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The Mountaineer Online

Tinnitus: Look for warning signs, increase your awareness

Maj. David G. Pedersen, chief, Fort Drum Hearing Program, places otoblock (foam) in the ear canal of Staff Sgt. Jesse A. Posner, 2nd Battalion, 22nd Infantry Regiment, 1st Brigade Combat Team, for an ear mold.  Photo by Kate Agresti.
Maj. David G. Pedersen, chief, Fort Drum Hearing Program, places otoblock (foam) in the ear canal of Staff Sgt. Jesse A. Posner, 2nd Battalion, 22nd Infantry Regiment, 1st Brigade Combat Team, for an ear mold.  Photo by Kate Agresti.

Maj. David G. Pedersen

Chief, Fort Drum Hearing Program, USA MEDDAC

Do you experience tonal, chirping, buzzing, whistles, humming, teapot kettle whistle, bacon frying sizzle, railroad crossing signal sounds in your ears? If so, you might have tinnitus.

Tinnitus is one of the most misunderstood aspects of hearing, but it can be one of the most annoying. It can be described as the presence of an internal sound in the absence of an external stimulus. This means only the person experiencing tinnitus can hear it.

Tinnitus associated with hearing loss is the No. 1 cause within the active-duty member population. Tinnitus caused by noise exposure is typically tonal in nature. It is caused by damage of the hair cells in the inner ear.

There are several theories of why this happens. The first is that the hair cell is ripped out of position. The brain is constantly processing sound, and where the hair cell is missing, the brain replaces it with a tonal sound (tinnitus). The second theory is that the hair cell is either bent or misaligned due to damage and the tinnitus is the result of a misfiring versus the signal being sent in synchrony. Either way, it can be annoying.

Medication is the primary cause of tinnitus within the older population. However, it is starting to have greater impact upon all populations.

The primary culprits of tinnitus associated with medication are antibiotics. This could be from augmentin or amoxicillin to ototoxic drugs used in intravenous antibiotics or chemotherapeutic agents. Individuals taking more than six to eight drugs can have an interrelation effect that could cause the tinnitus to worsen.

Medication has a higher involvement with tinnitus within the geriatric population. Noise exposure after certain ototoxic drugs can have a synergistic effect on hearing loss and tinnitus. For instance, people should avoid all noises for up to a year after being taken off chemotherapy agents, as it will have a four times synergistic effect on hearing loss.

The third predominate area of tinnitus is caused from middle ear pathologies. This can be caused from impacted cerumen (earwax), spongy growth of the middle ear bones (otosclerosis), misalignment of the middle ear bones where the transmission of sound is disrupted (ossicular disarticulation), or many other conditions. The tinnitus typically disappears when the middle ear issue is resolved.

There are numerous ways to handle the annoyance of tinnitus. Education is the primary method. Many people do not understand tinnitus, and so the perception of the condition is worse than the reality of the symptoms. Knowledge becomes power, and what used to be a problem is no longer such a big deal.

Audiology tackles tinnitus management by combating sounds with sounds. Individuals with tinnitus due to noise exposure (tonal tinnitus) are the easiest to treat.

Tinnitus is noticeable in quiet environments. It is not as noticeable when activity is taking place. The primary way to handle it is DO NOT BE IN QUIET! It does not mean to blare the television, stand in front of a jet engine or shoot weapons without hearing protection devices. It means to have some kind of stimulus going on in the background.

During waking hours, play the radio, music, TV or sound machine. The purpose is for the brain to pick up another stimulus so it does not concentrate on the tinnitus. Hopefully over time, the brain no longer places the concentration on the tinnitus. It is similar to taking something from the front burner of a stove to the back burner.

Sleeping is a different matter. It is still important to incorporate sound, but the type of stimulus needs to be different. You do not want to use anything that has linguistic input (e.g. TV or radio). Turn off the television and use something else.

Music is fine, but you do not want to listen to anything that you can sing along with or tap your foot to the beat. You want your body to relax. Even though you may feel you sleep better, your brain is kept active with the stimulation, so you do not obtain the quality of sleep you should have. Considering the restrictions, classical music and some forms of jazz would be beneficial. Baroque music is used for different tinnitus therapies, because it spans a greater number of frequencies as well as the peaks and valleys.

The volume of music does not need to be loud. It only needs to be at a volume where the brain picks up the alternate stimulus. Individuals with normal hearing may only need 10-15 decibels. Individuals with hearing loss only need the volume where their hearing is the best.

Sound machines are great devices for sleeping, as they emit a variety of nature sounds that help with relaxation as well as tinnitus. One of the devices that can be purchased readily has six different nature sounds with a timer so it does not have to run the entire sleeping period. Sound conditioners are nonobtrusive, so even light sleepers and those sleeping in the same room can benefit and sleep through it.

Hearing aids may be the recommended treatment for hearing loss. They provide the necessary amplification for speech communication, as well as sound awareness to occupy the brain so it does not concentrate on the tinnitus. It becomes a win-win situation. In rare occasions, hearing aids can exacerbate the tinnitus.

Formal tinnitus therapy plans may be available, such as Tinnitus Habituation Therapy (THT), Tinnitus Activities Therapy (TAT), Tinnitus Retraining Therapy (TRT), or Neuromonics Tinnitus Treatment. Formal tinnitus therapies can take up to 18 months of sessions with active participation of the patient. TRICARE does not pay for tinnitus services at this time, but active-duty members can be seen at Fort Drum regarding their tinnitus.

Audiology is not the only specialty that deals with tinnitus issues. Individuals who cannot cope well with their tinnitus are encouraged to seek help through behavioral health to aid with coping skills and possibly relaxation techniques.

Since the majority of tinnitus complaints are due to noise exposure and hearing loss, especially in the military, the best preventative method is to protect your hearing. It may not cure an existing problem, but it would aid in the contribution to noise exposure and hearing loss.

Tinnitus may be present in your life, but it does not have to be debilitating. Become proactive in protecting and responsibility in your hearing health care, so that tinnitus never becomes a problem.

The Mountaineer



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