Tinnitus

One Man's Military Perspective

By Colonel John T. Dillard, U.S. Army (Retired)

The top two disabilities for our returning veterans from Iraq and Afghanistan are hearing loss and tinnitus, or ringing of the ears (which is actually a sound inside the brain). Both conditions became a problem for me and for many of my friends in the service. A lifetime spent in the U.S. Army, starting in the 1970s, meant frequent exposure to gunfire and proximity to screaming jets and helicopter engines.

Even during a peacetime career in the military, our soldiers, sailors, airmen, and marines are subject to a barrage of auditory insults from the weapons and equipment they operate. It all stacks up to a gradual, although sometimes very abrupt, loss of hearing, usually starting at the higher frequencies. For those in the service, any age-related decline in hearing gets accelerated, to the extreme, by repeated exposure to noise at unsafe levels.

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For me, tinnitus began faintly and increased with more hearing loss, reaching a crescendo with one big acoustic trauma—a gunshot right next to me in 2009. I immediately began searching for any kind of treatment that would alleviate the loud ringing in my head, which was actually measured in a laboratory at being around a constant 70 decibels. That is roughly equivalent to the noise inside a fairly strong shower, and I soon discovered that people would use long showers to find a bit of relief by masking their tinnitus. (However, I take short showers!)

Armed with a background in biology and technology, I began to review all the research I could find. As it turns out, the typical tinnitus condition consists of several brain components: auditory (hearing it); attentional (your awareness of it); memory (persistence); and emotional (how it affects your mood). After many hours on the web, I spent thousands of dollars on things that didn't work, undergoing treatments in all areas of pharmacology, sound therapy, acupuncture, hyperbaric oxygen, and even transcranial magnetic stimulation.

None of these had any effect for me whatsoever. And despite some incredible recent advances in neuroscience to better understand all of the brain’s complexities, there is still no proven cure or even a viable treatment for tinnitus or to reverse hearing loss.

I eventually realized I would have to tackle my tinnitus with the only things out there that to me were credible for managing tinnitus. I eventually found an audiologist who would fit me with hearing aids that provided a built-in tinnitus masking sound. Without a doubt, this became the best purchase decision of my life...

Continue here to read the full version of "One Man's Military Perspective" in the Fall 2017 issue of Hearing HealthColonel John T. Dillard, U.S. Army (Retired), resides in Carmel, California, with his wife of 30 years. A senior lecturer at the Naval Postgraduate School in Monterey, Dillard spent his army career serving in mechanized and parachute infantry assignments and managing programs to bring new technological capabilities to warfighters. He serves on a consumer review panel of tinnitus treatments for the Department of Defense (DoD)’s Congressionally Directed Medical Research Programs and also conducts acquisition policy research for the DoD.

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Protecting Your Hearing Means Protecting Your Mental Health

By Carol Stoll and Lauren McGrath

October is Protect Your Hearing Month—and, today, October 10, is World Mental Health Day, a time for mental health education, awareness, and advocacy. Hearing loss and tinnitus (ringing in the ears) can increase one’s risk of developing mental illnesses including depression, anxiety, schizophrenia, and dementia, and can trigger episodes of extreme anger and suicidal ideation. Protecting one’s hearing not only prevents or delays hearing loss, but also benefits mental wellness. Understanding the signs of mental illness and having access to mental health resources is critical—and can even be life-saving—to all individuals with hearing loss or tinnitus.

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According to an April 2014 study published in JAMA Otolaryngology Head & Neck Surgery, 11.4% of adults with self-reported hearing impairment have moderate to severe depression, significantly higher than the 5.9% prevalence for those with typical hearing. Individuals with hearing loss have reported feeling socially inept in group settings, entering conversations at inappropriate times, talking off-topic, or dominating conversations and coming across as rude simply because talking is easier than listening. When a person cannot hear properly, engaging in conversations is a daily struggle, and can lead to social isolation and depression. Other factors that increase the risk of depression include being female, low-income, a current smoker, binge drinking, having fair or poor health status, trouble seeing, and sleep disorder. However, even controlling for these factors, those with hearing impairment still had significantly higher rates of depression than those without hearing impairment. In people 65 and older, hearing impairment is among the most common chronic conditions associated with depression.

In addition to depression, hearing loss has been linked to schizophrenia. Several studies support the social defeat hypothesis, which proposes that social exclusion and loneliness can predispose people to schizophrenia by increasing sensitization of the dopamine system. In a December 2014 study published in JAMA Psychology, participants with hearing loss reported significantly more feelings of social defeat than healthy controls. Though their psychotic symptoms were similar to the control group, exposing them to a stimulant drug showed that those with hearing loss had significantly higher than normal dopamine sensitivity. Further studies are needed to draw definite conclusions of the causation, but this research is a first step in understanding the relationship between hearing impairment, social defeat, and psychosis.

