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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.
Many people – myself included – may dismiss these messages. But I’ve recently started paying attention and turning the sound back down, after learning that hearing loss can also lead to tinnitus – when we hear sounds like whistling or buzzing that aren’t really there.
Hearing loss would of course be devastating, but for some reason, for me, the threat of tinnitus is even more of a deterrent.
Tinnitus has no drug treatments or other cures. Once doctors have ruled out simple causes like ear wax, people are usually offered advice on how to block out the noise, or talking therapies to help them get used to it.
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.
But the dearth of highly effective therapies may not be for much longer. As scientists have been learning more about what causes tinnitus, they have been developing a raft of new treatment approaches.
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.
Nerve cells then send messages from the hair cells into the brain, where they are interpreted as 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)The theory is that damage to some of the cochlea hair cells or their nerve fibres means there is weaker input into the brain at those frequencies.
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
One approach is to retrain or rewire the brain so it gets less sensitive. A basic version, offered through some NHS clinics, is called tinnitus retraining therapy. It involves people being played sounds through headphones, usually a kind of white noise.
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.
A more complex version of brain retraining involves people listening to sounds while holding a small paddle in their mouth that gives mild electrical stimulation to the tongue. It is used twice a day for 30 minutes each time.
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.
While approved in the US, it is not yet available through the NHS, so people have to pay for it themselves at private audiology clinics.
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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“I’m not encouraging people to do it, but they should be aware that this is something available at a private clinic. People are reporting significant benefits.”
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.
A similar approach is being developed by a US firm called Auricle, where the electrical stimulus is given by small skin pads on the jaw.
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.
Auricle has said that its experiments on animals shows this is more effective at causing rewiring of the relevant brain circuits.
Another technique at an earlier stage of development aims to encourage brain rewiring by using sound in a slightly different way.
The higher sensitivity that people with tinnitus experience may involve their brain cells firing in synchrony with each other too much, which is interpreted as false sounds.
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.
The alteration to the music is barely noticeable. So if the technique works, it could be turned into an app that does this kind of modification to ordinary music. “In principle, this can be implemented freely or cheaply on an unlimited scale,” he said.
Cause for optimism
While any of these approaches would be good news if they work, Dr Sedley said there is another cause for optimism.
Many people assume their symptoms will get progressively worse. But in a study of 51 people with new tinnitus, most reported improvement over six months in how much the sounds bothered them, and that they reduced in volume.
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.”
Nevertheless, GPs should still take it seriously when patients develop tinnitus symptoms, said Don McFerron, a retired ENT surgeon and president of charity Tinnitus UK. “People are often told there’s nothing that can be done about this and they should just go away,” he said. “There’s loads that can be done. It is infuriating.”
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.
“It is a realistic treatment goal for anybody struggling with tinnitus to at least try and achieve that. And sometimes it works.”
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Having a dim memory of the Alan Alda mid-life crisis movie, The Four Seasons, I’m loving the modern remaking of it as a Netflix series – mainly because of the stellar cast including Hollywood royalty Tina Fey and Steve Carell, who also co-wrote it.
Fey is best known for writing and starring in the iconic high school movie Mean Girls, and middle-age angst has turned out to be just as rich a comedic seam for her to mine. Alan Alda even pops up for a knowing cameo.
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