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SOUND in the ears

Silent noise

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In the din of the modern world, silence is often welcome. But for Nitish Gupte, it feels like punishment. For the 33-year old, Mumbai-based marketing professional, even the deepest silence is broken by a high-pitched hum. The source of that noise lies not elsewhere, but within him. Gupte is among the millions who live with tinnitus, a condition characterised by a buzzing, ringing, roaring or whistling sound in the ears. "If I wake up at night, I can't get back to sleep because of the constant ringing, " he says. "I do all sorts of weird things for relief, even if momentary, like getting under the shower ever so often or crackling and crunching a crisp packet next to my ear. At times, I feel like killing myself. "

He flips out when his doctor calls his experience a "sensation" or a "perception" of sound. It is difficult for Gupte to accept the fact that the sound at the root of his plight has no real existence and cannot be heard by anyone other than him. The sounds of tinnitus occur without external stimuli. And, that makes tinnitus one of medical science's big conundrums.

Tinnitus may result from protracted exposure to loud noise;an ear infection;damage to hair cells in the inner ear;excessive use of ototoxic medication (drugs that treat ear infections), such as aspirin, streptomycin, gentamycin and others that can damage inner ear;a blocked auditory tube;age-related degeneration of the brain's auditory pathways;a head injury, or a neurological disease.
However, the list is not limited to just these. "Many patients suffer from tinnitus without any detectable hearing loss, " explains Dr Anirban Biswas, a Kolkatabased consultant neurotologist (an expert who treats neurological disorders of the ear) and an expert on deafness, tinnitus and vertigo.

"Tinnitus is believed to affect one in every 7-10 people in the world and one in every 200 sufferers is severely bothered by the sounds, " he says. No reliable figures are yet available for India.

Biswas warns that tinnitus can portend brain and cardiovascular diseases, even multiple sclerosis. "All tinnitus patients need to be investigated thoroughly to diagnose underlying ailments and rule out sinister life-threatening conditions. "

Tinnitus triggers a vicious cycle: It induces stress, anxiety, sleeplessness, depression, paranoia and seclusion, which further aggravate it. Experts say it is more often an accompaniment to a hearing problem. Curiously, this affliction has as much to do with the brain as the ears. When the brain is deprived of regular sound waves, it works harder to find some and short-circuits itself in the process to give rise to phantom sounds.

Sadly, there is no absolute cure yet for tinnitus. "The treatment is never foolproof and the outcome varies hugely, " says Dr Sanjay Bhatia, consultant ENT surgeon and neurotologist at Fortis Hospital, Mumbai. As of now, most therapy focusses on reducing the distraction caused by abnormal sound and helping the sufferers make peace with it to lead as normal a life as possible. "A masking sound can help those with mild to moderate tinnitus, " advises Bhatia. "This can be any sound, from that of a radio to a fish-tank motor. "

Hearing aids can be used to introduce external sounds of the right frequencies and help influence the way the brain perceives sound. Relaxation music can greatly relieve tinnitus. Nowadays, says Biswas, one can also listen to fractal music, a special type of computer-generated, nonrepetitive music, which is produced using a mathematical calculation and is known to reduce tinnitus-induced stress.

Tinnitus retraining therapy helps habituate the auditory system to tinnitusrelated sounds and makes it easier to accept them. Explains Biswas, "It uses a combination of psychotherapy and Noise Generator, and involves regular treatment of up to 18-24 months, during which time the patient has to visit specially trained counsellor, psychologist and the doctor. Unfortunately, this modality is not practised ethically in our country. There is a dearth of trained professionals who can do justice to this treatment. "
According to Biswas, although not guaranteed cures, newer treatment modalities such as Tinnitus Phase-out Therapy - which involves hearing customised sounds for certain durations at certain intervals to get over sounds of a certain frequency - and deep electromagnetic wave stimulation are reasonably effective in some cases.

Enthused by the early findings of a study, researchers at the University of Texas are now suggesting that one way to address this problem could be to electrically stimulate an auditory nerve into ignoring the signals that cause the sound. And then release chemicals that make the brain receptive to auditory reconditioning, which can be achieved by simultaneously playing sounds of certain frequencies.

Exercises that aid better blood circulation also help. According to Bhatia, surgery is an option in definitive cases like intracranial tumour, vascular disorders, or abnormal compression of a cranial nerve. There's medication too. "Benzodiazepine-class drugs can help reduce anxiety among those with severe tinnitus, " says Bhatia. Adds Biswas, "Psychotropic drugs, too, can be effective when combined with counselling. " Clearly, the accent is on managing tinnitus so that the likes of Gupte can be offered a better quality of life.

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