"My friend the tinnitus"

misch — Tue, 29 Aug 2023 13:52:41 +0000

"My friend the tinnitus" misch Tue, 08/29/2023 - 15:52

For about 15 per cent of the population, absolute silence is a distant memory. Instead, they are accompanied by constant beeping, buzzing or humming, and the disco is not always to blame. While medicine is looking for causal solutions for tinnitus, new therapies can at least alleviate symptoms.

It is the year 1997. Maurice (name changed by the editors) has been on sick leave for a few days, curing a severe cold in front of a flickering television. He blames the fact that he suddenly can no longer hear the newsreader in one ear on the classic cold symptoms: "blocked nose and ears". The decision not to seek medical treatment immediately will deprive him of any chance of successfully treating the hearing loss – a seemingly causeless, sudden, partial or total deafness, usually in one ear – that he is unknowingly experiencing.

When, a few days later, he is hooked up to an infusion device in hospital that could help prevent permanent hearing damage within the first few hours, the chances of recovery are already slim. A week later, the confirmation: He will have 90 per cent hearing loss in his right ear, probably for the rest of his life. From now on, he will be accompanied by a cacophony of beeping, squeaking, buzzing, humming, and later even voices and birdsong.

"I definitely noticed that communication [at the workplace] was kept to a minimum. I was not shown any understanding from many sides."

Maurice (name changed by the editors)

It is still unclear exactly how the hearing loss (more on this later), which often occurs together with tinnitus (a constant beeping in the ear), came about: "It's a heart attack in the ear. At first I thought 'it came on its own, then it will go away on its own'. That was wrong, " he explains today, 26 years later, after opening the phone call with a noticeably routine but cheerful introduction: "You may have to repeat some questions more often. If you notice that I'm answering a different question than the one you asked, then feel free to call me off immediately. Not that you might ask yourself, 'What's he on at 10.00 in the morning?'" Since his hearing loss, he has learned exactly what to explain to outsiders to prevent communication problems.

Still and yet so loud

Over the years, his symptoms have intensified and spread to his left ear. Along with the dramatic decline in hearing, a tinnitus has emerged that has been consistently audible ever since: "When I close my eyes, it sounds like I'm standing next to a waterfall." The sound that has accompanied Maurice day and night for 26 years, his "friend the tinnitus", has changed over the years: Sometimes it was a high-pitched beeping, like the sound audible – to young ears – after an old tube TV is switched off, or a buzzing, sometimes a humming, "like a truck chugging next to you. That was the worst noise, it really messed me up".

Philippe van Cauter

"If you're lucky, your head turns it off, " says Brigitte (57), who has also been hearing a constant beeping since 2010. In her case, the "buzzing in the ears that you often hear after concerts, after listening to music loudly" simply never stopped. She also had a slight cold at the time and the symptoms were treated like those of a middle ear infection. For her, too, the cortisone infusion came too late. "Especially in the beginning it was really quite bad. Whenever you try to calm down, you fixate on that noise again."

The strangest and "most amusing" variety, Maurice says, were the birds and the voices that suddenly appeared at his house. His "little man in the ear". "I can't say what language I heard in my ear or what they said. At different moments it was different voices, sometimes it was like Chinese, sometimes it sounded like Mickey Mouse."

If you think of this as a psychological disorder rather than a purely physical one, you are right. Even though Maurice emphasises not hearing voices "in the head" but voices "in the ear" and is aware that they are auditory phenomena. While hearing loss and some types of chronic tinnitus can sometimes be clearly traced back to injuries of the eardrum or circulation problems of the inner ear, as in Brigitte's case, others are more mysterious. For to a large extent, tinnitus does not take place in the ear, but in the brain. Different types arise because the brain tries to pay special attention to sounds that are harder to hear and overcompensates for them. If it overshoots the mark, sufferers hear sounds that are not actually there – be it a constant beeping – or Mickey Mouse. What almost all of them have in common is that treatment is limited to combating the symptoms. There are currently no causal therapies.

"Especially in the beginning it was really bad. Whenever you try to calm down, you fixate on that noise again."

Brigitte

Since the noises do not come from outside, but are the result of an overinterpretation of the brain, they do not become quieter just because the ears become less sensitive with increasing age or because of injuries, explains audiologist Philippe van Cauter. On the contrary, external sounds, such as the noise that a hearing aid can play to mask the beeping, seem quieter – the noise seems louder. Especially in a quiet environment, for example at night when falling asleep, even very mild cases become harder to ignore: "The noise is like a small lamp that seems much brighter when it's dark."

