An Ounce of Prev

is Worth a P
by James W. Hall III, Ph.D.
Tinnitus is a symptom, not a disease. There is evidence, dating back more
It’s important to always remember this sim- than 50 years, that tinnitus can be viewed as
ple fact. When someone begins noticing an a normal auditory experience. In 1953, an
unusual sound in his or her ears, whether otologist (a medical doctor specializing in
it’s a ringing, buzzing, roaring, cricket the ear) and an audiologist conducted a very
sound, or any other sound or combination clever study (Heller and Bergman, 1953).
of sounds, the first logical step is to discover Eighty people were enrolled as subjects in
the underlying disorder related to the the study. Morris Heller, M.D., verified by
tinnitus. The exact type of tinnitus sound medical history and a physical examination
that a person hears is not important diag- that the subjects had no ear disease, while
nostically. Almost all tinnitus is associated Moe Bergman, Ph.D., performed an audio-
with a disorder in the auditory system — gram (a simple test of hearing tones) to con-
that is, somewhere within the ear or the firm that the subjects had normal hearing
nerves that carry signals from the inner ear sensitivity. One by one, the subjects were
to the hearing parts of the brain. By analyz- placed in a specialized sound-treated room.
ing information from the patient (what Upon emerging from the room, these nor-
health professionals call “taking a history”) mal-hearing subjects were asked if they
in combination with the results of diagnostic heard anything. The vast majority (75 out of
tests, a physician and an audiologist can the 80, or 94%) reported that they heard
usually rule out the diseases that include some type of sound in the room. The three
tinnitus as a symptom. sounds described most often by the subjects
The majority of people with tinnitus do were “humming,” “buzzing,” and “ringing,”
not have an active disease or pathology but, although a diverse collection of 23 other
rather, damage or dysfunction within the sounds were also noted (e.g., whistling,
inner ear that is related to exposure to high squeaking, and a thumping pulsation).
levels of sound and/or to the aging process. Because of this study, we’ve learned that
Nonetheless, until disease or pathology is almost everyone will hear sounds…that is,
ruled out with a thorough diagnostic assess- tinnitus…in a very quiet setting.
ment, it is irresponsible to simply offer to a It’s reasonable to assume that most
person with tinnitus reassurance that “it’s people who are reading an article in
nothing to be concerned about…most peo- Tinnitus Today already hear their tinnitus.
ple hear sounds like that.” Therefore, you might think it’s too late to
Persistent or almost constant tinnitus is prevent a problem that already exists.
very different from the temporary ringing- But there is a type of prevention that is
type tinnitus – called spontaneous transient important to focus on – the prevention of
tinnitus – that most people notice from time deteriorating quality of life sometimes
brought about by persistent tinnitus.
Knowledge is to time. Spontaneous transient tinnitus typi-
cally occurs abruptly, often when a person
Power. is in a quiet setting. The ringing sound lasts
—Francis Bacon only seconds, then fades away. Hearing
might be muffled during this brief time
period. The precise scientific explanation
for spontaneous transient tinnitus is not
known, but there is general agreement that
it is a normal auditory experience and not a
reason for concern about health or hearing.

14 TinnitusToday December 2004 American Tinnitus Association

vention
Pound of Cure
Hearing Protection – The First Line Professional Care – the Second
of Defense Line of Defense
The old adage coined by Ben Franklin, You may already have bothersome
“An ounce of prevention is worth a pound of tinnitus. But you can prevent further deteri-
cure,” certainly applies in any discussion of oration in the quality of your life. In fact,
the best treatment strategy for tinnitus. The you can almost always return to the quality
most common single cause of hearing loss of life you enjoyed in the past — before it
and tinnitus in adults is exposure to exces- was negatively affected by tinnitus. Sometimes, the
sive sound levels. As a rule, sound levels Knowledge is an essential ingredient in the
that you have to shout over to be heard can process of restoring quality of life and of silence can be
cause inner ear damage. The source or type
of sound — for example, rock or classic
recovering from the debilitating effects of
tinnitus. For a person with tinnitus, knowl-
like thunder.
music, gunfire, machinery noise, factory edge is truly power. What does a person — Bob Dylan
noise, or fireworks — does not determine with tinnitus need to know?
the risk for hearing loss. The two most
important factors that determine the risk for (continued on page 16)
hearing loss are the intensity (or loudness)
of the sound and the length of time that a
person is exposed to the sound. There is
also a genetic factor in the susceptibility to
noise-induced hearing loss. That is, some
people are more likely to sustain damage to
the tiny and delicate hair cells in the inner
ear than others. Two people may be exposed
to the same levels of noise for the same
duration of time, for example, two factory
workers or two musicians in an orchestra or
a rock band. Despite the similarity in sound
exposure, one person will develop a signifi-
cant and permanent hearing loss, while the
other person’s hearing will remain normal.
Other risk factors are associated with
the onset of tinnitus, among them middle
ear problems (pressure imbalances behind
the eardrum due to Eustachian tube dys-
function), sinus disease, temporomandibular
joint (TMJ) disorders, high levels of per-
sonal stress, and some drugs used to treat
health problems unrelated to tinnitus. In my
clinical experience, a person will often first
notice tinnitus when two or more of these
risk factors occur during the same period of
time. Prompt medical or, as appropriate,
non-medical attention to each of these disor-
ders can help prevent persistent tinnitus.

