That Ringing in Your Ears? Don't Assume It Will Just Fade Away

That ringing in your ears? Don’t assume it will just fade away.

http://www.washingtonpost.com/natio...967ffe-03b7-11e5-8bda-c7b4e9a8f7ac_story.html

By Joyce Cohen July 13

If you’re unlucky, all it takes is one loud concert to spark a lifetime of ear problems — a constellation of symptoms that include not just hearing loss but also ringing in the ears, sound sensitivity, a feeling of aural fullness and even chronic ear pain.

Scientists are just now starting to understand the more nuanced workings of the inner ear, or cochlea, a tiny, snail shaped organ buried deep inside a skull bone — and about how noise exposure can gum up the complicated system in multiple ways.

Many people are familiar with muffled hearing and ringing ears — called tinnitus — after a concert or loud sporting event. Even if these symptoms go away within days, they can portend permanent ear damage, even years later.

The effect of noise is cumulative, insidious and, researchers say, irreversible. “Over the course of one’s lifetime, the damage builds up,” said Paul Fuchs, a professor of otolaryngology at the Johns Hopkins School of Medicine.

According to the National Institutes of Health, about 50 percent of Americans age 75 and older have a disabling hearing loss, where their trouble understanding speech becomes apparent to them and to others.

Among teens, many of whom are wedded to ear buds and loud music, nearly 20 percent report some hearing loss. Tinnitus, a usually relentless ringing that can be much more distressing than hearing loss, plagues 10 to 15 percent of adults, according to various studies.

Chris Munson, 55, an engineer and former home-audio enthusiast from suburban Dallas, loved his music loud in his younger days.

He also had tinnitus that came and went. In hindsight, he said, “it was absolutely a warning sign, but if you don’t know how to read those warning signs, you ignore them.”

One day eight years ago — having listened to excerpts from films including “The Matrix” with his elaborate home-theater setup the previous night — Munson awoke with “my head in a ball of sound,” he said. The ringing worsened over time, spreading from one ear to both and expanding from one steady tone to several fluctuating ones. This time, the ringing didn’t go away. Instead, it worsened over time.

Soon afterward, Munson also developed mild hyperacusis — a sensitivity that renders everyday noises uncomfortably loud or even painful. He describes his tinnitus as a screaming, constant multi-tone with no real-world correlation. Now he gets an ache in the ear canal from the hum of the refrigerator and the snap of a pop top. To avoid clinking dishware, which causes him ear pain, his family eats from paper plates.

The home theater gathers dust.

“Your ears have a budget,” he said. “Spend it too quickly and you’re broke.”

How does loud or unending noise damage hearing?

Basically, a sound wave vibrates the eardrum and then passes to the cochlea, which contains rows of microscopic hair cells bathed in fluid. These hair cells move with the sound and send signals through the auditory nerve to the brain, which interprets the sound.

Noise that’s too loud or long-lasting destroys the hair cells, causing hearing loss or partial deafness. But that’s not all. Recent studiesshow that noise also severs connections between nerves and brain, a likely cause of such abnormalities as the inability to separate background from foreground sound. People typically notice the problem when conversing in a crowded restaurant.

The mechanisms of tinnitus remain a mystery. One study used electrodes to measure the brain activity of a 50-year-old man with tinnitus and hearing loss. The patient had been a recreational firearm user in his younger days.

The effects of the tinnitus permeated many parts of his brain, while a matching tone activated only the part of the brain that processes hearing. In other words, the “noise” of tinnitus affects the brain far differently than a similar real noise does. That may explain why tinnitus is so distressing, said Phillip Gander, a postdoctoral research scholar at the University of Iowa, who is the study’s co-author.

Noise can also activate pain fibers in the inner ear. These fibers, which have been identified in mice though not yet in humans, probably explain the pain that occurs with an intensely loud noise as well as pain that can linger after the noise stops, said Jaime García-Añoveros, an associate professor at Northwestern University and the senior author of a new study on “auditory nociception” or, in lay terms, “noise-induced pain.”

Another unexplained symptom — the feeling of aural fullness or pressure in the ear canal, not unlike the pressure felt during an airplane descent — may be caused by these same pain fibers, García-Añoveros said.

