the sounds that we are capable of hearing in a given situation at the one time. To try and do so would be overwhelming. Typically we notice one thing after another - the sound of a door banging, the buzzing of a fly, and the drone of the air conditioning in the room. The rumble of traffic in the distance, all these sounds may be all present at the same time but typically we tend only to notice the sounds one at a time.

The process of attention is simply to bring something into our conscious mind, our attention system. We attend first to those things that occur in a surprising way. For example, if the door bangs, it arouses our attention, though if it happens frequently then the power of the sound to grab our attention tends to diminish over time.

Secondly, we attend to those things that are useful to the activity in which we are engaged. For example, the murmur of voices in the next room indicating that guests have arrived. If a sound is boring or repetitive or meaningless we tend to stop paying attention to it.

The ticking of a clock, the hum of air conditioning in a room, the sound of our own breathing, all become monotonous and no longer draw or catch our attention, unless for some reason our attention is drawn to the sound by it changing in some way.

In a similar way when we are engaged in a repetitive activity, like driving a car, our immediate attention can wander from the task. We can drive automatically though our mind may be miles away, but if anything occurs which potentially signals danger, like a flashing red light in the distance, our attention is drawn immediately back to the task at hand.

Tinnitus has been termed a disorder of attention. In most instances tinnitus is not a significant warning signal in terms of your physical or psychological survival. In most cases it is an annoying but benign symptom of changes that have occurred in our auditory functioning. It deserves to be treated like any other repetitive, boring sound in the immediate environment. We should be able to ignore it, to selectively focus our attention away from it, yet often when we first experience tinnitus we cannot stop thinking about it.

We worry it, like a dog worries a bone. Part of the process of adjusting to tinnitus is finding out about our tinnitus, about the significance that it has to our health and emotional well-being so that we can begin to treat it with the disdain that it so richly deserves.

If we see our tinnitus as just another boring, repetitive sound in the environment, we can choose to attend to it or ignore it as we see fit. Obviously if it changes in some way or gets louder, our attention will be drawn back to it.

But through an understanding of the factors which affect our perception of tinnitus, we can work out what has caused it to change, and through that process allow it to recede back into the general level of background sound.

Emotion regulation or emotion focused scoping strategies refer to attempts to reduce potentially dysfunctional or destructive emotional reactions, which are the results of exposure to stress. Strategies such as denial and wishful thinking are used to avoid directive confrontation with the source of the stress.

Some researchers into stress management and coping emphasise the positive adaptive value of problem solving mechanisms where the problem-focused approach facilitates mastery of the environment. Emotion-focused coping styles on the other hand, are viewed by some researchers as being less adaptive in comparison to problem-focused coping strategies.

Some examples of PROBLEM-SOLVING ACTIVITIES directed towards minimizing the impact of tinnitus are:

 

 

 

 

The Tinnitus Prison

It is common for the brain to concentrate on negatives in a person's life and cause the person to view their particular problem, or situation, in unrealistic or exaggerated circumstances. The bigger the negative or perceived problem, the more the mind focuses on the problem.

This increased focus can cause mental and physical problems, resulting in further isolation from friends, family and society. When this happens, your life has no enjoyment or fun and every minute of your existence revolves around your tinnitus. Thus you are confined and isolated in your tinnitus prison.

This not only affects you, it can affect everyone you care about and have contact with, as they suffer the results of your depression and your withdrawal from life. Inevitably you end up in a downward spiral where your tinnitus and self-imposed isolation builds a self-imposed 'brick wall' around you as impenetrable as any prison wall.

You must break out of this 'tinnitus prison' and start 'living life'.

To do this take planning: planning to enjoy yourself, planning to start living life, planning for the future - by building ladders of positive expectations to scale the walls of the prison you are in.

This can be in the form of a day-to-day plan to visit friends, go for a walk, etc., or it can take a more structured and long-term form.

You can plan in a formal way, and there are many personal planning documents available on the Internet that will help you do this, or your plan can be a simple written list detailing what you would like to achieve over the next week, month, or year. The level of planning is up to you, whether it is highly structured or very informal, as long as you work towards achieving your objectives, all types of planning documents are equally beneficial.