In older adults, hearing loss is associated with cognitive decline and dementia, according to a February 2013 study published in JAMA Internal Medicine and several other studies conducted at Johns Hopkins University. The scientists concluded that reduced social engagement and a cognitive load focused on coping with hearing loss rather than higher level thinking can lead to poorer cognitive functioning and faster mental decline. Hearing aids could possibly be a simple fix to increase healthy brain function in the older adult population and reduce the risk of dementia.

Exposure to noise often results in tinnitus instead of or in addition to hearing loss, which can also contribute to a range of psychological disorders. Tinnitus affects about 1 in 5 people in the U.S., and causes permanent ringing in the ears. Though research for therapies is ongoing, there is currently no cure. Without therapy, constant ringing in the ears can be debilitating; it can affect job performance, cause insomnia, and provoke fear, anxiety, and anger. This can lead to depression, anxiety, suicidal ideation, and can exasperate post-traumatic stress disorder (PTSD).

Compromised hearing is an invisible disability, often unnoticed or ignored even by those affected. However, hearing loss and tinnitus are widespread and can have serious psychological repercussions. Hearing loss caused by noise exposure is completely preventable by taking simple measures like turning down the volume on your earbuds and using hearing protective devices in loud situations. Regular hearing screenings can also help detect hearing issues early on. Talk to your audiologist about best ways to treat or manage your hearing impairment. Find help for mental illnesses here.

Per the National Institute of Mental Health: "If you are in crisis, and need immediate support or intervention, call, or go the website of the National Suicide Prevention Lifeline (Voice: 1-800-273-8255 or TTY: 1-800-799-4889). Trained crisis workers are available to talk 24 hours a day, 7 days a week. Your confidential and toll-free call goes to the nearest crisis center in the Lifeline national network. These centers provide crisis counseling and mental health referrals. If the situation is potentially life-threatening, call 911 or go to a hospital emergency room.”

Receive updates on life-changing hearing research and resources by subscribing to HHF's free quarterly magazine and e-newsletter.

 
 
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New Study Suggests Serotonin May Worsen Tinnitus

By Erik Robinson

Millions of people suffer from the constant sensation of ringing or buzzing in the ears known as tinnitus, creating constant irritation for some and severe anxiety for others. New research by scientists at OHSU shows why a common antidepressant medication may actually worsen the condition.

The study, published Aug. 22 in the journal Cell Reports, focused on the action of serotonin, an important neuromodulator in the brain. Researchers examined brain tissue in mice, specifically the dorsal cochlear nucleus where sensory integration occurs and tinnitus is believed to develop. Researchers discovered that neurons known as fusiform cells within this portion of the brain become hyperactive and hypersensitive to stimuli when exposed to serotonin.

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“We saw that the activity of those neurons went through the roof,” said senior author Laurence Trussell, Ph.D., a professor of otolaryngology in the OHSU School of Medicine and scientist in the Vollum Institute.

The study could have implications for a common class of antidepressants known as selective serotonin reuptake inhibitors. SSRIs can alleviate symptoms of moderate to severe depression and anxiety by increasing the level of serotonin in the brain. Serotonin is a chemical compound that acts as a neurotransmitter thought to be responsible for maintaining mood balance.

However, the new research suggests that SSRIs prescribed to treat anxiety or depression may worsen patients’ tinnitus. Tinnitus is defined as the chronic perception of sound when there is no internal or external acoustic source.

“If you’re a physician treating a patient with hearing loss or tinnitus, you may want to be careful about prescribing a drug that compounds their feelings of anxiety,” said Trussell, who also suffers from tinnitus and has an appointment in the Oregon Hearing Research Center at OHSU. “The SSRI may be enhancing the thing you’re trying to fix.”

Lead author Zheng-Quan Tang, Ph.D., a senior postdoctoral fellow in Trussell’s lab, noted that a review of existing scientific literature indicated that many patients reported an increase in tinnitus soon after they began taking SSRIs.

“Estimates vary, but at least 10 percent of the U.S. population is affected by tinnitus,” Tang said.

The OHSU scientists are interested in exploring another area of research focused on a type of ion channel in the membrane of neurons that is activated by serotonin. If the scientists can determine a way to deactivate those channels, they may be able to allow the beneficial effects of antidepressants while limiting the severity of tinnitus.

The study was supported by the Hearing Health Foundation and National Institutes of Health grants NS028901 and DC004450.

This research synopsis was republished with permission from the Oregon Health & Science University

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That Annoying Ringing in Your Ears Has a Name: Tinnitus

HHF's communications and programs manager, Laura Friedman, shared her knowledge of tinnitus treatments with Boomer in "Have You Heard? That Annoying Ringing in Your Ears has a Name: Tinnitus."

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There are currently no permanent solutions to cure this constant, unexplained noise, but the efforts of HHF's Hearing Restoration Project, an international scientific consortium working collaboratively in search of a biological cure for hearing loss, may produce one.

