QUESTION: I have suffered from tinnitus -- a ringing in my ears -- for several years. I never sought medical treatment because I didn't think anything could be done about it. While recently searching the Internet, however, I came across a Montreal clinic that uses a type of magnet therapy to treat tinnitus. I live in the Toronto area. Are there any clinics that offer it close to me?
ANSWER: This type of magnetic treatment is called repetitive transcranial magnetic stimulation or rTMS. The equipment sends pulses of a magnetic field into the brain. The goal is to alter brain activity -- much like breaking up gridlock on congested city streets.
Although rTMS has produced promising results in treating some mental disorders -- including depression -- the equipment is primarily used for research purposes in Ontario and is not readily available to patients.
But don't feel too disappointed about the lack of access to rTMS for tinnitus in your area. The published results for tinnitus show modest short-term improvement and only in a minority of cases.
So it may not be the right treatment for you. Indeed, your first impression may have been closer to the mark -- there's not a lot that can be done to completely silence the ringing in your ears.
One of the challenges of tinnitus is that it isn't actually a disorder but a symptom of some other underlying condition, explains Dr. Joseph Chen, chief of the department of otolaryngology at Sunnybrook Health Sciences Centre.
You can't "cure" a symptom. Instead, you need to treat the source of the problem in order to stop the symptom -- or make it more tolerable.
For many individuals plagued by tinnitus, the source of their irritation can often be traced to some form of hearing loss.
In a person with normal hearing, delicate hairs in the inner ear vibrate when hit with sound waves. This movement generates electrical signals that are carried along a bundle of nerve fibres -- each one responsible for a different frequency -- to the brain's auditory cortex where they are interpreted as sounds.
This elaborate hearing system can be damaged by frequent or prolonged exposure to loud noise. The auditory nerve fibers that convey information about moderate intensity, high-pitched sounds are especially vulnerable.
"Once these auditory nerve fibres are damaged, they don't tend to recover over time," says Larry Roberts, professor emeritus and director of the Human Neural Plasticity Lab at McMaster University in Hamilton.
Studies conducted by Prof. Roberts and other research teams suggest that tinnitus occurs when the neurons -- or nerve cells -- involved in the processing of sounds become disconnected from the ear.
"We think the sound of tinnitus is generated by abnormal synchronous activity that develops among neurons in the auditory cortex when there is a loss of input from the ear," says Prof. Roberts.
In other words, "the neurons are designed to talk to one another and when the ear stops talking to them, they start talking among themselves," he explains.
The brain is essentially adjusting to the missing external sound frequencies by making its own noise. This "phantom" sound may take the form of buzzing, hissing, ringing, roaring or clicking. People experience it at different volumes -- from a low background drone to a high-pitched whine. Whatever form it takes, it can interfere with concentration and sleep -- and cause a great deal of distress.
In addition to hearing loss, tinnitus may be triggered by other medical conditions or even by a variety of medications. For instance, high doses of acetylsalicylic acid (ASA or Aspirin) as well as certain antibiotics, anti-depressants and cancer drugs have been known to produce tinnitus or to make it worse. A major head trauma, such as whiplash, can also disrupt auditory nerves and set the stage for tinnitus.
However, simply having hearing loss does not automatically lead to tinnitus. "In fact, some people who are totally deaf don't have tinnitus," says Dr. Chen, who is also a professor at the University of Toronto. "It depends on how [an individual's] brain responds to a lack of sound in a certain frequency range."
So there is a great deal of variation when it comes to tinnitus. And how a person reacts to the noise will, in part, determine if it becomes just a minor annoyance or an overwhelming burden. (Some tinnitus patients develop an additional affliction called hyperacusis, which is a reduced tolerance to high-pitched noises like alarms, children's crying and clapping. In severe cases, even ordinary sounds may seem very loud.)