Remember: you are in control of your life. If you decide that you want more out of your life, you can have it. You only need to decide what you want and work towards it.

The planning process is about assessing the past, determining future objectives and identifying the intermediate steps necessary to reach those objectives with realistic time frames.

Remember that your objectives should be SMART: Specific, Measurable, Attainable, Rewarding and Timely.

When you have gone over your Personal Planning Document and it is as good as you can make it, put it where you will see it each day, and review it and watch your progress towards the objectives each month.

Be pro-active, take charge of your own destiny. Nobody can or will do it for you: you must do it yourself.

By Ian Peterson, Vice-President of the Tinnitus Association Victoria.

Article reprinted with permission.

 

 

 

 

Show me the Evidence 

Occasionally I am approached to give approval to a product claimed either to stop tinnitus or greatly reduce its severity. By getting the TAV on side, the manufacturers know that their product will gain credibility. I have also had hundreds of calls from TAV members and other people with tinnitus who want to know whether I would recommend a particular 'alternative' treatment or medicine they have read about or heard about from a well meaning friend.

I actually consider 'alternative medicine' to be a misnomer. A treatment or medicine is whether it works or it doesn't. Why are products or treatments that cannot be tested or are not tested, or consistently fail tests, considered 'alternative'?

If a treatment is demonstrated to have curative properties in properly controlled double-blind trials, it ceases to be alternative and simply becomes an accepted treatment or medicine.

If a therapy or treatment is anything more than a placebo, properly conducted double-blind trials, statistically analyzed, will provide the evidence.

In double-blind, placebo-controlled study, approximately half the patients in the study are given the active drug and half are given a placebo or 'sugar pill'. It is double-blind when neither the patients nor the experimenters know who are receiving the active drug and who are receiving the placebo. The patient does not know initially that a placebo is involved. The implication is that all patients in the study are getting the active drug. When the study is completed, the code is broken and everyone finds out who took what. The results are then recorded. If the active drug does not do better than the placebo, the drug is considered of little or no value as a treatment.

For example, in the case of the Chinese herb, ginkgo biloba, a double-hidden, placebo-controlled study was conducted at the Medical School in Birmingham, England. This extensive, year-long 1,115 patient study showed that ginkgo biloba had no greater therapeutic effect than the placebo for tinnitus relief.

As a result of this study, I have the confidence to inform people that the evidence indicated that ginkgo biloba does not provide relief from tinnitus.

However, the problem has more complex implications for your general well-being than just wasting time and money. Whilst experimenting with a range of 'purported cures' for your tinnitus, each dashed hope is followed by a feeling of deeper isappointment and despair. And as I know from personal experience, you manage your tinnitus less successfully after each successive failure.

So the next time you are considering embarking on the 'latest' treatment for tinnitus, ask not only to see the evidence, buy in the absence of such evidence and ask why proper scientific tests have not been conducted.

And do not be deceived by anecdotal evidence. When two or three people are reported as getting relief from a particular product, this does not constitute proper scientific evidence.

Some members have argued that surely it can do no harm for the TAV to print such anecdotal experiences in the newsletter. I hope this article has demonstrated why the TAV believes such information would be counter-productive. As we tell participants at our monthly Tinnitus Management Seminars, when a proven treatment for tinnitus is discovered you won't read about in some obscure health column in a glossy magazine. It will be banner headlines around the world.

We can all continue to hope that someday there will be a cure for tinnitus. In the meantime, it is important to remember that with accurate information and a change in the way you think about your tinnitus, it can be successfully managed.

Many years ago in Scotland, a new game was invented.

It was ruled "Gentlemen Only ... Ladies Forbidden"

and thus the word GOLF entered into the English language.

 

 

 

 

The Sleep Connection

The degree of distress that head and ear sounds (tinnitus) cause is often directly related to the quality of our sleep. The best way to tone down the noises can be to re-establish a more normal sleep pattern.

