Do You Hear What I Hear?

Vincent Van Gogh, the 19th century post-Impressionist artist, painted a self-portrait depicting a bandaged ear. Why the bandaged ear, you ask? Interestingly, it was reported that Van Gogh cut off part of his own ear.

There have been a number of proposed reasons as to why he did it, but one thought is that he suffered from a severe case of tinnitus. Pronounced “TIN-ih-tus” and derived from the Latin word tinnire (to ring), the word describes any perception of sound in the ear or head for which there is no obvious physical source.

Although extreme, the unfortunate case of the Dutch painter, who incidentally was also reported to have been afflicted by mental illness, highlights the extent to which tinnitus—in its severity—can affect one’s quality of life.

What is tinnitus?

A common yet poorly understood disorder, tinnitus affects many people at some point in their lives. Tinnitus can vary in intensity, ranging from a barely audible hiss to a loud roaring buzz.

Most people, however, describe their tinnitus as a high-pitched ring or cicada-like chirping. For many, tinnitus is inconsequential and considered nothing more than a slight nuisance, but for some it can be debilitating.

Tinnitus is not a disease. Rather, it is a symptom that can result from a number of conditions. There are two categories used to describe tinnitus: subjective and objective.

Subjective tinnitus is the most common form and is an internal sound perceived only by the patient.

Objective tinnitus is less common and is considered real noise that can be heard by the patient and examiner. It can be associated with temporomandibular joint (TMJ) problems, muscular spasms or vascular abnormalities resulting in turbulent blood flow.

Tinnitus can occur in one or both ears and can be pulsatile—synchronised with the heartbeat, usually associated with a vascular source—or nonpulsatile—usually constant and can be attributed to a variety of conditions.

Who gets tinnitus?

Anyone can be affected by tinnitus, regardless of age. According to the Ear Science Institute Australia, 1.5 million Australians suffer from severe tinnitus.

The prevalence of tinnitus in adults is in the range of 10 to 15 per cent and tends to be more common in men, affecting mostly those in the age range of 65 to 74 years. Amongst the hearing impaired, the incidence of tinnitus is as high as 75 to 80 per cent.

Although tinnitus seems to correlate with age-related hearing loss, it is not uncommon for younger individuals also to present with tinnitus because of exposure to loud noise, such as from nightclubs, rock concerts and listening to overly loud music.

Exposure to workplace noise without the use of appropriate hearing protection can also result in the development of tinnitus and hearing loss.

What causes tinnitus?

The exact physiological mechanism responsible for tinnitus is unknown and is currently an area of hot research. As previously mentioned, tinnitus is not a disease entity in its own right, but rather a symptom which can accompany any one or more of several conditions affecting the ear, the nerve responsible for hearing and balance or the brain.

Most cases of tinnitus do not pose a serious health risk; however, if you have tinnitus that develops suddenly, is heard only on one side, is associated with dizziness or is synchronised with your heartbeat, it would be advisable to see a medical doctor to help investigate the cause.

An audiologist who is a university-trained hearing health professional specialised in identifying and assessing disorders associated with hearing and balance, can also provide guidance and help in the management of tinnitus.

Tinnitus can be triggered by many factors:

• head trauma
• ear infection
• impacted wax in the ear canal
• stress, certain types of drugs/medications such as anti-inflammatory agents (e.g., salicylates), antimalarial drugs, chemotherapy medication, diuretics and a family of antibiotics known as aminoglycosides
• tumours of the nerve responsible for hearing and balance
• Ménière’s disease
• certain neurological illnesses such as multiple sclerosis

Treatments

Managing tinnitus presents a significant challenge because the underlying cause is often unclear. There is no single cure for all patients, which in turn makes treatment options just as diverse as the origins of tinnitus.

Nutritional and herbal alternatives
Dissatisfaction with the lack of an effective cure for tinnitus has led to an increased interest in the use of nutritional and herbal alternatives. Many natural treatments have been advocated to have remedial effects on tinnitus; however, these claims have been mostly anecdotal due to lack of convincing scientific evidence of their efficacy.

• vitamin B complex
• mineral supplementation with zinc, magnesium and calcium
• herbal extracts such as Ginkgo biloba
• acupuncture
• ear canal magnets
• low power laser

Multidimensional treatment
A good tinnitus treatment program should take a multidimensional approach to tinnitus management and be designed for each patient based on their specific needs.

Due to the link between tinnitus and psychological distress, one of the primary goals of an effective treatment program is to provide patient education and reassurance to help allay the anxiety associated with fear of the unknown.

Medical examinations and tests to rule out a sinister cause for the tinnitus can also be conducted if deemed necessary, and these can provide additional reassurance to the patient.

Tinnitus resulting from exposure to loud noise can be prevented by taking appropriate precautions such as wearing suitable hearing protection or, if possible, avoiding the loud activity altogether.

Another approach to managing tinnitus is through the use of wearable devices called noise generators that produce a low-level noise to help mask the sound of the tinnitus.

For those with hearing loss, a hearing aid may help by amplifying external sounds and diminishing tinnitus awareness.

Lifestyle changes
There are also lifestyle changes that are conducive to minimising tinnitus. Even if these measures do not eliminate the tinnitus altogether, they certainly won’t make it any worse.

• stress reduction through adequate sleep
• regular exercise
• limiting alcohol, caffeine and tobacco intake

For more information visit the Tinnitus Association Victoria website attinnitus.org.au