The Consumer Handbook on Tinnitus
Richard S. Tyler, PhD, Editor
Marc Fagelson, PhD
East Tennessee State University, Johnson City TN
Dr. Fagelson is Director of Audiology and Assistant Chair, Department of Audiology and Speech Language Pathology at East Tennessee State University. In 2001, he opened the Tinnitus Clinic at the James H. Quillen VA Medical Center and he enrolled nearly 1,000 patients for services since then. Dr. Fagelson's particular interest in the tinnitus clinic centers on the management of combat veterans whose tinnitus is compounded by post-traumatic stress disorder. He received his PhD from the University of Texas at Austin in 1995, MS in Audiology from Teachers College—Columbia University in New York, and BA in English, also from Columbia University
Consumer Handbook on Tinnitus (Second Edition)
ISBN: 13: 9780982578582
Tinnitus is the sensation of ringing, buzzing, whooshing or other sound in the ears or head without an external stimulus. You are not alone if you feel that your experience with tinnitus has changed you as a person. It can impair your ability to carry out basic activities, such as sleeping, relaxing, or enjoying a quiet peaceful location. It can influence the ability to interact with other people. Aspects of patients' lives once taken for granted and enjoyed can be transformed by tinnitus into negative events to be avoided. Patients with tinnitus complain of losing the ability or the desire to maintain relationships. You may feel that your identity is changed, and that your value to family, friends, and society is diminished. Individuals may find themselves less able or willing to help other people or to seek help on their own. Add to this sense of displacement the realization that tinnitus is not amenable to a simple cure, and the result is a distressing situation for millions of sufferers. Despite the lack of a "silver bullet" cure for tinnitus, developments over the past several decades, many of which are summarized in this book, suggest that patients can learn to manage the way that tinnitus affects them. Unfortunately, many tinnitus sufferers and many healthcare providers do not access these sources of assistance. One objective of this book is to provide information regarding the tools available to individuals who need help managing their tinnitus.
Remember, you're not alone, despite the way that the tinnitus may make you feel isolated. In this introductory chapter, we review risk factors for patients developing and being bothered by tinnitus. We'll also address potential environmental and personal stressors that can worsen tinnitus, how to convey tinnitus's effects to family and friends, and avenues along which individuals and families for whom tinnitus is a problem can find information and interventions that may improve coping strategies.
Also worth noting is the use of words that appear in italics in this book. All such words are defined for you and appear in the helpful Glossary found just before the Index.
Who Gets Tinnitus?
Tinnitus affects millions of people around the world. Several respected long-term health and demographic studies indicate that approximately 10-15% of the adult population experiences chronic or persistent tinnitus. Nearly half of the people who hear persistent tinnitus are bothered by it, and in the general population, about one person in 200 believes that the tinnitus substantially reduces their quality of life. Tinnitus affects people regardless of race, gender, nationality, and socio-economic standing; it is clear that noise exposure and stress contribute substantially to tinnitus severity (Baigi et al., 2011). Although tinnitus does not always co-occur with a significant hearing loss, tinnitus is more prevalent among individuals with impaired hearing than it is among a normal hearing population (Davis & Amr Rafaie, 2000). However, the correlation between tinnitus annoyance and hearing loss is low (Jakes et al., 1985).You might have normal hearing, or a slight to moderate hearing loss, and still be very bothered by your tinnitus.
The results from several surveys indicate that tinnitus can affect anyone at any point in their life. Because males comprise a greater percentage of the veteran and occupationally noise-exposed populations, the trends among younger patient groups indicate tinnitus is experienced more often by males than females. However, when the population sampled exceeds 60 years the gender effect decreases such that prevalence among elderly females is about equal to that of elderly males. The prevalence of tinnitus across other demographic categories shows no specific preference for ethnicity, religion, or socioeconomic status. It is clear that tinnitus is an experience shared by millions, while at the same time it is an isolating and uniquely disturbing sensation. Others might not know you have tinnitus; people who know that you have it may not understand the implications.
Many patients with tinnitus who seek clinical services receive extensive counseling, reporting afterwards that striving to understand its mechanisms and causes supports their ability to control the way that tinnitus affects them. While it is clear that anyone can develop tinnitus, it may be as likely that individuals annoyed by tinnitus can learn novel coping and management strategies that reduce the amount of distress (Cima et al., 2012). A priority of this book is to offer a variety of useful information supporting that idea and the following chapters provide a framework within which the reader can find information pertaining to specific causes (physical and emotional) and related problems (such as sleep interruption).
For some patients it is important to distinguish the initial 'cause' of tinnitus from a subsequent 'trigger' incident after which a patient's pre-existing tinnitus becomes worse. Tinnitus can be triggered and exacerbated by a variety of auditory and non-auditory events, and in many cases, the appearance or increase of tinnitus loudness is confusing and frustrating. A surprisingly high percentage of patients with tinnitus attribute the sound to something other than the function of their ears or auditory system. For example, a patient may indicate that tinnitus severity increased a certain number of years ago, and when questioned, the patient reveals that they experienced a major life change, such as retirement or the loss of a loved one, at about the same time. A patient's reaction to their tinnitus depends heavily on their personal experiences, beliefs and psychological state.
Chapter Two addresses tinnitus causes and triggers. In addition to non-auditory sources of tinnitus exacerbation, noise exposure, either long-term or when produced by brief explosive sounds is often reported by patients as a primary cause of tinnitus development. Other common tinnitus causes include medications, aging processes, head trauma, and whiplash (Kreuzer et al., 2012). It often difficult for patients and practitioners to identify a specific cause; several contributing factors may produce a disturbing auditory sensation even when the patient is not affected by an obvious ear disorder.
Chapter Three discusses the mechanisms of tinnitus. While the precise neural coding of tinnitus within the auditory system and brain is not known the sensation must be linked to ongoing neural activity, and must be represented in the part of the brain that processes sound. Tinnitus is not a phantom perception; it is real. To understand how tinnitus emerges as a perception, it is helpful to think of the auditory system as a complex system of telephone wires. A "poor" connection occurs when a substantial number of the wires carry static either along with, or instead of, the signal of interest. A volume control on your phone can help make the transmission louder; however turning it up increases the static as well as the signal to which you're trying to listen. It would be helpful if a person's hearing pathway could squelch or reduce the unwanted signal, as do some radio transmission systems. Unfortunately, the likelihood is that the patient with hearing loss and tinnitus will continue to experience the unwanted effects of a "poor" connection. In response to the decrease in signal strength (hearing loss) their hearing pathway may modify its own processing in a manner similar to that of amplifying the transmission. While such a change in processing may increase the signal's loudness, it may also increase the strength of the static. You can think of tinnitus as 'static' in your nerve fibers that increases in level as the hearing system adapts to the status, or decrease in hearing related to the health of your ears. The basic operating properties of the auditory system outlined in this chapter support the idea that the neural equivalent of the unwanted "static" is the tinnitus signal. There are many ways the static can be created, and understanding this helps patients appreciate that there are many opportunities to get relief.