Most deeply restorative Delta-wave (D-wave) sleep happens in the first three hours of the night. This contrasts with active sleep (REM - rapid eye movement) when ear and eye muscles contract rhythmically and brain cells fire way at a rate 20% faster than in wakefulness, assimilating challenges and changes encountered in our waking lives and filing significant information in our memory bank.

An overload of unresolved problems or new demands, twinges of pain from conditions like arthritis, and the stimulus of tinnitus may jumble sleep stages, with REM starting too early in the night and a shortage of D-wave sleep.

If this goes on for long, it upsets the balance of brain chemicals regulating complex biological rhythms. The result is fatigue, difficulty concentrating and reduced ability to tolerate sounds of tinnitus - in other words a vicious circle.

Another factor is that it is natural, after the age of sixty, to have a smaller sleep quota and to drift in and out of consciousness at intervals during the night. This may be one of the reasons we're apt to develop annoying tinnitus in later years.

Sleep disturbance can be either the cause or the result of tinnitus. Sometimes it is hard to tell which came first.

How can we escape this cycle?

• Keep the same hour of going to bed and getting up including the weekends.

• Don't nap for more than 20 minutes. Nap at the same time each day or not at all. Avoid naps after 4pm - don't nod off in front of the TV.

• Be sure your room is dark and under 22 degrees Celsius, your feet warm and your bed large enough; if your partner's movements disturb you, sleep in another bed (men thrash about more).

• Have some physical exercise during the day.

• Don't work or do anything physically or mentally demanding in the three hours before bedtime.

• Avoid alcohol later in the night.

• Don't drink caffeinated drinks after noon. It takes eight to ten hours for all traces of caffeine to be eliminated.

• For more help consider medications available on prescription. Discuss the options with your doctor.

Article reprinted from the September 2001 MSGV Whirligig Newsletter

Otitis Media - "Glue Ear"

Otitis media, glue ear and fluid behind the eardrum are all terms used to describe a common cause of treatable hearing loss in children.

How does it happen?

Behind your eardrum there is a space called the middle ear where three tiny bones sit which form a chain to help conduct sounds from the ear drum to the inner ear. Normally this space is filled with air. When a child has otitis media, this air is replaced by fluid. A visit to a GP is recommended to treat any ear aches or infections.

It is important to know that the hearing loss can be present without any obvious signs of infection. The hearing loss is conductive, which means the transmission of sounds to the inner ear is affect, and fluctuating, which means the degree of the hearing loss can vary.

How is it treated?

Medication may be prescribed by a GP, but in all cases it is important to determine that the fluid in the middle ear does not persist. If it does, it can be drained during a simple operation by an Ear, Nose and Throat Specialist and ventilation tubes, called grommets, may be inserted.

Why should we be concerned about this?

Conductive hearing loss can be a 'silent' problem: children may have no obvious signs except for behavioural problems or they may seem to hear only when they want to. Hearing loss present during critical speech and language development may cause learning difficulties which may not show until later.

What should parents do if they are concerned?

If you have any suspicions about your child's hearing, have your child examined by your GP, and a hearing test carried out by an audiologist.

 

 

 

 

Treating Tinnitus at the Brain Level

If researchers could identify the types of cells that become hyperactive, they could potentially find ways to reduce the level of cellular activity. This could pave the way for development of effective Tinnitus treatments. Research published recently by Dr Tom Brozoski at Southern Illinois University has already identified one group of cells in the dorsal cochlear nucleus that becomes hyperactive after noise exposure. These cells are called fusiform cells, a group of neurons whose levels of activity are known to affect structures higher up in the auditory system.

Future research by Dr. Paul Finlayson in our laboratory will help define other types of cells that become hyperactive after intense sound exposure. Experiments by Or Jinsheng Zhang have already demonstrated that certain drugs can inhibit hyperactivity when they are applied directly to the D. C. N. surface. Tinnitus research by Jos Eggermont at the University of Calgary has also found hyperactivity in higher-level structures of the brain, such as the auditory cortex.

Despite these promising signs, many new experiments lie ahead before a treatment for Tinnitus at the brain level will be possible. Chief among these: we need to continue testing a wider range of drugs to identify other chemicals that will affect activity in the dorsal cochlea nucleus without major side effects.

