“He’s still got a hum in the drum. Plays music to drown it out.”
Doc, Baby Driver
Have you ever heard a ringing in your ears after coming home from a night out or a gig? Or maybe after being too close to a loud noise? While for many this temporary irritation recedes quickly, others are living with it permanently. This noise, in both cases, it known as tinnitus.
Despite the condition affecting an estimated 13.2% of UK adults, scientists still have little understand about what causes it and even less of an idea about how to fix it.
A complicated condition
Diagnostically, tinnitus is defined as hearing noises that come from inside your ears rather than from outside sources. While often described as a ‘ringing’ or ‘buzzing’, it can be experienced as nearly anything including as a whooshing, whistling or creaking. In rare cases, sufferers can even hear songs or musical instruments (known as musical tinnitus).
Its severity can range from being a slight annoyance to utterly debilitating.
Most studies about tinnitus have varied methods and data making direct comparisons and patient reviews difficult. This problem is compounded by the fact that it usually can’t be ‘heard’ or observed by practitioners, meaning the most common way to understand how patients are suffering are self-reported, subjective questionnaires.
As you can imagine, severe tinnitus can often have a host of negative psychological effects. Living with a constant noise in your ear can cause sleep problems, concentration difficulties, anxiety, depression and general productivity issues. Speaking as a sufferer myself, tinnitus can also lead to a feeling of isolation as you find yourself struggling to do the most basic things. Your brain fixates on it, constantly trying to detect volume changes making it even more distracting.
Despite this rather bleak outlook, researchers have identified a handful of key correlations and causes which are guiding current research towards understanding the condition and maybe one day, developing a cure.
Mechanistic mysteries
The most common cause of tinnitus tends to be age-related hearing loss and inner ear damage caused by repeated exposure to loud noises. Musicians who don’t wear proper hearing protection, for example, often become tinnitus sufferers later in life.
There are a host of other causes too though. This includes ear wax build up, head and neck tumours and jaw problems. It can also be brought on by a bad reaction to medications and rarer ear issues such as Ménière’s disease. It can also, as in my case, begin completely spontaneously with no clear root or cause.
Even with this host of identified relationships and causes, the exact mechanism is shrouded in mystery. The most accepted explanation for tinnitus is increased neural activity in the auditory brainstem – essentially an over-excitement of the nerve cells that normally process sounds. But even the exact way this happens isn’t fully understood.
As neural imaging technology has become more sophisticated, scientists are increasingly employing it to better characterise tinnitus. But, as with many neural conditions, the complexity of the nervous system means that data is still relatively sparse.
The wide variation in how tinnitus is both studied and experienced by patients is a significant reason as to why a treatment remains elusive.
The path to a cure
While no single ‘cure’ for tinnitus exists, there are treatments that can alleviate symptoms. These range from being tried-and-true conventional medicine to highly experimental.
Sometimes, when the tinnitus is being caused by something specific like an ear wax build-up or an acoustic neuroma (a type of tumour that develops close to the ear), fixing the underlying issue can silence the tinnitus.
For most sufferers, however, the treatment usually lies in ‘learning to live with it’.
Cognitive behavioural therapy (CBT) – a therapy founded on the idea of changing thought and behavioural patterns – is a common way to support the badly affected sufferer’s conditions. Since much of the distress caused by tinnitus isn’t physical, but mental, it can trap you in negative thought cycles that exacerbate the symptom. CBT strives to fix that over the course of several sessions.
Tinnitus retraining therapy is also a commonly applied treatment. This uses a combination sound technology, like devices worn on the ear, and conventional therapy to train the patient’s brain to ignore the tinnitus. Normally broad-band noise will be played to divert the patient’s attention while they are brought through a series of deep relaxation and stress management exercises, thereby decoupling the association tinnitus has with negative thoughts.
Research continues into a pharmacological cure – a medication to help symptoms – but none have been approved by mainstream health authorities yet. A handful of newer medications that modulate the central hearing pathways have shown some promise in reducing the perception of tinnitus for some patients, however.
There are also a handful of more ‘out there’ cures being explored. In 2020, researchers at the University of Minnesota delivered a combination of audio tones and electrical shocks to the tip of the tongue in patients with tinnitus. The study found 66% of them said they had ‘benefited’ from the device (with a further 77.8% saying they would recommend the treatment for other people with tinnitus). The study, which works on the basis that electrical stimulation paired with sound has been shown to drive a reorganization of neural pathways, demonstrates that the search for a cure is more persistent than ever.
“A hum in the drum”
The titular character of the 2017 Edgar Wright film Baby Driver, Baby, suffers from tinnitus and plays music to drown it out. The quote at the beginning of this article comes when another character asks why he always wears earphones (something I also do to help drown out my tinnitus). For me, it was the first time I’d ever seen a piece of media portraying somebody with the condition and actually went a long way towards helping me come to terms with it.
Because you see tinnitus is invisible. It lives in your ear like a demon, distracting you from conversations, disrupting thought patterns, and making life a shade worse. If you look at one of the many tinnitus support forums on the web, you can see the sense of deep frustration, hopelessness and despair brought on by the condition.
But worse, the science of it is still shrouded in total mystery. From cause to mechanism to treatment, researchers are still trying to pry apart the secrets of this strange condition. That said, our understanding of tinnitus is growing daily. As neural imaging software becomes even more sophisticated, a cure could become within reach within our lifetime.
One day, maybe I’ll know what silence sounds like again. But for now, the earphones will have to do. (And for any regular club-goers reading, I beg of you, wear ear protection!)