"One of the more interesting experimental treatment possibilities for tinnitus is reported by Laura Friedman...Since hair cell loss in the Corti (the organ containing sensory hair cells required for hearing) leads to hearing reduction, missing hairs may cause persistent imbalances in the auditory nerve, resulting in tinnitus. To address this possibility, the HHF’s Hearing Restoration Project is working to discover factors that would allow new human hair cells to be regenerated and restored in the Corti, or to convert non-sensory cells into hair cells."

Read the full article from Boomer, here.

 

 

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Paying Tribute on Armed Forces Day

By Siera Whitaker

May 20 is Armed Forces Day and Hearing Health Foundation is paying tribute to the men and women who serve in our armed forces.

The number one and two war wounds for active service members and veterans are hearing loss and tinnitus, directly impacting their ability to conduct missions and follow instructions. According to the U.S. Department of Veterans Affairs, by the end of 2014 over 933,000 veterans received disability compensation as a result of hearing loss, and about 1.3 million received compensation for tinnitus.

Extended, unprotected exposure to noise that reaches 85 decibels (the sound of a lawnmower) or higher can cause permanent inner ear damage. The Centers for Disease Control and Prevention (CDC) states difficulty with hearing is the third most commonly reported chronic health condition in the U.S.; approximately 40 million Americans ages 20 to 69 have hearing loss in one or both ears, and one main cause is excessive, loud noise.

When it comes to hearing loss and tinnitus, soldiers are at an increased risk. They are susceptible to noise-induced hearing loss (NIHL) because they are exposed to loud machinery and explosions on a constant basis. In combat, soldiers are often exposed to sudden noises, such as from an improvised explosive device (IED) or other similar weapon, which are difficult to predict and be protected against. These sudden noises can result in temporary hearing loss and put military personnel at risk. However, the word “temporary” should be approached with caution. Repeated short-term hearing loss can damage the sensitive hair cells in the inner ear, leading to hearing loss that becomes permanent.

Hearing loss as a result of noise is 100 percent preventable. Wearing hearing protection such as noise attenuating helmets, which use ear cups to protect against hazardous sound, or Tactical Communication and Protective Systems (TCAPS), can go a long way to reduce overall exposure.

Since these brave men and women are disproportionately impacted by hearing loss and tinnitus that likely affects many other aspects of their lives, Hearing Health Foundation is proud to pay tribute to them on Armed Forces Day. If you are a veteran, current service member, or have family or friends who have bravely served our country, please check out our veterans' resources and share your story about hearing loss or tinnitus with us.

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Enjoy Summer Concert Season Right

By the Better Hearing Institute

With at least another month-and-a-half left of summer concert season, we thought it would be a good time to remind music lovers to pack the earplugs. It’s an easy and smart way to make sure you can enjoy those tunes for years to come.

Bringing earplugs to that next concert is more than a good idea, it should be a must, says the Better Hearing Institute (BHI). Millennials and teens especially should think twice about music volume because data show that hearing loss is on the rise in these age groups, which means they’re permanently losing some of their hearing at younger ages.

But take heart. Earplugs really can help. One study, carried out in conjunction with an outdoor music festival in Amsterdam last fall, found that festival-goers who wore earplugs were roughly five times less likely to have some temporary hearing loss than those who didn’t wear them. The earplug-users also were less likely to suffer from tinnitus afterwards.

Any sounds at or above 85 dBA for a prolonged period of time can be unsafe. The sounds at that Dutch music festival were at 100 decibels, pretty consistently, for 4-and-a-half hours. At that sound level, hearing damage can occur in just 15 minutes.

Luckily, earplugs are pretty easy to come by. Disposable earplugs, made of foam or silicone, usually can be found at local pharmacies. They’re practical because you can still hear music and conversation when they’re in your ears. But when they fit snuggly, they’re effective in adequately blocking out dangerously loud sounds.

The impact of noise on our ears

We hear sound when delicate hair cells in our inner ear vibrate, creating nerve signals that the brain understands as sound. But just as we can overload an electrical circuit, we also can overload these vibrating hair cells. Loud noise damages these delicate hair cells, resulting in sensorineural hearing loss and often tinnitus (ringing in the ears). The cells that are the first to be damaged or die are those that vibrate most quickly—those that allow us to hear higher-frequency sounds clearly.

Warning signs of too much noise

If you have to shout over the noise to be heard by someone within arm’s length, the noise is probably in the dangerous range. Here are the warning signs:

  • You have pain in your ears after leaving a noisy area.

  • You hear ringing or buzzing (tinnitus) in your ears immediately after exposure to noise.

  • You suddenly have difficulty understanding speech after exposure to noise; you can hear people talking but can’t understand them.

Repeated exposure to loud noise, over an extended period of time, presents serious risks to hearing health.

The content for this blog post originated in a press release issued by The Better Hearing Institute on July 19, 2016.

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