Drugs need to be identified that reduce the spontaneous activity in the D. C. N. without worsening hearing. It also needs to be determined if reductions of this spontaneous activity occur when the same drugs are given intravenously. We believe this information, which will come largely from animal studies, will continue to unveil the neural underpinnings of Tinnitus, a step necessary to pave the way for the development of treatment alternatives worthy of formal clinical trials.

Dr Kaltenbach, PhD is a professor in the Department  of Otolaryngology at Wayne State University in Detroit, Michigan, and is a member of A. T. A's Scientific Advisory Committee.

Reprinted from American Tinnitus Association "Tinnitus Today", March 2005.

 

 

 

 

Advances made in Understanding and Treatment of Tinnitus

Stimulation with Electricity

Direct electrical stimulation of the inner ear has shown promise for treating tinnitus. Early research showed that the delivery of electrical current to the cochlea by an electrode reduces tinnitus in some patients. (Aran et al.. 1983: Kuk et all.. 1989)

Furthermore, many patients who receive cochlear implants to treat profound hearing loss also report that their tinnitus is reduced when implants are activated (Tyler 1995, Miyamoto and Bichey 2003.) (Cochlear implants stimulate the cochlea with an electrode array). Research has now begun with the intent of creating cochlear implants specifically for tinnitus (Rubenstein et al.. 2003).

Habituation

Smalls, visual images, tactile (touch) sensations, and sounds that do not change and are unimportant are eventually ignored. For example, rarely do we think about the pressure of clothing on our skin, unless it is brought to our attention. Often the sound of the refrigerator in the kitchen is not heard until the motor turns off. This unconscious decrease of attention is referred to as habituation. Many people with tinnitus do not attend to the sound that is, they have habituated the tinnitus. Hallam (1989) proposed that people who have difficulty with their tinnitus have failed to habituate it. This theory also implies that people with continuous tinnitus usually have less difficulty than those with intermittent tinnitus. It also suggests that counselling can help reduce the fear or importance of tinnitus.

Attention

Tinnitus is also considered an attentional problem. Objects that are unusual, important, or are prominent tend to 'grab' our attention. Treatment that makes tinnitus appear less important, unusual, or prominent could be advantageous.

Cognition

Some researchers think of tinnitus as a cognitive, or thinking problem. For example, believing that we could not make a putt on the golf course, or that we could never learn to ice skate could very easily influence our chances of success at those endeavours. Some people with tinnitus develop negative thoughts about their tinnitus, for example, that it is a precursor to hearing loss or that it represents the beginning of a terrible disease. This negative thinking can make it more difficult to adjust. A variety of cognitive therapies have been developed to help people rethink their thoughts about tinnitus (Sweetow 1986).

Learning

 Learning theory suggests that rewarded behaviour is more likely to occur again. For example, if our partners are very appreciative when we buy them flowers, we are more likely to buy them flowers in the future. The reverse might also be true. If you received 'bad news' the last five times you answered the doorbell (i. e. report of a car crash) you might automatically have a negative reaction the next time the doorbell rings. That is a learned response. (Jastreboff and Hazell 2000).

Counselling

Many early counselling procedures focused on providing information to patients (Hallam 1989: Tyler et al.. 1989: Jastreboff and Hazell, 1993). Newer procedures evolved from cognitive therapy and are effectively helping people cope with pain and depression. Based on the pioneering work of Hallam (1989) abd Sweetow (1984) a new, well-defined protocol, cognitive-behavioural therapy, has been implemented and tested by Henry and Wilson (2001a.b). There is even newer research into counselling reatments that focus on aspects of a patient's life, not just on the tinnitus, and require active participation by the patient (Tyler et al.. 2004).

Sound Therapies

The use of low-level sounds to help patients with tinnitus has evolved into a variety of sound therapies. Jack Vernon (1977) was a pioneer in this area, being one the first to suggest such an approach. There are now many types of sound therapy, all of these therapies aim to reduce the contrast and decrease the prominence of the tinnitus.