American Tinnitus Association December 2004 TinnitusToday 15

 An Ounce of Prevention (continued) of life can usually return to the point where
the tinnitus was no longer persistent, and
• Tinnitus is a symptom, not a disease no longer a concern. !
or pathology. The first logical step in the Reference
treatment of tinnitus is to determine Heller, M.F., and Bergman, M. (1953). Tinnitus in
whether or not it is a symptom of a med- normally hearing persons. Annals of Otology,
ically treatable disease, and then to receive Laryngology, and Rhinology 62: 73-93.
appropriate medical management. Each
year, millions of Americans experience Dr. Hall is a clinical professor and Chief
tinnitus that is unrelated to active ear of Audiology at the University of Florida,
disease or pathology. College of Public Health and Health
• A person with tinnitus needs to know Professions. To contact him, write, e-mail,
as much as possible about his or her hear-
or call:
ing. Following a simple medical examina-
tion, a physician often tells the person with Department of Communicative Disorders
tinnitus, “There’s nothing wrong with your University of Florida, P.O. Box 100174,
hearing.” This statement is rarely accurate. Gainesville, Florida 32610-0174,
A detailed audiologic assessment almost Tel: 352-273-6168, Fax: 352-273-6545,
always shows a disruption in normal audi-
tory functioning. The common and some- [email protected]

Anti-Vertigo Drug
times minor form of auditory dysfunction
due to aging or noise exposure poses no
health risk, and it may not even require a
hearing aid. However, for a person with
very bothersome tinnitus, documentation of to be Studied for
Balance Disorders
his or her auditory problem will validate the
concerns about the tinnitus and provide an
understandable explanation for the tinnitus.
This is an important step in the effective
tinnitus management. and Tinnitus
• Environmental sound enrichment can
minimize the perception of tinnitus and, Researchers at the University of
over time, contribute to retraining of the Arkansas for Medical Sciences (UAMS)
brain to ignore or “habituate” the tinnitus. received funding from the National
• People with tinnitus should avoid Institutes of Health to study the drug
silence and, instead, surround themselves scopolamine in relieving the symptoms of
with pleasant sound. Inexpensive devices space motion sickness. An earlier study,
that generate a constant, low-level, pleasant done in conjunction with NASA, revealed
background sound are available at a number scopolamine as the optimal drug for space
of stores and online. For the person with motion sickness due to rotation.
tinnitus, sound-generating devices should be Expanding on that study, UAMS
used at all times – in the home and in the researcher John L. Dornhoffer, M.D., will
office. At bedtime, a special sound pillow evaluate patients with tinnitus and vertigo
can be easily plugged into a tabletop sound to determine the extent of central nervous
machine or CD player. In the presence of system (CNS) deficits which underlie some
soft background sound, the brain must work of the symptoms associated with these con-
harder to detect the tinnitus. Since the back- ditions – particularly fatigue, inability to
ground sound is not important or meaning- concentrate, and depression. The ability of
ful, the brain can gradually tune it out. scopolamine to control CNS deficits in these
While tuning out the background sound, the patients will then be evaluated.
brain can tune out the tinnitus as well. For now, due to a temporary unavailabil-
Every person with tinnitus has reason to ity of intranasal scopolamine, the focus of
be hopeful. With the adherence to some the study has shifted. Researchers will look
straightforward strategies, it is often possible for the level of CNS involvement in tinnitus
to prevent the onset of bothersome tinnitus. to find new therapies to alleviate or lessen
There is no “magic pill” for the treatment of the associated symptoms.
tinnitus. However, with the services of a For more information, contact: Donna
skilled tinnitus professional, people with Blake, Project Coordinator, UAMS Dept of
tinnitus that negatively affects their quality Otology, Stephens Spine Institute #902,
Little Rock, AR 72205, (501) 526-7171

16 TinnitusToday December 2004 American Tinnitus Association