If you seek medical help for tinnitus, you will likely be sent for a hearing test. The results may reveal that you have enough hearing loss to justify using a hearing aid. Once you start wearing the device, you may find that your tinnitus becomes less bothersome. "Anything that restores hearing generally will diminish tinnitus," says Prof. Roberts.
In the laboratory setting, he notes, it's possible to silence the ringing for at least brief periods of time - a phenomenon known as residual inhibition. Equipment in the lab will generate a sound that contains all the frequencies in the person's tinnitus. The sound is played for about a minute and then shut off. In the following 30 seconds or so, most tinnitus sufferers will notice that the ringing has stopped or is reduced in severity. Within a few minutes though, the tinnitus is, in most cases, once again restored to its full intensity.
There are several treatments that attempt to prolong the effects of residual inhibition, or mask the sound of tinnitus.
In such treatments, the patient is exposed to the tinnitus frequencies for extended periods of time, rather than just a few minutes. It may be played in the background at a low volume or the patient may listen to a recording through earphones. Severalcompanies offer the devices through the Internet.
Prof. Roberts points out that these devices can be fairly costly, although a few less expensive options are available.
Another treatment approach is rTMS -- the magnetic therapy you mentioned in your question.
At the Montreal Tinnitus Clinic, rTMS is attempted only when other approaches have failed to produce the desired results. "It's a non-invasive way to access the brain by using magnetic stimulation," explains Marcel Mazaltarim who is director of the clinic. He says the aim of the treatment is to calm the overactive neurons in the auditory cortex, while stimulating the brain's frontal lobe to help alleviate depression, which sometimes accompanies tinnitus.
So, how well does it work? Mr. Mazaltarim acknowledges that this is not a cure. But rTMS, combined with other treatments, may help reduce the symptoms to make tinnitus more bearable, he says.
Overall, Prof. Roberts says, these technological solutions have only a limited effect -- or maybe no effect -- on quieting the tinnitus, but they may reduce an individual's response to the sound.
"These are procedures that someone who is really distressed with tinnitus might consider."
He suggests most patients may be better off trying to modify their reaction to tinnitus, rather than attempting to silence the sound itself. Certainly stress, lack of sleep and depression can make the experience worse.
Relaxation techniques and cognitive behavior therapy might help take your mind off the ringing noise. As you might expect, there are also a few high-tech options that can help nudge you in this direction. For instance, patients can use various forms of neurofeedback to help shift their attention away from tinnitus.
"Taking control of your life is very important. Concentrate on activities that give you satisfaction. Don't let tinnitus command your attention," says Prof. Roberts.
"One of the universal properties of tinnitus is that when people get engaged in activities that absorb their concentration, their awareness of tinnitus diminishes. "
Of course, this is easier said than done, especially for those who are prone to anxiety, depression or obsessive thoughts.
In the early stages of tinnitus, it may be extremely hard to imagine living with a bothersome sound day in and day out. What's more, it may interfere with sleep, leading to even more stress and anxiety, further exacerbating the tinnitus.
Dr. Chen says an anti-depressant or anti-anxiety medication may help some patients get through this rough patch.
Most people will eventually adjust to their tinnitus. "The annoyance and intrusiveness of tinnitus will diminish even though the sound is still there," says Prof. Roberts.
What is equally certain is that they are going to have a lot more company in the years ahead.
An aging population, combined with our increasingly noisy environment, will likely swell the number of people suffering from hearing loss and put them at increased risk of developing tinnitus.
Think of all the people now constantly listening to music and chatter on headphones through one device or another. To make matters worse, the volume on the devices is often set too high.
Recent U.S. studies show that almost 20 per cent of adolescents already have evidence of some mild hearing impairment and that's up from about 12 per cent a decade earlier, says Dr. Roberts.
"This is not good news because the solution to tinnitus is to prevent hearing loss in the first place," he says.
"I think it is reasonable to expect that tinnitus is going to become a more common problem."
Co-authored by Paul Taylor, Personal Health Navigator at Sunnybrook.
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