Background environmental sounds and music have been used by patients for many years. Tinnitus Masking Therapy, using both partial masking and complete masking was introduced in the 1970's and '80's (Hazell and Wood, 1981: Hazel et al.. 1985) Jastreboff and Hazell (1993) developed Tinnitus Retraining Therapy, where a noise is presented at a 'mixing point' to blend with the tinnitus. A new sound therapy uses specially processed music and noise are combined. Of course, all sound therapies are accompanied by some form of counselling.

 It is exciting to see so many researchers now considering the challenges of tinnitus, and so many clinicians sincerely willing to help tinnitus patients. Tinnitus is a complex problem, which is why the search for a cure requires systematic and innovate research.

We now have a solid understanding of many of the psychological and physiological aspects of tinnitus. New treatments being studied, including magnetic brain stimulation and direct electrical stimulation of the inner ear, may one day actually 'switch off' the tinnitus.

 

 

 

 

The Vicious Cycle ...

FAMILY SUPPORT

• Learn as much as you can about Tinnitus.

• Challenge distorted thoughts, maintain a positive mental attitude.

• Get them moving.

• Be compassionate, but tough.

• Be patient: learning to manage Tinnitus takes time.

• Maintain your social contacts and interests.

• Keep yourself and your spouse emotionally and physically fit.

• Limit the time discussing Tinnitus.

THE IMPORTANCE OF FOCUS

The more a person focuses on their Tinnitus, the louder it will appear, and the more distressed they will become.

LIFESTYLE

The anecdotal evidence of a direct link between Tinnitus and stress is overwhelming.

As much as possible, reduce the stress in your life and have a positive mental attitude.

TINNITUS CATCH 22

The more attention you pay to your Tinnitus and pursue ways of lessening its effects, the more you are likely to focus on it and treat it as significant.

There is no cure for Tinnitus. Searching for treatments that purportedly lessen the effects of Tinnitus is counter-productive.

Avoid monitoring your Tinnitus.

OVERCOMING YOUR FEARS

Once you have addressed your fears, you must put them aside.

Failure to do so will make it more difficult to manage your Tinnitus.

STRESS MANAGEMENT

Employ relaxation and stress management strategies that work for you.

Relaxation should be proactive.

ACCEPT YOUR TINNITUS

You must stop worrying about your Tinnitus and accept it as part of your life.

YOU MUST MOVE ON

Although it is natural to grieve the onset of your Tinnitus, it is unhealthy to remain angry, anxious or depressed.

 

 

 

 

 

What causes Tinnitus?

Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the brain. Some tinnitus or head noise is normal. If one goes into a soundproof booth and normal outside noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body sounds, because outside noise masks them. Anything, such as wax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently tinnitus. Today, loud noise exposure is a very common cause of tinnitus, and it often damages hearing as well.

Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms and high intensity music. Some medications (for example, aspirin) and other diseases of the inner ear (Ménière's syndrome) can cause tinnitus. Tinnitus can, in very rare situations, be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).

What is the importance of noise induced hearing loss?

The industrial and technological revolution may have propelled society to higher levels of achievement. At the same time, however, this progress has also made the world a noisier place in which to live. In fact, noise pollution is a growing health hazard and is everywhere.

Car alarms, leaf blowers, gunshots, boom boxes, and traffic congestion fill our cities with decibels (the measure of sound intensity). Even escaping to the country may not provide a quiet refuge. Thus, farmers are at high risk for exposure to noise from their farm machinery.

What's more, potentially harmful noise is not necessarily unpleasant or unwanted. For example, the music at a concert or the pounding of a jackhammer on the street can be equally damaging to the inner ear. The reason for this is that any sounds (acoustic energies) delivered with equal intensity, regardless of their source, are equally dangerous. Eventually, continued or repeated exposures to high intensity sound can cause acoustic trauma to the ear. This trauma can result in hearing loss, ringing in the ears (tinnitus), and occasional dizziness (vertigo), and non-auditory effects, such as increases in heart rate and blood pressure.