“What they’re detecting is not necessarily sound. They could be detecting spilled contents of damaged cells — a sensation from your ear that is not a hearing sensation.”

Everyday hazards
Noise doesn’t even have to be all that loud to be damaging. A long exposure to less-intense noise, such as a job in a noisy restaurant, can be especially pernicious. Bryan Pollard, president of the nonprofit Hyperacusis Research, says people report ear problems caused by all sorts of commonplace hazards, from lawn mowers to smoke alarms to power tools.

Once noise-caused sensitivity has set in, hyperacusis patients report crippling ear pain, sometimes from things as simple as a shopping trip filled with “noises they were not aware could be dangerous or surprise noise they did not anticipate,” Pollard said.

Even if people are aware that exposure to excessive noise can be bad, “I don’t think they have a sense of what it means should they acquire a hearing impairment,” said Gregory Flamme, an associate professor of audiology at Western Michigan University. “I don’t think they know how or when to protect themselves.”

People face more day-to-day noise than they realize, he said, from vacuum cleaners, blenders, hair dryers, movies and other things. Flamme uses noise dosimeters, which people wear to measure the total noise dosage during a day or other time period. One rousing basketball game could give a person what would normally be a month’s worth of exposure.

The ensuing damage depends in large part on individual susceptibility. In mouse studies, a gene governing susceptibility to noise-induced hearing loss has just been discovered, but it remains impossible to predict whose ears will prove to be “tough” or “tender,” as researchers put it.

Christine Reiners, 49, never thought twice about the loud tunes she listened to as a teenager. A few years ago, she started taking exercise classes. They ran just twice a week for an hour, but the music blared.

Last year, she woke one night with “the sound of an alarm” in her head. It never stopped. “It’s horrible — a high-pitched screech,” she said, sometimes joined by a chirp. She has trouble sleeping and concentrating.

Reiners has visited many doctors, receiving such misdiagnoses as an ear infection, intracranial hypertension and sinusitis. She even had sinus surgery, which didn’t help.

“It’s hard knowing that it’s not going to get any better,” said Reiners, a mother of two from North East, Md. “I’m praying it doesn’t get worse.”

According to hearing specialists, limiting the volume and duration of noise exposure goes a long way toward safety, as does the proper use of hearing protection such as earplugs or protective earmuffs.

A rule of thumb: Earplugs are needed when the noise is so loud that people sitting next to each other must raise their voices to be heard.

Because there are no ways to fix noise-induced hearing problems, “the only solution is prevention,” said Larry E. Roberts, a professor emeritus and auditory neuroscientist at McMaster University in Canada. He views loud noise as a public-health hazard akin to smoking, and he would like to see aggressive public-awareness campaigns.

Research is starting on ways to reverse hearing impairments, but “the challenge of restoring functional hearing with molecular engineering is great and is likely decades away,” Roberts said. “Think of smoking. We can do lung transplants, but this is not the solution for lung cancer. “



Cohen is a writer who lives in New York.

 

There you have it. Ear pressure and pain are tinnitus related symptoms due to nerve damage. No amount of neti potting/nasal sprays will fix that.

Be careful with your hearing, there's no limit on how bad this can get and there's no reason it won't get worse if you keep abusing it.

We won't be able to fix the hearing organs for decades still if ever, and even then it will likely never be as good as the original thing.

 

But I know a lot of cases which had t for months before it faded away ? It all depends on the person

 

It's quite rare but it does happen.

