Hearing loss is an increasingly common problem, not only among musicians but among the general population as well. A less frequently discussed but equally (some would say more than equally) troubling ear problem is tinnitus.
Tinnitus, the subjective perception of noise, often accompanies hearing loss, but may occur by itself. Since tinnitus (pronounced TIN-itus, not tin-EYE-tus) is an entirely subjective symptom, the answer to the question in this column’s title is a resounding “No!” Only the sufferer is aware of this noise, which is typically described as a constant hissing or whooshing sound. Occasionally there is a tonal center to the sound (one musician I know uses his tinnitus to tune his violin), but despite the name, tinnitus rarely sounds like ringing bells.
Tinnitus usually signals a problem with the auditory system. This pathway begins in the inner ear (cochlea) but continues through the brain stem, all the way to the cortex. Any mechanical, electrical, or chemical dysfunction along this pathway can produce tinnitus. While tinnitus can occur by itself, it is frequently accompanied by hearing loss. In many cases, the degree of hearing loss can be mild or affect only the high frequencies, and thus may not be obvious. The tinnitus, on the other hand, is by definition perceived, and can cause anything from a mild annoyance to thoughts of suicide. Fortunately, most cases are mild—more of a nuisance that only occasionally intrudes on normal activities.
While there are many ear problems that can cause tinnitus, the two most common causes are noise damage to the inner ear and age-associated deterioration. Although we can modify the aging process, we cannot eliminate it. Noise exposure, however, is another matter. We live in an increasingly noisy world, immersed in constant sound which frequently reaches unphysiologic levels. Our ears were not designed to deal with noise levels of 95+ decibels (the sound of a New York subway train pulling into the station). Add to this the sound of amplified music, car horns, sirens, and all of the other daily indignities inflicted on our ears and, well, you get the point.
The ear’s initial response to noise trauma is a constriction of the blood vessels. The sensory cells (hair cells) get less oxygen and nutrition and increased accumulation of toxic waste, causing temporary dysfunction. This is what happens after a rock concert. The hearing loss and tinnitus experienced after such acoustic trauma is initially temporary—but after repeated exposure, the ear will not recover, and both hearing loss and tinnitus may become permanent.
To minimize noise exposure, avoid venues where excessive noise is the norm. Invest a few bucks in a pair of ear plugs and carry them with you in anticipation of the unanticipated. Smoking and diabetes (both of which affect circulation) are significant co-morbid factors for both hearing loss and tinnitus. Control of both of these is within your reach.
How loud is tinnitus, and how do you deal with it? As suggested earlier, tinnitus—both its loudness and its pitch—is a symptom entirely in the ear of the beholder. There is no good objective way to measure the impact on one’s life caused by tinnitus. Certainly, the sufferer’s personality is an important factor. Tinnitus estimated at 10 decibels can be easily dismissed as a trivial annoyance by one person, while the same intensity of sound can drive another person to distraction.
How do you incorporate that incessant noise into your life? The prize for greatest ingenuity undoubtedly goes to the Czech composer Bedřich Smetana. He suffered from tinnitus and, when composing his autobiographical E minor string quartet (“From My Life”), he wrote his tinnitus into the first violin part!
For most patients, the best way to deal with tinnitus is by diverting one’s attention. Focusing on other activities often makes the tinnitus fade into the background. If the environmental sounds are loud enough, the sound of tinnitus may be covered or masked. When the world is quiet, often at night or early in the morning, the hissing or whooshing is more intrusive. Bedside noise generators (mimicking the sound of rain or surf) are helpful. Falling asleep with the radio or TV softly playing is another option. In cases where tinnitus is accompanied by significant hearing loss, a pair of unobtrusive hearing aids may be doubly useful—it restores hearing and masks the perception of tinnitus. I have several singer patients who wear hearing aids, and usually the benefits outweigh the drawbacks.
What about vitamins or supplements? There are many products on the market, each one promising a cure, but tales of true success are anecdotal. Most contain a variety of vitamins, gingko, and other herbs. The newest one, called “Quietus,” is further distinguished by its unintentionally bizarre name (“quietus” is an old English synonym for “death”).
In general, I have no problem with patients trying such concoctions for a while, as long as they are not harmful—and keeping in mind that some substances may interact with prescribed medications. At times, patients respond to such treatments, but it is unpredictable and not the norm. One reason why successful treatment is so elusive is that tinnitus has many causes and it can reflect altered function anywhere along the auditory pathway: it is not a disease but a symptom.
From the medical point of view, I need to make two final points. Since tinnitus is a symptom, you should see a physician to determine its cause. Just as a headache can signal anything from tension or sinusitis to a brain tumor, tinnitus can also indicate a variety of conditions, some of which are treatable, and may indeed require treatment.
Lastly, if after medical workup your tinnitus turns out to be of the common garden variety sort, you should not despair but look more globally at treatment options. In many years of practice, I have had patients respond positively not only to medications but also to yoga, meditation, tinnitus retraining therapy, hypnosis, and acupuncture, just to list a few “out-of-the-box” approaches.
As with so many conditions, once you know that you are not at risk for a serious problem, your list of management options opens up. Minimize noise damage and stay healthy, active, and positive, and your tinnitus will fade into the background.