Noise remains the most common preventable cause of irreversible sensorineural (involving the ear's sensory nerve) hearing loss.

What are acoustic trauma and noise induced hearing loss?

Acoustic trauma occurs when any excessive sound energy strikes the inner ear. If it is brief, the noise may cause a reversible, temporary auditory fatigue, technically known as a temporary threshold shift. For example, after a loud rock concert, it is common to experience hearing dullness and ringing for several hours. In this situation, if symptoms persist beyond several days, oral steroids (cortisone-type medications) may help the inner ear recover. If the noise is loud enough and the duration of exposure long enough, however, it may cause a permanent threshold shift. This condition is called noise induced hearing loss, and has no cure and is irreversible.

Hearing loss produced by a sudden and very loud noise (blast injury) is called acute acoustic trauma. If the sound is loud enough, it can cause the eardrum to rupture or the person to have a complete loss of hearing. Sometimes, particularly if the sudden loss is total and combined with dizziness, immediate surgical exploration of the ear may be necessary. In this circumstance, the ear surgeon may need to locate and patch a hole (perilymphatic fistula) between the inner ear fluid space and the middle ear space.

How can a person tell if a noisy situation is dangerous to their hearing?

People may differ in their sensitivity to noise. Nevertheless, as a general rule, noise is probably damaging to the hearing if the noise:

• Makes it necessary to shout to be heard over the background noise
• Causes ear pain
• Makes the ears ring
• Causes a loss of hearing for several hours or more after exposure to the noise

In contrast to popular belief, there is no truth to the idea that a person is able to "toughen up" the ears by frequent exposure to loud noise. In reality, cumulative noise in the past has probably damaged the ears to such a degree that a person doesn't hear the noise as much. Unfortunately, no treatment is available for noise induced hearing loss once the damage has occurred.

How loud can a sound get before it affects hearing?

Many experts agree that continual exposure to more than 85 decibels (dB) may be dangerous to the ears. As already mentioned, the decibel is a measure of the intensity of sound. The faintest sound the human ear can detect is labeled 0 dB, whereas the noise at a rocket pad during launch approaches 180 dB. A quite whisper is approximately 30 dB, normal conversation is 60 dB, and a lawnmower is 90 dB. Decibels are measured logarithmically, which means that the sound energy of noise increases by units of 10. Therefore, a dB increase of a sound from 20 to 30 dB is an increase of 10 times, and a db increase of a sound from 20 to 40 dB is an increase of 100 times (10 times 10).

Studies have shown an alarming increase in hearing loss in children and young adults. Evidence suggests that loud music along with increased use of portable CD players with earphones may be responsible for this increase. Here, the problem is the long duration and close exposure to the loud music.

What factors increase a person's susceptibility to noise induced hearing loss?

The following factors have been associated with an increased susceptibility to noise induced hearing loss:

• Blue eyes
• Light skin
• Family history of hearing loss
• Diabetes mellitus
• Meniere disease
• Iron deficiency
• Vitamin A deficiency
• Older age
• Atherosclerosis (hardening of the arteries)
• Smoking tobacco

How else can noise affect a person?

After exposure to noise, tinnitus, which is a ringing or another sound in the ears, occurs commonly. The tinnitus is a sign that inner ear damage or nerve destruction has occurred. Initially the tinnitus will just be temporary, lasting only several hours. As more cumulative exposure and damage occur, the tinnitus will last longer until eventually it will become permanent.

Loud noise will also cause some people to have anxiety and irritability, an increase in heart rate and blood pressure, or an increase in stomach acid. In addition, very loud noise can reduce efficiency in performing difficult tasks by diverting attention from the job.

Do hearing protectors prevent a person from communicating with others?

The answer is no, at least for people with normal hearing. In fact, just as sunglasses help vision in very bright light, hearing protectors enhance speech understanding in very noisy places. Even in a quiet setting, a normal-hearing person wearing hearing protectors should be able to understand a regular conversation.

Hearing protectors do slightly reduce the ability of those with damaged hearing or poor comprehension of language to understand normal conversation. Nevertheless, it is essential that persons with impaired hearing wear earplugs or earmuffs to prevent further inner ear damage from noise.