 

Id say it's a 50 / 50

 

It really depends on the health / age of the person , and whether he acts quick to try and recover from what ever the damage is from t

 

This is a garbage article! Not just speaking from experience but also from what ENTs have told me. This guy obviously overexposed himself to sound but the mistake he made was in the aftermath of his tinnitus. You don't avoid sound just because you have tinnitus. You limit your exposure to dangerous levels and continue to listen to what you love. By avoiding sound you promote and create hyperacusis that may not have been there before. Do my ears still ring? Yes from time to time. Do they sometimes not ring? Yes from time to time. Thinking back to my childhood did my ears ring then? Yes they did from time to time. In fact I remember sitting in the car waiting for my mom to lock the door and me hearing ringing in my ears and thinking "oh that's what silence sounds like." The biggest problem for a lot of us is an over sensitivity to the sound in our ears as we get older because we don't recover from trauma as quickly as we did as children. So we have to be more careful but that doesn't mean we should stop. In fact my ENT encouraged me to return to concerts, but with hearing protection. Which I've done (but only for acts I really want to see). And guess what, my ears are no different than they were two years ago. Even before the traumatic incident that led me to have painful ringing in my ears. Stop sharing this pessimistic, end of the world bullshit. We understand so little about how sound and human hearing works. You have to keep going regardless. In an interview with Dave Grohl, he mentioned that all he hears is loud ringing in his ears but does he wear hearing protection or even care for that matter? No! He knows it comes with the territory of being a rock star and is literally one of the happiest people I've ever seen in my life. Happiness is a choice, life is your perspective. Choose both.

 

I don't know which article you read, but it has nothing to do with ''happiness'' or how one may cope with tinnitus. It is a very informative post about the inner pathological workings of T and H. It also mentions that noise in damaging in subtle ways that we cannot detect in standard hearing tests.

It also mentions there might be pain receptors in the ears, which may explain hyperacusis much better than any theory we have right now should those receptors be found in humans.

This is the research news forums. Not the support forums. Articles like this are very much at their place here. More understanding of the condition, even grim as it may be, it a step forward towards a meaningful cure not called habituation.

 

I wonder if humans will evolve to have ears that can listen to loud music/noise without getting damaged. T seems to be a thing caused by manmade inventions (blare of a speaker in a concert, car honking, jet engine, etc) so our ears are not built to handle them 100%. I do believe science can work faster than evolution in the aspect of trying to reverse hearing damage/ regrow hair cells needed for hearing. This article is a good read and I hope more people can be more aware of this.

 

Did we read the same article? This is clearly an emotional piece meant to garner attention by people with sensitive hearing. It references science articles but is not itself one.

 

It would be fantastic if science would be able to reverse hearing damage and regenerate hair cells. But what I find disturbing in articles written about scientific research and development on this matter is that they always say: 10 years from now there will probably be a cure to hearing damage, tinnitus and hyperacusis. But somehow that period remains 10 years. Because if you take an article from, say, 3 years ago, they say it will take 10 years. But if you take a recent article from just a couple of days ago, they STILL mention a 10 year period, whereas, in the meantime, it should obviously have become a 7 year period. How do you, fellow T&H sufferers, think about this ?

 

I think that would just be a wide estimation, pherhaps to could be as little as 5 years or as much as 15 years. I'm sure something will show up within the next 15 years

 

10 years is a grossly unrealistic estimation. Even now in 2015. I would assume at least 30 years before a normal person can walk-in in an ENT clinic and get a treatment to reverse his hearing loss. Until then all treatments will be largely experimental and reserved to small scale trials.

 

It's possible that you are right but however just look back 30 years. If we go back to 1985, what did the world look like then?

When it comes to medicine it can sometimes go really, really fast. A friend of mine has a daughter that was born prematurely (week 24 or something I think). 15 years ago the survival rate for children born prematurely in the week she was born was about 5% (and this was in the year 2000!). Today the survival rate is about 95% for children born in the same week as she was born in.

If we look at surgery. I used to play football (and then I mean soccer as I'm European ) . If you had a knee injury in 1985 you were basically done! That's it, career over. My dad injured his knee (tore the meniscus) and back then he had to quit. The success rate for recovering from an injury like his after surgery back then was about 50/50. Today it's about 99,9% and it takes about 3-6 weeks. You walk out of the hospital the same day of the surgery and can start rehabilitation training the same week. Back in 1985 you had to wear a cast for two months and then rehabilitate for 2-3 months after that. And then we shouldn't compare torn ligaments that were not only career ending back in 1985 but crippling in everyday life. Today a football player recovers from a torn ligament in about 6-9 months (12 moths at most).

