Health

Millions of Americans Hear Constant Ringing in Their Ears

Why can't we make it stop?
January 16, 2018, 6:28pm
Danielle Wehunt/Stocksy

I was visiting my hometown in Michigan when I noticed an odd muffling sensation in my left ear, like I’d been swimming and had some residual water clogging the works.

The muffling turned into dizziness—a kind of light-headed disequilibrium akin to a pot-induced body buzz. Neither sensation lasted long; an hour or two at most. But when they departed, a high-pitched ringing remained.

The ringing ebbed and flowed. At least, I think did. This all happened five years ago, and my memory of it is hazy. I can’t remember just how many dizziness episodes I experienced before seeing a doctor about it. After some hearing tests and an MRI to rule out things like nerve or brain tumors, I was told I likely had Ménière’s disease—a rare inner-ear disorder that can cause symptoms like vertigo, tinnitus (ear ringing), nausea, and sensations of “congestion” in the ear canal.

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My doctor told me sodium and stress could exacerbate these symptoms, so I cut back on the former and tried to mitigate the latter with meditation and exercise. The dizzy spells and muffling sensations stopped, and haven’t come back, which is fortunate. Ménière’s can be crippling. (I’ve since learned that the singer Ryan Adams has the disease, albeit a much more severe case than mine.)

But the ringing in my left ear has stuck around. So, like 50 million other Americans, I have tinnitus, which is broadly defined as the perception of sound without a source.

Like a lot of other people with tinnitus, I describe the sound in my head as a “ringing,” even though it’s not really a ringing at all. At least, it isn’t for me. It’s a steady, high-pitched squeal—one that’s volume and intensity ebbs and flows. (If you’ve ever heard those radio tests of the emergency broadcast system, you have some idea of the sound squealing in my head.)

I know from reading about tinnitus that some people experience it in both ears, and I can’t decide whether that would be worse or better. Also, the quality of the sound can vary from person to person. Some hear a buzzing, while others here a clicking, pulsing, or hissing.

So what exactly is tinnitus? Not what I thought. Since I experience it as a sound, I’d always assumed the problem was in my ear.

“The big surprise is that tinnitus is usually not coming from the ear, but from the brain,” says Michael Kilgard, a professor of brain sciences at the University of Texas at Dallas.


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“We figured this out when people with severe tinnitus on one side asked to be deafened in that ear,” Kilgard says. “Even after the auditory nerve was surgically cut, they still had tinnitus.” In some cases, the tinnitus actually grew worse after this procedure.

But if it’s not an ear problem, what is it? “Tinnitus comes from hyperactivity in the brain’s auditory cortex,” he says. The part of the brain that translates sound into sensory information is “over-excited,” and is hearing something that doesn’t exist.

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There are different causes and “subtypes” of tinnitus. But for many, the condition stems from hearing loss, explains Susan Shore, a professor of head and neck surgery, biomedical engineering, and integrative physiology at the University of Michigan.

A common case is a shooting enthusiast or military vet who has had repeated exposures to gun blasts. While the amount of sound an ear can tolerate varies from person to person, gun-strength noise can damage nerves in the ear, which leads to hearing loss, which the brain interprets as a loss of sensory input, Shore explains. The brain attempts to compensate for that loss of input by recruiting nerves from other systems. Sometimes these other nerves overcompensate, and the result is tinnitus.

In some ways, it’s comparable to the phantom sensations, including pain, felt by people who have lost a limb. When confronted with gaps in its mosaic of sensory input, the brain seeks to fill them—not always ably.

When you understand that tinnitus is a neurological condition—not something physically broken or malfunctioning in the ear—you start to grasp the difficulty in treating, let alone curing it.

Some combat it by using “sound therapy”—or camouflaging the phantom ringing with music or white noise. (For many, including me, the tinnitus is much more apparent during moments of silence.) Others turn to drugs—antianxiety meds or antidepressants—or cognitive behavioral therapy to lessen their tinnitus-related anxiety and distress, and to train their attention to focus on other stimuli.

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Some just learn to ignore it. “How much it bothers people is not correlated with how loud it is,” Kilgard says. “There’s an emotional component to it that comes from the brain’s amygdala, and stress tends to make it worse.”

There is no cure for tinnitus. But that may soon change. Both Kilgard and Shore are working on nerve-stimulation therapies that have significantly reduced tinnitus in early clinical trials.

Kilgard’s treatment involves implanting a small electrode on a nerve in the neck that helps the brain interpret sensory stimuli. “By playing tones over and over again [in the ear] while stimulating the nerve, we can turn down that over-activity in the brain’s auditory cortex,” he says. “It’s not 100 percent effective, but about half of patients get about half better.” He says he’ll continue to adjust the therapy in follow-up trials, and will hopefully achieve even better results.

The treatment Shore is developing is less invasive, and has also worked well for some tinnitus patients. Like Kilgard’s, it involves playing sounds in the affected ear or ears while a throat-attached device delivers small electric impulses to touch-sensitive nerves below the skin. And like Kilgard’s, the idea is to calm the brain’s over-excited auditory cortex. “In our trial, the loudness of the tinnitus was reduced by half,” she says.

So for me and other tinnitus patients, there is reason for hope. Kilgard says his treatment may be ready for widespread use in just two to three years. “Our goal is to have the tinnitus stop completely, and we’re not there yet,” he says. “But turning it down—getting [the ringing] down to a two, not an 11—is still much better.”

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