There is one unwelcomed commonality shared by Ronald Reagan, Barbra Streisand, Charles Darwin and Alex Trebek. Give up? It’s tinnitus; usually referred to as ringing in the ears. (For those interested in word origins, tinnitus comes from the Latin word tinnire, meaning “to ring.”)
Many people hear an occasional roaring, hissing or buzzing that comes from within – not caused by anything in their surroundings. It usually goes away in a few minutes, and that’s that. Doctors diagnose tinnitus if the sound is constant, or comes and goes frequently.
Dr. Jeffrey Livingston is a board-certified otolaryngologist (more commonly called an ENT) at Vero ENT Associates. We spoke to him about recent research from Georgetown University Medical Center (GUMC) in Washington, DC, and Technische Universität München (TUM) in Germany.
Researchers at those universities say abnormalities in the brain lead to tinnitus – that mechanisms in the brain which usually control noise lose the ability to do so. These brain abnormalities in turn lead to a perception of noise long after any stimuli has ended. Dr. Livingston says that the research “is consistent with the prevailing theories about tinnitus.”
The scientists were able to follow the flow of signals through the brain and show where the noise controls should be occurring, but weren’t.
Their research also pertains to chronic pain from an injury.
Prof. Josef Rauschecker from GUMC says that certain areas of the brain act as a central gatekeeping system for perceptual sensations, evaluating the meaning of sensory stimuli. Tinnitus and chronic pain occur when these gatekeeping functions are compromised. Prof. Rauschecker says, “Some people call these phantom sensations, but they are real, produced by a brain that continues to ‘feel’ the initial injury because it cannot down-regulate the sensations enough.”
One of areas of the brain involved in this gatekeeping is the nucleus accumbens, a cluster of neurons sometimes called the brain’s “pleasure center.” It modulates the effects of dopamine, a neurotransmitter linked to the brain’s complex system of motivation and reward. Not surprisingly, the researchers found depression, anxiety, and uncontrolled stress – all modulated by the nucleus accumbens – are closely associated with tinnitus, chronic pain, or both.
The study was published in Trends and Cognitive Sciences. The team hopes the findings will be the first step in developing therapies; Prof. Rauschecker says, “Both conditions are extraordinarily common, yet no treatment gets to the root of these disorders.”
The study is relevant only to tinnitus caused by loud noise, officially referred to as “acoustic trauma.” But the most common cause of tinnitus is hearing loss caused by aging. It is estimated that nearly 30 million people in the US have tinnitus; the highest incidence is in those 65 or older; with a 27% incidence in that group.
Other causes of tinnitus include a build-up of earwax, ear infections, use of antibiotics, dental problems, underlying medical issues, or injury to the inner ear following surgery or radiation therapy. Dr. Livingston says that caffeine and aspirin can exacerbate the condition.
Vero’s Dr. Livingston says that tinnitus is a neurophysiologic condition (having to do with the nervous system). He says, “Some people can have condition without being bothered by it. It depends on how they react to neural input.”
There are two main types of tinnitus (this information is from WebMed):
- Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear, changes in the ear canal, or blood flow (vascular) problems in the face or neck. You may hear sounds such as your own pulse or the contractions of your muscles.
- Nonpulsatile tinnitus is caused by problems in the nerves involved with hearing. You may hear sounds in one or both ears. Sometimes this type of tinnitus is described as coming from inside the head.
It can be a frustrating condition for both the patient and the doctor, although it can be treated. Dr. Livingston says, “It’s important that people suffering from tinnitus get a hearing test to try to identify any underlying medical condition. We can then treat that condition, which is often something simple.”
If the tinnitus remains after treatment for the underlying cause, or resulted from loud noise, there are various non-medical options that may help reduce or mask the symptoms. Dr. Livingston spoke of a treatment called “tinnitus retraining therapy,” which combines counseling (education about tinnitus and coping mechanisms) and “habituation” – the natural ability of the brain to filter sound out on a subconscious level so that it does not reach conscious perception. Simple, everyday examples: except when it first kicks on, we don’t “hear” a whirring fan, the sound of a rainstorm quickly disappears from our awareness, and the music we put on to keep us company as we work fades into the background unless we purposely seek it out.
Vero ENT Associates is located at 1235 36th Street, Suite A, in Vero Beach; the office phone is 772-563-0015.
