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When listening to music or a podcast on our headphones, we may sometimes get a warning that the volume is too loud and could damage our hearing.
Hearing loss would of course be devastating, but for some reason, for me, the threat of tinnitus is even more of a deterrent.
Part of the problem is that it is a mysterious condition. While it has long been linked with hearing loss, we don’t know exactly how one leads to the other.
We hear by means of a small spiral-shaped organ in the inner ear called the cochlea, about the size of the tip of our little finger. It is lined with exquisitely sensitive hair cells that can each detect different frequencies of sounds.
Supporting the link between hearing loss and tinnitus, people often have hearing loss at only some frequencies – for instance, high or low-pitched – and the sounds of their tinnitus are at the same pitch.
Long-term noise exposure can lead to tinnitus (Photo: HMVart/Getty)In response, the receiving brain cells get turned up in sensitivity. So, background and random nerve cell firing that should be undetectable can now lead to the perception of sounds when there are none there.
Retraining the brain
The idea is that this replaces the lost inputs to the brain. Some studies suggest it lowers the intensity of tinnitus, or at least helps people get more used to it, although the evidence is mixed, according to Tinnitus UK.
Sold as a device called Lenire, this is designed to exploit the fact that some sensory nerves from the mouth and jaw lead into the same brain region as those from the ear. This boosts brain rewiring and so makes retraining therapy more effective, according to the manufacturer, Neuromod Devices.
There is some evidence from randomised trials that it works better than basic sound therapy alone, but Dr Will Sedley, a neurologist at Newcastle University, said the results would be more convincing if the firm had compared the device against a placebo version. “It’s scientifically a little bit unsatisfying,” he said.
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Real-world results from 250 patients at a US audiology clinic, presented at a recent medical conference, found that nine out of 10 users had a meaningful reduction in tinnitus after three months, and this lasted for at least a year in nine out of 10 of those improvers.
There are differences, though, which Auricle says makes the approach especially effective. The sounds used are delivered as repeated pulses, at the same pitch as the person’s tinnitus, to precisely target the brain cells affected by the initial damage to hair cells in the cochlea.
Another technique at an earlier stage of development aims to encourage brain rewiring by using sound in a slightly different way.
One way to disrupt that synchrony is to play electronically altered sounds. “We modify synthetic musical notes so that we keep activating neurons representing different frequencies at slightly different times,” said Dr Sedley.
Cause for optimism
While any of these approaches would be good news if they work, Dr Sedley said there is another cause for optimism.
The condition can certainly affect some people badly, and they need specialist help, he said. “But there’s a distinction between benign tinnitus, which thankfully is the majority [of cases], and people who are very badly affected.”
Even current talking therapies can give more benefit than people expect, as they could be working by a kind of brain rewiring, said Dr Sedley. “What you could achieve is going from something that you’re aware of most of the time and highly distressed by, to something like hearing an air conditioner in the office. It’s always there if you listen for it, but you barely ever think about it.
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