Full Text of Tinnitus Introduction

Tinnitus usually takes the form of unpleasant subjective sounds in the head and ears: more than 50 different sounds have been reported. Musical tinnitus is quite common in later years, though rare in young people.

Tinnitus can also be expressed by sensations of pressure, fullness, pain, or vibrations. as well as extra-sensitive hearing and hearing loss, temporary or permanent. It can sometimes be confusingly similar to temporo-mandibular joint dysfunction (TMJ).

In another version of tinnitus - Meniere's syndrome - the balance centre becomes involved, leading to episodes of dizziness or vertigo.

But no matter what form it takes, tinnitus is almost always distressing. It can interfere with concentration by day and disturb sleep at night.

Tinnitus can be brought on by shock or stress of any kind, emotional or physical. It results from nervous system changes stimulated by the activation of the body's "emergency response" to the unconscious perception of threat. Some people are much more susceptible than others to developing tinnitus. (It's been theorized that tinnitus may actually be the sounds of the nervous system at work, so-called "stochastic sound", overhead by the conscious brain because of heightened arousal.)

The extreme sensitivity of the auditory system means that any anomaly, including hearing loss, is sometimes, but not always, accompanied by tinnitus. Because tinnitus can involve the emotional centres of the brain, it can be both a consequence and a cause of depression and anxiety.

Surveys have revealed that about 17% of people have or have had tinnitus, either occasionally or continuously. About 1/3 of those with persistent forms have mild to moderate cases, and about 5% have the condition is a form that seriously interferes with their ability to work and enjoy life.

Tinnitus is a distinct condition and not an inevitable result of hearing loss. Many people with excellent hearing have tinnitus, and many with poor hearing have no tinnitus at all.

The distress that tinnitus often causes can be gradually reduced by calming the overstimulation of the nervous system. In serious forms, this process is almost always a slow one.

The obscure nature of tinnitus makes the support and understanding of family, friends and health-care professionals extrememly important for the morale of those who suffer from it.

The main approaches to treatment include:

1. Reassurance that tinnitus usually subsides substantially with supportive measures, and that many people live comfortably with its sounds and sensation. The fact that tinnitus is invisible makes it appear to be a rare affliction.
2. Congenial form of diversion or relaxation, especially non-demanding physical activity such as walking or swimming. Exercise, preferably done before mid-afternoon, can promote a sense of wellbeing and improve sleep, key elements in moderating disturbing tinnitus.
3. Several forms of sound can be employed to divert attention away from tinnitus and decrease the intensity of its intrusive "subjective" nature.
   1. A "Sleep Sound" device, originally designed to muffle outside noises, can take away some of the nighttime quiet that makes tinnitus especially intrusive when trying to fall asleep.
   2. A small bedside fan may be comforting. Some find a "sound pillow" helps them go to sleep more readily.
   3. A hearing aid can sometimes be helpful both because it makes external sounds crisper and clearer, and because the slight sound it emits may act to make tinnitus less obvious.
   4. For those with good hearing, "sound generators" are designed to produce a calming mix of neutral sound that can be calming to the deep nervous system and may slowly subdue tinnitus.
4. Anti-depressants or other medications can often help when sleep disturbance and difficulty concentrating make adapting to the presence of tinnitus difficult or impossible. Those most often used are tricyclic and SSRI anti-depressants, and novel anti-psychotics.

Though "alternative" treatments of every type have been proposed and tried for tinnitus, including acupuncture, sacro-cranial therapy, herbal mixtures, homeopathics and dietary supplements, none have proven effective.

Elizabeth Eayrs, Executive Director of The Tinnitus Association of Canada