It has been argued that hearing protectors might reduce a worker's ability to hear the noises that signify an improperly functioning machine. Most workers, however, readily adjust to the quieter sounds and can still detect such problems

How can someone tell if their hearing is already damaged, and what can be done about it?

Hearing loss usually develops over a period of several years. Since the hearing loss is painless and gradual, many people may not notice it. What someone may notice is tinnitus, which is a ringing or another sound in the ear. The tinnitus could be the result of long-term exposure to noise that has damaged the hearing nerve. Or, a person may have trouble understanding what people are saying or may hear everyone as mumbling. Such hearing difficulties are especially apt to occur when one is trying to hear in a noisy place such as in a crowd or at a party. These difficulties could be the beginning of high-frequency hearing loss.

A typical hearing test (audiogram) of a person with noise induced hearing loss will initially show only a high frequency loss at 4000 Hz. (Hertz or Hz is the measure of sound frequency or pitch. Four thousand Hz is high frequency, while 250 or 500 Hz would be low frequency). With continued noise exposure and hearing loss, the audiogram will show a broader loss to include lower (deeper) frequencies.

Noise induced hearing loss will almost always affect both ears equally, but in some situations, especially with firearm usage, it may be worse in one ear than in the other. For example, firing a rifle tends to injure the ear opposite the side of the trigger finger due to the shadow (blocking the sound) effect of the shooter's head.

 

 

 

 

 

What is Tebonin?

The articles for this edition of the Newsletter are taken from TAV Tinnitus News July 06 and ATA Tinnitus Talk June 2006 edition.

TO SPEND OR NOT TO SPEND?

A full page article/advertisement in New Idea (13-5-06) talks about a natural product called Tebonin. It claims that Tebonin relieves the symptoms associated with tinnitus. Tebonin is manufactured from ginkgo biloba, a herb that has been used for a range of health problems for many years.

A German physician, Dr. Willmar Schwabe, extracted a concentrated and purified extract known as EGb761. Schwabe Pharmaceuticals claim there are many trials showing the effectiveness of the EGb761 extract in relieving the symptoms of tinnitus. I contacted the Australian distributor of Tebonin EGb761 and asked if I could have copies of the trials. They said copies will be sent to me by experts in Germany at Schwabe Pharmaceuticals.

Hopefully, there will be more information on Tebonin in the next newsletter.

In the meantime, can I remind members that a large double-blind placebo-controlled study on ginkgo biloba at the Medical School in Birmingham showed that gingko had no greater therapeutic effect than the placebo for tinnitus relief.

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MELATONIN ASSOCIATED WITH ALLEVIATING TINNITUS  SYMTOMS, BETTER SLEEP.

A new study asserts that melatonin use is associated with improvement of Tinnitus and sleep. Melatonin is a hormone produced by the pineal gland, known to be involved in regulating the sleep-wake cycle.

This prospective open-label study involved 18 patients between the ages of 18 and 70 who had idiopathic, troublesome, unilateral or bilateral, non pulsatile Tinnitus of six month duration or greater who sought treatment at the Washington University Department of Otolaryngology– Head and Neck Surgery. The average age of the study subjects was 61 years and the average duration of Tinnitus was 11.3 years.

The patients took three mg of melatonin, one pill, one to two hours before bedtime for four weeks of observation during which time the patients received no melatonin.

The patients’ ratings of their Tinnitus systems and poor sleep improved during the study, even after they stopped taking melatonin. Perhaps the melatonin pills had long lasting effects, the researchers note.

The scores indicated that after taking melatonin there was alleviation of Tinnitus symptoms and better quality sleep. Still the researchers speculate that the changes might not be real or if they are real, whether they are clinically significant. Furthermore, due to a lack of control, there is difficulty in establishing a cause and effect  between the degree of improvement in sleep. No adverse effects were reported by any of the patients.

