Tinnitus--Puzzler Ailment Gets a New Hearing

By JOHN CAREY

July 4, 1988 12 AM PT

<i> Carey, who also has a mild case of tinnitus, is assistant managing editor of The Scientist</i>

Nelly Nigro can remember the day when her ears began to ring. “It was in August of 1982,” she says. “I was a pharmacist at the UCLA Medical Center and workmen were remodeling part of the hospital.” A noisy labeling machine was moved near Nigro, where its metallic clatter echoed deep into the pharmacist’s ears.

The clamor was well below levels permitted by law. But that night, she said, “the noise in my head didn’t go away.” It sounded just like someone was clanging cymbals in her head, Nigro remembered. “I couldn’t sleep. It drove me up a wall.”

Nigro, 64, knew that the cacophony was a condition called tinnitus (pronounced ti-night-us or tin-i-tus).

But knowing its name didn’t make it less agonizing. When stress at work exacerbated the symptoms, Nigro was forced to take early retirement. “I sat at home and thought, it will only go away when I die,” she recalled.

Nigro finally found some relief in 1985 in the form of a Los Angeles area tinnitus self-help group. “The important thing was finding others to talk to that understood,” she said. “Before, I thought people didn’t believe what I was saying.’

Nigro needn’t have worried about finding others with tinnitus. The National Center for Health Statistics estimated in the mid-1960s that 36 million adult Americans have noises in their ears, and more than 7 million have severe cases. A more recent survey by the American Tinnitus Assn. in Portland, Ore., puts the number of people with severe forms at 9 million. And because modern life is getting noisier, “I expect that number to increase,” said Jack Vernon, a professor of otolaryngology at the Oregon Health Science University.

Tinnitus may not be quite as mysterious today as it was in the 7th Century B.C., when the Assyrians wrote of “the hand of a ghost (that) seizes on a man and (makes) his ears sing.” But it is a condition that still puzzles. Identifying the cause also is a difficult task, and there is no real cure.

To begin with, the noises in people’s heads vary from ringing to hissing, from constant din to periodic crashes, from a steady pitch to rising and falling tones. Common drugs like aspirin or caffeine intensify tinnitus in some people but not in others.

While treatments such as certain anti-anxiety drugs and biofeedback may help some people, they may bring no relief to others, or even make the condition seem worse.

“When I got tinnitus, I just assumed that a specialist could get rid of it,” said Bob Dellinger, a 40-year-old Los Angeles journalist whose ears began to ring after a fall in 1979. “I was really depressed when I found it wasn’t that simple.” The internal noises were so agonizing that Dellinger was unable to concentrate enough to write for five years.

“Tinnitus is a greatly neglected area,” said Vernon, who has seen more than 4,000 patients during the last decade in his Portland clinic. “We don’t understand the underlying neurological mechanisms.”

Fortunately, one common problem of the past--doctors who tell people that the ringing in their ears is imaginary--appears to be vanishing.

“There has been a tremendous advance in the sensitivity of the professional community to the problem,” said Dr. Abraham Shulman, an otolaryngologist at the State University of New York’s Health Science Center in Brooklyn. In addition, researchers who are probing the mechanisms of hearing are developing theories that explain the causes of some types of tinnitus.

Physicians do know that tinnitus is a symptom, not a disease, and that it accompanies almost everything that can go wrong with the ear. Tumors, otosclerosis (a hardening of the delicate bones of the middle ear that transmit vibrations from the ear drum to the fluid-filled inner ear), infections, blows to the head, even wax in the ear canal can cause internal noises.

As a result, the first step for anyone with tinnitus, Vernon said, is to have an ear and throat physician (otolaryngologist) check the outer and middle ears for obstructions or disease. “About 85% of patients with ear problems will have tinnitus,” said Dr. John House, President of the House Ear Institute in Los Angeles.

In the majority of cases, however, the problem seems to lie deep in the inner ear. A marvel of biological complexity, this organ turns the vibrations of sound into electrical impulses and sends them to the brain.

