Ring-a-Ding-Ding

For me, it all started at about 3:00 am on February 9th, 2008.

At that moment I woke up coughing so ferociously that I ended up injuring a whole set of muscles in my chest. Over the next 10 days, I had every classic flu-like symptom you can name, with one particularly obnoxious addition: a persistent, irritating ringing in my ears. The flu-like symptoms gradually packed up and moved on. The ringing, unfortunately, moved in to stay. At the walk-in clinic up my street, Dr. Blood 'n Guts was pretty bite-down-on-this-bullet about my situation: “At your age, it's probably tinnitus,” he said, pausing gravely after giving the ringing its clinical name, “and that can be a real pain in the ass. You'll just have to get used to it.” The ear, nose and throat guy I ran into sometime later confirmed this standard medical advice: “You've got the kind of tinnitus that either goes away or doesn't,” he said.

Depending on whose figures you read, anywhere from seventeen to thirty percent of humanity has tinnitus in some form, the majority of them being older people. This at first seemed an outrageous figure to me, since I'd almost never heard anybody talk about it. But now that it's happened to me, it seems that everybody my age has a tinnitus story. Whenever I complain about it, the response invariably is “Oh, I've had tinnitus for years”, or “I know somebody who's got it.” It's like the elephant in the doctor's waiting-room: Either we're dealing with a scourge that has cowed a large part of the older population into silence, or we're looking at a condition where its denial is simply a part of being able to lead a normal life---like the schizophrenia sufferer who's learned to ignore the FBI agents following him everywhere.

Tinnitus is a perceived sound without any external source; a phantom perception like the “phantom limb” sometimes felt by people who've had amputations. Tinnitus most often comes in tandem either with the hearing loss you can expect when you age, or---paradoxically---an oversensitivity to noise called hyperacusis. In the less aged, it's usually the result of long-term exposure to loud noise---a phenomenon the Hearing Loss Association of America may some day dub Ozzy Osborne syndrome. Whatever its efficient cause, it's a product of the nervous system: Bits of the nerve pathways normally associated with hearing fire off phantom signals which your brain interprets as sound.

Unfortunately, it's usually irritating sound as well: sufferers have reported it as a clanging, hissing, roaring, or whooshing; like breaking glass, clicking, shrieking, banging, or owls hooting; as a ringing, buzzing, chirping or sizzling; or the sound of rushing water and chain saws. So far nobody's complained of it sounding like Britney Spears covering Billie Holiday's Strange Fruit, but it'll probably happen sometime.

It's a very private affliction: Most people won't notice anything wrong with you, at least partly because when you're with other people, the problem's not as bad---you're distracted, and talking seems to drive your private noise into the background as well. (In fact, if you're a complete party animal, tinnitus is probably no big deal for you---most of your day you're either completely distracted, or unconscious.)

Tinnitus intrudes when you most want quiet and repose; when you're alone, with your Self. You have no peace, no solitude, nowhere to simply withdraw---there's always this obnoxious reminder of everything that's bad about the world constantly buzzing in your head. What's particularly maddening is that since this interior noise is most effectively suppressed when you're in the presence of others, it soon begins to feel like you exist only for others. At its worst, tinnitus robs you of your sense of self.

Whatever else you may say about Google, it does allow you to achieve a state of futility in research far more quickly than you ever used to be able to. For the most part, the web offers little scholarly information for people who want to do something about an illness. You're given unparalleled access to people offering quack cures, prayers, and exhortations to Nietzsche-like acts of will. But you're given no theory; no method. Nothing to do.

That's why the phrase 'Tinnitus Retraining Therapy' caught my eye when I was trolling through Google Scholar for something worthwhile to read about tinnitus---it sounded like work, and that sounded good. The reference turned out to be a Cambridge University Press title: Tinnitus Retraining Therapy: Implementing the Neurophysiological Model by Pawel Jastreboff of the Emory School of Medicine and Jonathan Hazell of University College, London. What I was able to read of it on Google Books introduced me to a thoroughly scholarly analysis of the my problem, whose chief virtue was that it gave me something to do; a disciplined hand in my own recovery. (Publishers worried about the access Google Books gives online readers to their product can also breathe a sigh of relief---I ended up buying the book.)

The gist of the authors' argument runs something as follows: There are a lot of people out there with tinnitus, but only about a quarter of them find it troubling enough to go and see a doctor about---the rest experience it but don't suffer from it. What are they doing right?

What their brains have done right is to habituate themselves to the phantom sounds: their limbic systems (that section of the brain responsible for emotions) have learned to be unperturbed by the dissonance, in turn allowing their autonomic nervous systems to place the tinnitus on a sort of Do Not Call list of neurological signals that can be ignored. People with brains thus habituated can call up their tinnitus sounds if they concentrate, but the signals themselves no longer intrude on everyday life. Their tinnitus has become, in effect, background noise.

How do you get from something as irritating as seagulls screeching on your balcony and as persistent as an automated telephone bill-collector, to background noise? Ideally, what you want to do to make a nerve impulse less offensive to your limbic system is simply turn the volume down. Unfortunately, that option isn't available.

But you can turn the background noise up. In my case, I bought a $20 MP3 player, transferred a file of wide-frequency white noise onto it, set it on “repeat”, and listened to it throughout the day through a pair of ear-bud headphones. The volume is set just below the level that would cover up the tinnitus completely: You want it to be there still---after all, you're trying to get accustomed to it, not pretend that it doesn't exist.

And it's not much more complicated than that. The process of habituation can take months, but the relief is almost instant---however the retraining process proceeds, the background noise you're now carrying about with you certainly helps you get through your day.

So, in a sense, Dr. Blood 'n Guts was right---I am just going to have to get used to it. But I've acquired a tool that at the very least makes my days a lot easier to endure. Results at the moment are still up in the air---every day still seems a new adventure---but a good attitude helps. Like the chain-gang captain said to Paul Newman in Cool Hand Luke, “you have to get your mind right.”

-Published in Zoomer Magazine, Winter 2008