The study suggests that melatonin use is associated with improvement of Tinnitus and sleep. The impact of melatonin on sleep was greatest among patients with the worst sleep quality, but its impact on tinnitus was not associated with the severity of the Tinnitus. This suggests that melatonin may be a safe treatment for patients with idiopathic Tinnitus, especially those with sleep disturbance die to Tinnitus.

 

 

 

 

Where are we Now?

There is a difference between people who experience tinnitus and people who experience from tinnitus. Tinnitus is very common: 30 percent of adults in Britain have experienced tinnitus of short duration and about 10 to 15 percent of the population have experienced prolonged tinnitus. Looking at people who seek treatment, 8 percent consult their GP and 3 percent visit a hospital.

Looking for the cause

Where are we now regarding mechanisms of tinnitus? If the ear was the cause of tinnitus and you treated the ear, you could get rid of tinnitus, but we have moved on a bit from there. Although the cochlear hair cells are still implicated in all forms as sensorineual hearing loss, there are different theories about how they are involved in generating a tinnitus signal. The management of tinnitus depends on the mechanism, but most people coming into tinnitus clinics will have tinnitus of sensorineual origin.

Early thinking

When people first looked at tinnitus management, they wanted some kind of pharmacological sure. A cure for tinnitus would be wonderful and various drugs have been tried that night work temporarily for some people, but to date we do not have a pill we can give to everybody with tinnitus to take it away. That may change, and we hope it does, but that is the situation today.

Electrical stimulation of the nerve has also been tried. In people with the latest generation of cochlear implants, 80 percent find their tinnitus suppressed. People with brainstem implants (an electrode pad is put into the brainstem rather than the cochlear) find similar results, but this is obviously not something you can use for people with normal hearing. Many other treatments have been tried and some do help with stress and anxiety, things like biofeedback are known to help with relaxation, but a lot of therapies and devices do not do what they claim.

At the moment there is no surgical or medical cure that works for everybody. So the best we can do is offer people with longstanding, distressing tinnitus a way of habituation to it.

What is habituation?

Habituation means more than 'getting used to' or 'developing tolerance of' tinnitus. With regard to tinnitus, it means tinnitus affecting one less and becoming less aware of tinnitus.

We all experience tinnitus. When we put on a new pair of shoes, a new scarf or tie, it is a new sensation, but soon after we don't see or feel it because we have habituation to it.

You can measure habituation in single cells and you can measure it in animal behavior. You can train animals to habituate. People whose tinnitus levels fluctuate find it more difficult to habituate, because every time they hear tinnitus there will be a strong reaction to it. Only when a person 'I have that before, it is not meaningful', can habituation start.

We can help with habituation. People have looked at different techniques, psychologists have suggested various ways, including relaxation, and have come up with a good cognitive behavioral therapy that works very well. If you can identify what people think about tinnitus, if they are anxious and depressed by it, and if you can change that, perhaps you can change the way they respond to it.

Masking out the noise

Masking has been tried, giving people a wide-band noise louder than their tinnitus and hoping they hear that rather than their tinnitus, but it is very difficult to mask tinnitus and any benefit is short term.

Complete masking however evolved into 'partial masking for the tinnitus retraining level' which means setting the level of the noise generator at or just below the level when it mixes with tinnitus. People hear the tinnitus as well as the sound therapy, thus reducing the contrast between tinnitus and background noise, and the tinnitus becomes less obvious. It has also been suggested that people do well with sound therapy because it gives them a feeling of control over their tinnitus.

The combination approach

In a research study conducted by Ross Dineen in Australia, where one group received information about tinnitus plus sound therapy, a second group given information about tinnitus and relaxation, and the third group received information, sound therapy, relaxation and behavioral therapy, the biggest change measure by response to tinnitus came from the third group. We cannot cure tinnitus, nor can we get rid of it for all the people all the time by all of the approaches we have at the moment.

Today's recipe for tinnitus treatment is a mixture of cognitive and behavioral management, sound therapy and relaxation techniques - a combination approach.

By Catherine M^cKinney, Audiological Scientist, Head of Audiological Services, Guy's and St. Thomas' Hospital, London.

Reprinted from Quiet - Journal of the British Tinnitus Association. Autumn 2000