Tinnitus: Terror in Your Ear

One saturday in May 1990, Montrealer Bruno Gaumond, a 41-year-old graphic artist, hopped onto his bike to go shopping. As he cruised through an intersection, a car slammed into his bike and Gaumond was thrown headfirst to the pavement.

       At the hospital, doctors diagnosed a concussion and several fractures. When Gaumond came to, he heard a strange whistling in his right ear. "It sounded like some electronic device," he says, "and continued day and night. It was torture!"

       Three months later Gaumond consulted an ear, nose and throat (ENT) specialist who told him he had tinnitus -- and that it could be with him for the rest of his life.

 
The Noise Within

       More than 360,000 Canadians suffer from tinnitus, and 150,000 of those are severely affected. The disorder can strike anyone, regardless of age or sex, and has affected men and women for ages. Jean-Jacques Rousseau, the 18th-century philosopher, complained of a buzzing in his ears that went on for 30 years. Vincent Van Gogh is said to have cut off his ear during an excruciating bout of tinnitus.

       "The problem was hidden for a long time," says Marthyne Brazeau, an audiologist at Notre Dame Hospital in Montreal, "because people were afraid to tell their doctors they heard sounds that others did not."

       Tinnitus can take different forms -- buzzing, whistling, humming, ringing, hissing, even the sound of a waterfall. The sound may be heard in one ear or in both, or it may seem to come from somewhere inside the head. It may appear suddenly or progressively, remain permanent or be intermittent, and can vary in intensity. It may also simply disappear.

       In June 1992, 49-year-old Judy Toews, a Parks Canada employee in Winnipeg, came down with an ear infection that left her with a peculiar buzz in her left ear. "I assumed it would clear up in a few days," says Toews, "but instead it got louder."

       After a few weeks, Toews consulted an ENT specialist, who told her she had tinnitus and would have to learn to live with it. During the next six years, her condition worsened to the point where she had to take medication to fall asleep. "I became hostile and hated going out because I was jealous of people whose heads were quiet," she says.

       Then, in the spring of 1998, Toews noticed her head noise diminishing. "One morning, I suddenly realized that my tinnitus was almost gone -- I couldn't believe it!"

 
Multiple Causes

       The auditory system is complex: Sound waves stimulate hair cells in the inner ear, causing electrical impulses to travel along the auditory nerve to the brain. Once in the brain, these impulses are then perceived as sound.

       Tinnitus is often an indication that there is a problem affecting the auditory system. It can be caused by a head injury, muscular contractions or a dysfunction related to the joints involving the jaw, head or neck.

       There are two basic forms of the condition: objective and subjective tinnitus. Objective tinnitus refers to a sound the doctor can hear when examining the ear. It might be the sound of blood circulating or it might be the pulsations of the heart, carried by the carotid artery, which runs close to the ear. Objective tinnitus can be treated with medicine or surgery, but it affects only a handful of patients.

       In the vast majority of cases, doctors deal with subjective tinnitus: Only the patient can hear the noise.

       "After taking a thorough medical history, we examine the patient for any treatable causes of this form of tinnitus, such as wax lying against the eardrum," says Dr. Phillip Wade, an ENT specialist at the Toronto General Hospital and chief ear consultant at the Canadian Hearing Society.

       In high doses, some medications such as aspirin or nonsteroidal anti-inflammatory drugs may also cause tinnitus. Other possible causes: high blood pressure, diabetes or high cholesterol, an auditory problem such as MŽnire's disease (an accumulation of lymphatic liquid in the inner ear) or the hardening of the cartilage between the middle ear bones. Other causes include hearing loss due to noise exposure or age, though various degrees of deafness may not necessarily be present in conjunction with the condition.

       When the doctor cannot find an organic or mechanical reason for the sound, he may be unable to eliminate it. The treatment for tinnitus may then require the services of not only an ENT specialist but also an audiologist and sometimes a psychologist or psychiatrist.

 
Cricket Chirps

       Doug Medcalf's problems first appeared in 1965, when he was 40. A power plant engineer in Mississauga, he was constantly exposed to compressor and steam-generator noise. At first a noise started in both ears that sounded like cricket chirps.

       Just after his retirement in 1985, however, Medcalf fell into a mild depression, and the stress of a family problem seemed to increase his head noise to a frightening volume. The cricket chirping changed to a loud, steady, high-pitched whine. Sleep was next to impossible without sedation. "I teetered on the brink of insanity."

       "Tinnitus is devastating for severely affected people," says Suzanne MacLaren, an audiologist at the Tinnitus and Hyperacusis Centre of Calgary. "That's why it's so important to offer support and counselling. For most people, the brain will eventually filter out the tinnitus so that they are mostly unaware it is there. But for 25 percent of sufferers it becomes a serious problem."

 
Retraining the Brain

       One way to bring tinnitus under control is to mask the noise with another. A masker is a device that looks like a hearing aid and produces a static hisslike sound that may be easier to tolerate than the tinnitus.

       Masking has been the treatment of choice for years, but a new treatment is on the rise. Tinnitus Retraining Therapy (TRT) was introduced in 1988 by Pawel Jastreboff, director of the Tinnitus and Hyperacusis Centre of Emory University in Atlanta. Today, TRT is used in over a dozen countries, including the United States and Canada.

       TRT consists of training the brain through counselling to be either unaware of or untroubled by the tinnitus. Frequently, patients will be fitted with a noise generator that is worn about eight hours a day and set at a very low sound level. Positive results of the combined therapy may appear within just a few months, and most patients report significant improvement after 18 to 24 months.

       Most experts agree that tinnitus sufferers should practise relaxation methods to help them cope. Audiologist Brazeau recommends listening to relaxation CDs showcasing sounds of waves or the jungle to calm down and induce sleep.

       Antidepressants can improve the well-being of some patients, but all drugs have side effects, so doctors recommend taking the time to find a medication that's right for you.

       Ten years after his accident, Bruno Gaumond has his tinnitus under control. Some days, when he's particularly preoccupied, he even manages to forget about it. "With time, I've become used to it," he says. "But the monster is still there. As soon as I think about it, it returns."

       Doug Medcalf has found relief. Six years ago he contacted the Tinnitus Association of Canada and, along with other tinnitus victims, began a long journey to composure and sanity. Gradually, with the aid of a masker, physical exercises, antidepressants and duplicate bridge (a concentration game), he has reached the stage where his tinnitus no longer troubles him. "I enjoy life again. The head noise is still there, but most of the time I can ignore it."

For more information on tinnitus, contact the Canadian Hard of Hearing Association at 1-800-263-8068, or the Tinnitus Association of Canada at 416-762-1490.