It is often impossible to pinpoint exactly where the condition is coming from – often not at all. Sometimes it can be traced back to a blast or injury in the ear. But not everyone who has tinnitus was at the disco for too long. Just like a heart attack, the infarction in the ear happens seemingly out of nowhere and cannot be traced back to any clear cause, even after examinations: In Maurice's case, the doctors suspect acute stress as the main factor, an assessment he himself shares: "It couldn't be due to noise or music, I never experienced a loud bang either. The doctors told me at the time that I could just as easily have had a heart attack, only that it manifested itself in my hearing. The assumption seems to have been confirmed: "I have been retired for two years and have already noticed a clear improvement a few weeks later. In good moments, I sometimes even manage to ignore the noise altogether."

He himself is "one of the lucky ones who didn't become depressed or suicidal, even though it was really extremely bad at the beginning", says Maurice. Among people with tinnitus, the likelihood of suffering from both depression and anxiety disorders increases from about 9 per cent each to about 26 per cent in both cases. At the same time, affected people usually sleep less long. Besides the lack of peace and quiet, social relationships are also put to the test, says Maurice: "I can tell my family 'My friend the tinnitus is back', they understand. Meanwhile, when I see people and they speak clearly, I can lip-read something, on the phone it's more difficult." In noisy situations and when several people are talking at the same time, this becomes very difficult. However, it was in the workplace where "sometimes really bad statements were made", Maurice counters. "People always have to tell me everything three times. I definitely noticed that communication was kept to a minimum. I was not shown any understanding from many sides. Others thought I was faking, even though I really didn't benefit from the situation." Brigitte also describes her tinnitus as an isolating experience. Her social contacts, she says, have not been directly affected, except that she has to concentrate extra in loud conversations, but it is still an experience that "no one else really understands." So a condition caused by stress continues to increase that same stress. This may also be the reason, Maurice speculates, why his symptoms have spread to both ears, even though they typically only occur in one.

Brigitte, who was able to successfully block out her beeping in her ear for a long time, also noticed that her symptoms became stronger during periods of stress after they had almost disappeared for a long time. "You learn to live with it. But in situations where you're not doing well, like after my mother died and now my father a few months ago, I really noticed it getting stronger again. I'm not normally a stressed person, so I really see the beeping like a warning from my body that something is wrong." She says it is especially moments when you think you are calming down that the tinnitus pulls you out of.

It is a vicious circle that Philippe van Cauter often observes in people, not only at work and in periods of mourning, but also in moments that should actually be relaxing. "Even when they are very tired, many people with tinnitus find it enormously difficult to fall asleep. The stress only makes it worse. It becomes increasingly difficult to bear." Both Maurice and Brigitte had to take sleeping pills, especially in the beginning, to even get a wink of sleep. In extreme cases, van Cauter says, tinnitus can even make people unable to work because the effects are too drastic: "There are cases of people literally losing their minds, not remembering in conversations what was said ten minutes ago. It can be, if it's really pronounced, an absolutely debilitating condition."

Silent acceptance

This is made more difficult by the knowledge that there is not very much that can be done about the condition, "other than accepting the noise, " says the audiologist. "The majority of people with severe tinnitus, which is usually also accompanied by hearing loss, wear hearing aids, " he says as he taps his own ear. Barely visible: a small hearing aid that helps him forget about his own tinnitus: "These usually also have a function built in that allows the noise to be masked with a tuned pitch that is less annoying. Particularly glaring or unpleasant noises can thus move into the background, where one finds it easier to ignore them, but at the same time hear voices and ambient sounds well.

New treatments such as Notched Noise Therapy seem promising for people who consistently hear a single specific sound. Once this has been accurately identified, sufferers are played a noise over an extended period of time from which the frequency of their tinnitus is filtered out. In this way, the brain is supposed to adapt its sound perception and unlearn the tinnitus.

Nevertheless, according to van Cauter, it is important to face one's tinnitus with a clear mind and realistic expectations. A fact that Brigitte and Maurice have come to terms with, with varying degrees of success. Walking among people, working, physical activity, Maurice sums up his method of keeping his personal concert in the ear small. "And if you suspect a hearing loss, see an ENT (ear, nose and throat doctor or physician) immediately!" "Yoga, relaxation, progressive muscle relaxation exercises, out in nature, jogging, anything that distracts you, " Brigitte adds. "And earplugs at concerts… you always think you don't need them until it's too late."

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Mon, 09/04/2023 - 06:00

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