The key elements in this process are thousands of cells, each sprouting scores of hairs, in a structure called the cochlea. Vibrations in the cochlear fluid bend the hairs, stimulating the cells to fire off nerve impulses. Because some of the hairs bend only at specific frequencies, we are able to distinguish a Chopin mazurka from a police siren.

Certain drugs (such as quinine) and loud noises (like the 110-plus decibels of a jet engine) are known to damage the hair cells and cause hearing loss. In the last few years, however, researchers in Great Britain have also found damaged hair cells in the ears of tinnitus sufferers.

How could damaged cells cause the internal noises of tinnitus?

According to the current leading theory, each cell has a low level of electrical activity even in the absence of external sounds. When some cells are damaged, a control mechanism compensates by turning up the volume of all the cells. And when amplified, the electrical activity in the cells becomes “noise.”

“It’s still a theory,” said Jonathan Hazel of the Royal National Institute of the Deaf in London. “But it is the one that fits most of my patients.”

Since damage to these cells cannot be repaired, “there is not much point talking about a cure for tinnitus,” said Hazel. Instead, researchers try to minimize the impact of the noise. “Tinnitus is very much like pain,” explained House. “If you can take the edge off, it makes it more bearable.”

One strategy that has been effective in several clinics is “masking,” using noise-producing devices that prevent tinnitus sufferers from hearing their own internal sounds. But it doesn’t always work. “The masker sound itself can drive you nuts,” said Dellinger, who tried one of the devices.

Now a writer for The Tidings, a weekly Catholic newspaper, Dellinger has learned to live with his internal noises. “I have even grown to like one of the sounds,” he said.

In some cases, anti-anxiety drugs help combat the depression that can be both a symptom of and contributor to tinnitus. House has found that biofeedback techniques can also reduce stress that exacerbates the infernal noises. Sometimes, just learning what tinnitus is--or simply talking about it with other sufferers--can help.

Said Marcia Harris, a Los Angeles tinnitus sufferer who three years ago founded one of more than 115 self-help groups around the country, “The most important thing is to let people know that they’re not crazy--and that there is hope.”

To locate the self-help group nearest to you, write the American Tinnitus Assn. at P.O. Box 5, Portland, Ore., 97207.

SUFFERING FROM TINNITUS

Physicians call tinnitus a symptom, not a disease; it accompanies almost everything that can go wrong with the ear. Tumors, otosclerosis (a hardening of the delicate bones of the middle ear), infections, blows to the head, even wax can cause internal noises.

In most cases, the problem is in the inner ear, an organ that turns sound vibrations into electrical impulses and notifies the brain. Key to this process are thousands of cells in the cochlea, each sprouting scores of hairs that stimulate nerve impulses. Some drugs ad loud noises are known to damage hair cells and cause hearing loss. Researchers have also found damaged hair cells in the ears of tinnitus sufferers.

Tinnitus sufferers hear a range of noises from ringing to hissing, constant din to periodic crashes, a steady pitch to rising and falling tones.

According to a leading theory, each cell has a low level of electrical activity even in the absense of external sounds. When some cells are damaged, a control mechanism compensates by turning up the volume of all the cells. And when amplified, the electrical activity in the cells becomes “noise.”

LOCAL REFERRALS BY AMERICAN TINNITUS ASSN.

Los Angeles County

Auditory Vestibular Ctr.--14427 Chase St., Panorama City

Biofeedback Center, U of L.A.--16661 Ventura Blvd., Encino

Burbank Community Hospital-Biofeedback--466 East Olive Ave., Burbank

Donald A. Cadogan, Ph.D.-- 134 S. Encinitas Ave., Monrovia

Gallatin Medical Clinic--10720 S. Paramount Blvd., Downey

Gateway Hearing Aid--540 N.Central Ave 111, Glendale

Hearing Care Associates--16311 Ventura Blvd., Encino

Hearing Instruments Dispensers--4220 Long Beach Blvd., Long Beach

House Otologic Medical Group--2122 W. 3rd St., Los Angeles

Dr. Artine Kokshanian--1030 S. Glendale Ave., Glendale