Aug. 2, 2004 PORTLAND, Ore. -- Every minute of every day, Bill McClellan hears an incessant hissing or ringing noise that fluctuates between a faint low-pitched static to a piercing high-pitched ring.
If he manages to fall asleep amid the cacophony, he awakens a few hours later to the same intolerable din. His resulting sleep deprivation makes it difficult to concentrate and his attention span is short. He can't stand to drive because the whine of his tires on the highway synchronizes with the ringing in his ears, creating an unbearable racket in his head.
McClellan, 53, of Chehalis, Wash., is one of 40 million Americans with tinnitus, a perception of sound with no external source that only the sufferer can hear. For 2 1/2 years McClellan repeatedly sought help for his tinnitus, but was consistently told nothing could be done.
"An audiologist and several clinics all told me the same thing: 'Go home; nothing can be done; it will only get worse as you get older.' Tinnitus is the most frustrating thing I've ever had to deal with in my life. It's claustrophobic. At times the ringing is so bad, I don't want to go on."
Unfortunately, McClellan's experience is typical of most patients with chronic tinnitus, according to Robert Folmer, Ph.D., a clinical neurophysiologist in the Oregon Health & Science University Tinnitus Clinic, OHSU Oregon Hearing Research Center.
"For years patients have been told, 'Nothing can be done for tinnitus, so you just have to live with it.' When patients hear these words, it's like hitting a brick wall. What are they supposed to do next? They're left with little or no hope," said Folmer. "Even though there is no cure for many cases of tinnitus, clinicians can help patients obtain relief from the symptom now with proven tinnitus management strategies."
To help clinicians identify, treat and help patients manage this debilitating condition, Folmer, along with colleagues William H. Martin, Ph.D., and Yong-Bing Shi, M.D., Ph.D., recently published research findings and practice recommendations in an article featured on the cover of the July 2004 issue of the Journal of Family Practice.
In the article, the researchers provide detailed evaluation and treatment guidelines for physicians who might otherwise send patients home with no hope. They write that in some cases, underlying conditions -- infections, high blood pressure, hypothyroidism, diabetes or autoimmune disorders -- contribute to tinnitus and may be treated with medication, thereby resolving the problem. There are medications, they explain, known to be ototoxic, or damaging to the ear, which also may exacerbate tinnitus, such as some chemotherapy agents, diuretics, anticonvulsants or medications containing a large amount of quinine. When possible, patients should be given alternative medications that do not contribute to hearing loss or tinnitus, they write.
If no treatable underlying cause of tinnitus is found, the researchers advise physicians to start a comprehensive tinnitus management program. For patients like McClellan, who has severe chronic tinnitus -- lasting six months or longer and having a significant impact on one's ability to enjoy life -- the researchers recommend a number of proven tinnitus management therapies, individualized to meet each patient's needs.
Among the recommended options is acoustic therapy. Patients listen to "pleasant sounds" such as music, relaxation CDs or a tabletop sound machine in any environment that is too quiet. For those who experience chronic insomnia with their tinnitus, a tabletop sound machine connected to a pillow embedded with speakers may provide relief. In-the-ear sound generators that produce broadband sounds like rain or a distant waterfall to muffle or mask tinnitus can be worn during the day. Patients with significant hearing loss often benefit from wearing hearing aids. Hearing aids will sharpen patients' hearing and also decrease their perception of tinnitus.
In addition to tinnitus management, Folmer and his colleagues are at the forefront in tinnitus research. At present they are working on two tinnitus research projects: one involving the use of functional MRI to identify brain activity associated with tinnitus perception and suppression, and another using transcranial magnetic stimulation for tinnitus suppression.
"The goal is not necessarily to mask or remove the patient's perception of tinnitus," Folmer said. "In many cases that's not possible. We want patients to pay less attention to their tinnitus, so we help them to understand and gain control of it until it's no longer a negative factor in their lives."
McClellan, a microscope salesman, first learned of the OHSU Tinnitus Clinic from a friend who works at OHSU. He immediately made an appointment. As a result, for the first time since being diagnosed, he has achieved relief.
"At the clinic I learned that it's all linked," he said. "I wasn't getting enough rest at night because my tinnitus woke me up at 2 or 3 in the morning, so they recommended I take Ambien. Now I take Ambien at 10 and I'm sound asleep until 6. With adequate sleep, the ringing isn't so bad. They also told me my blood pressure was up, a contributing factor to tinnitus, and recommended I have my heart meds increased, and I have. The clinic revealed the things I should be doing."
McClellan also has purchased two custom-made in-the-ear sound generators, but says it's too early to tell whether they will provide him with long-term relief from tinnitus.
OHSU Tinnitus Clinic
The OHSU Tinnitus Clinic was the first medical clinic in the world established to help tinnitus patients, and it is one of the few full-time tinnitus clinics in the country. More than 8,000 patients from every state and some from around the world have been treated at the clinic since its inception in the 1970s. For more information, visit http://www.ohsu.edu/ohrc/tinnitusclinic.
Robert Folmer, Ph.D., is an associate professor of otolaryngology/head and neck surgery, OHSU School of Medicine; and a clinical neurophysiologist, OHSU Tinnitus Clinic, OHSU Oregon Hearing Research Center.
William Martin, Ph.D., is a professor of otolaryngology/head and neck surgery, OHSU School of Medicine; and multi-program director of the OHSU Tinnitus Clinic, OHSU Oregon Hearing Research Center.
Yong-Bing Shi, M.D., Ph.D., is an assistant professor of otolaryngology/head and neck surgery, OHSU School of Medicine; and medical director of the OHSU Tinnitus Clinic and the Northwest Center for Voice and Swallowing.
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