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Living with tinnitus

While there's no cure yet for tinnitus, some psychological therapies are helping people live with the sometimes frightening condition, writes Judy Hobson

Imagine having a humming or whistling noise in your ears or head every hour of every day. Not only are the intrusive sounds a constant distraction during daylight hours, they can also make getting off to sleep at night a real problem.

The condition is called tinnitus, after the Latin word for ringing, and is common among the over 60s because our ears get damaged naturally during the ageing process.

Around 20 million people in the UK experience tinnitus in varying degrees at some point in their lives. In most cases it disappears after a few months, but an unlucky ten percent- 6.5 million people- are left with persistent tinnitus and have to cope with buzzing and hissing in their ears every day.

For 65,000 of these, it turns their lives upside down,, and there have been occasional reports in the media of people driven to suicide by their tinnitus.

Dr Laurence McKenna, consultant clinical psychologist at the Royal National Throat, Nose and Ear Hospital in London, says: "Tinnitus can be very frightening. People are concerned that it will ruin their quality of life and can feel helpless.

"Some worry about their mental health and have had suicidal thoughts, but only a very tiny number do commit suicide, and in these cases there are usually other factors involved and tinnitus is the straw that broke the camel's back."

There is good news, however. While, as yet, there is no cure for tinnitus, a range of treatments including cognitive behavioural therapy (CBT), mindfulness-based cognitive behavioural therapy (MCBT), relaxation techniques and sound therapy are helping people to live with it.

CBT, for example, encourages people to change the way they think about tinnitus and to realise that certain patterns of behaviour are unproductive, which makes tinnitus less of a burden.

Dr McKenna adds: "The difference between those who really suffer and those who don't is mainly psychological. If you're shouted at repeatedly, after a ime you stop reacting to the same old thing. This biological process is known as habituation. Some tinnitus sufferers are able to habituate more easily than others.

"They're also frightened they'll never be normal again and, while their nearest and dearest may be sympathetic, they feel they don't really understand and this pushes their stress levels up even further."

For a large number of those who find it hard to habituate, the onset of their tinnitus comes after a stressful life event- financial worries, work difficulties, exam pressure, marriage break up or the loss of a loved one.

Some, Dr McKenna find, believe that by keeping busy and never sitting down they can 'unfocus' form their tinnitus. He says "They'll have the radio, television or a sound generator on the whole time, but this avoidance strategy keeps their fear of tinnitus alive. They're on the run form it and end up emotionally exhausted. Using techniques such as CBT we can help them to realise what's going on and get them to think differently about their tinnitus. 

"Peple will say I do my best not to think about it but this can create a paradox. If I tell you not to think about an elephant, it's inevitable you will. This strategy doesn't work either and the battle  you're waging to push your tinnitus to the back of your mind simply locks it in there.

"Mindfulness can help a person to allow the tinnitus to come to the front of their mind, and because the struggle is now over they'll have a different experience."

What causes tinnitus?

Beth-Anne Culhane, an advanced audiologist and hearing therapist at St George's University Hospital in South London, says: "It is thought the unwanted sounds are caused bu what is going on in the brain rather than the ears themselves. The ear is the receptor that picks up information which is sent to the brain. Tinnitus occurs when there is a change in this signalling system and you start to hear body sounds that your brain has stopped filtering out. While it occurs more frequently in people with hearing loss, it's also found in those with normal hearing."

For some it starts after a traumatic event or when they're struggling with pain. It can follow a middle ear infection or develop after a respiratory tract infection and be a side effect from platinum based chemotherapy drugs. Impacted earwax can also cause the condition as can an under or overactive thyroid gland.

A known preventable cause is repeated exposure to excessive noise which is why some rock musicians and people who worked on construction sites before wearing earplugs was compulsory have the condition. With its Plug'em campaign, the British Tinnitus Association is urging people to wear earplugs at gigs and when hey use noisy DIY tools.

Mrs Culhane adds: "We see people who are very disturbed by the condition. Some struggle to keep working because their tinnitus disturbs their sleep, so it's very rewarding identifying a therapy that suits their needs so their tinnitus is no longer such a big deal. But no one size fits all. Each patient is different and the impact the condition has on their lives is different too.

"Generally GP's are good at referring people to audiologists or ENT specialists when their tinnitus is a problem, but some patients are simply told to get on with it or that it will go away.

"The more you listen to your tinnitus, the more you're likely to hear it, so it makes sense that GP's don't initially refer you on if you don't seem too distressed by it. In some cases the tinnitus foes, but if it hasn't after three months, I'd urge people to go back to their doctor and ask to be referred to their local audiology service."

Dr McKenna says: "It's very unhelpful and incorrect to tell people who are in a state of high anxiety that they have to learn to live with tinnitus. The fact is that the outlook is really good for them because they can be given support to help them cope with the tinnitus.

"Relaxation has been used for many years and from our research we know it helps. Mindfulness enables people to realise how their emotions and actions affect their tinnitus and encourages them to approach it differently and see the difference that it makes.

"In a recent study comparing the use of relaxation therapy with mindfulness CBT in tinnitus patients, stress levels dropped significantly in both groups but a greater change was found in the mindfulness group."

Sound therapy, Mrs Culhane says, does not make the tinnitus stop but it can make the patient less aware of it and can be very helpful. It includes the use of hearing aids, devices that deliver white noise and bedside generators that emit natural sounds such as the sea. It is usually used in combination with one of the other techniques- relaxation, mindfulness or CBT. And simply talking to someone can help. A recent study discovered that people with tinnitus found it very useful talking to another person about it.

People with tinnitus can often experience feelings of isolation. Attending a support group, run by the BTA, can help them overcome these feelings and to realise they are not alone. It also enables them to pick up tips from others on coping strategies.

Do you have tinnitus? What do you think of this article? 

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