So your prediction might be true as we don't know how hard or complex the problem of tinnitus might end up being but at the same time it is possible that a cure comes within 2-3 years and then depending on what is required (it could be a pill or a complicated surgical procedure) it could be available for the common man in 5 years.

It really depends on when we get that break through and then how complicated an eventual treatment is. The more complicated or costly the treatment is the more time it will take to be available for virtually everyone. But if it's a pill or an injection then it will definitely not take that long until everyone can get it.

 

@Silvio Sabo

My 30 years estimate was referring to hearing loss specifically. For tinnitus I think it will happen sooner but it will still take some time before it is readily available to everyone (if it ends up being TMS, expect very long wait times!)

 

Much as I'd prefer not to have to admit it, I'm inclined to agree with Nucleo and his interpretation of the article.

My tinnitus has nothing to do with my state-of-mind and it certainly doesn't come and go. It rings away incessantly because I've damaged my hearing. Since I can't 'un-damage' it, sadly I can't see why my tinnitus would simply go away.

 

I think this is the key point, we are now subjecting ourselves to sounds that human ears were never designed to be subjected to, and sadly an admittedly small percentage of the population end up damaged with Tinnitus, Hyperacusis, hearing loss

It seems that many who become elderly and suffer natural age related hearing loss do not suffer these conditions, however some of us are unfortunately unlucky or not careful on our route to old age.

I think the article has many good points that people should take on board, but those that need to read it won't be in forums like this, and for those of us here it us too late.

I think it will be decades before there is a cure as such, also If tinnitus is a rain noise I'm not sure how curing hearing loss will help that

 

Then logically you would expect the more you damage your ears the worse your tinnitus would be, right? Except with tinnitus being the strange unknown condition it is, even that isn't true. Not all deaf people or people who have gone deaf in life get tinnitus. As a young child I lost nearly all my hearing in my right ear and severely damaged all high frequency hearing in my left ear (along with some damage across the board). I never had tinnitus until the last few years and only as a result of an additional small loss in hearing.

Knowing that, it gives me hope that the issue is more in the brain than the ears, and is why it often goes away for most people.

-Mike

 

This is a very tempting assumption to make but there actually is no direct link between the amount of hearing damage using audiograms (very outdated golden standard of audiology) and severity of tinnitus. People with no hearing loss shown on audiograms can have very bad tinnitus with hyperacusis and that jazz (no pun intended) and some people with lots of noise induced hearing loss can have no tinnitus. And of course all the states in between can exist as well.

Until audiologist start routinely testing for ''hidden hearing loss'' with auditory brainstem response tests we won't know for sure. It is rumoured that hidden hearing loss is way more prevalent than perception hearing loss.

What a sorry state the field of audiology is in right now.

 

I have very little hearing loss in both ears, exactly the same, one frequency, but T in just one ear. I know people stone deaf, partially deaf or in between no tinnitus. I know a guy no hearing loss, plays in a band, T never alters a bit blasts music all day to mask, over 20 years of this still no hearing loss.
Luckily for us who live in the real world, or who had fun 30 years ago, the cure for T is coming and the cure for hearing loss may be the same. Autiphony are testing their new T trialing drug on hearing loss now. Personally I don't notice my hearing loss at all.

 

I've never wanted anyone to be so right about something as much as this, Mike.

My tinnitus, which correlates with hearing loss, came around during a period of heavy stress. So in terms of the way we treat this condition going forward, I guess I feel like medical science needs to better understand the interaction between hearing loss and the way our brain interprets the loss of aural stimulation.

 

Useful article... thanks for posting @dan. I'm gonna forward it to my wife 'cos even knowing how t affects me, I still caught her using the lawnmower yesterday without protection. People just don't realise how delicate our ears are until it is too late, and the more well-informed articles like this that make it into the mainstream press the better for the world.

I've got friends a similar age to me (mid 40's) who still go to gigs without earplugs. I've told them how much tinnitus bothers me, but somehow the message never really sinks in. I think most folks are in a similar situation nowadays with noise awareness to that people were in with smoking in the 60's/70's. They know it might be harmful in a vague sense, but it doesn't feel real or as though it might actually affect them.