There is no known cure, but new technology offers ways to cope with ‘ringing in the ears’
By Deborah Jeanne Sergeant
On March 21, Kent Taylor, the founder and CEO of the Texas Roadhouse restaurant chain, died from suicide at 65.
In a press release his family sent to the Associated Press, Taylor “took his own life” following “a battle with post-COVID related symptoms, including severe tinnitus.”
Tinnitus, also called “ringing in the ears,” is not a disease but usually a symptom of damage to the auditory system. People with tinnitus hear “phantom sounds” such as buzzing, humming, clicking, chirping or, rarely, looped, repetitive music.
For a small minority, the unwanted sounds become extremely bothersome and interrupt sleep and activities of daily living. Scattered anecdotal reports have linked COVID-19 with tinnitus. Shortly before his death, Taylor, a longtime philanthropist, committed to funding research on tinnitus.
COVID-19 has also been linked with depression and anxiety. Left untreated, depression and anxiety raise the risk of suicide. Research printed in a November 2020 issue of Lancet Psychiatry indicates that after reviewing 69.8 million electronic health records, 20% of the 62,000 patients diagnosed with COVID-19 were also diagnosed with a psychiatric disorder such as anxiety, depression or insomnia within three months. Of those, 5.8% were a first-time mental health diagnosis. The study compared people with COVID-19 with patients without COVID-19 during the same period, which means that the illness itself, and not just societal shifts and stress, contributed to the increase in mental health diagnoses.
Regarding the death of Taylor, Lixin Zhang, neurologist and founder of Dent Neurologic Institute in Amherst, said “I was really shocked but not surprised.”
Annually, he treats about 1,500 patients with tinnitus, which he said can be very severe.
Among patients with severe tinnitus, he very often sees tinnitus, hearing loss and anxiety, depression and/or stress concurrent conditions, although other health conditions can cause tinnitus.
“If you manage the clear underlying factors, like anxiety, stress and depression, their tinnitus will be improving,” Zhang said.
Since tinnitus is in part of the brain that correlates with hearing loss, those with tinnitus usually have hearing loss.
“The brain won’t receive hearing stimulation and becomes hyperactive to compensate for the hearing loss,” Zhang said.
He said that for most patients with tinnitus, wearing a hearing aid to amplify the sounds they miss can help reduce the effects of hearing only the unwanted sounds.
Other causes can include excessive earwax, trauma, certain medications, temporomandibular joint (TMJ) issues, blood flow issues, psychiatric disorders, tumors, vestibular issues such as dizziness or vertigo and autoimmune diseases. Diet, stress, alcohol and caffeine can worsen tinnitus. Though it has no cure, interventions can mitigate its effect.
Of the more than 45 million Americans with tinnitus, only 4% say that it significantly interferes with their activities of daily living such as sleep and work.
No medication currently exists to treat tinnitus; however, Zhang is leading early research exploring medicine that can interrupt the signal from the ear to the brain.
“A lot of the treatment involves covering the tinnitus with a noise that’s more pleasant,” said Salvatore Gruttadauria, doctor of audiology with Diversified Hearing and Balance Centers in Buffalo, Kenmore, Elma, Hamburg, Lockport, Niagara Falls, Warsaw, Williamsville and Westfield. “If they listen to music or are in meetings all day, they don’t focus on the tinnitus.”
Much like people who eventually become used to the different sound of a new refrigerator, many people with tinnitus can learn to not pay attention to the phantom sounds. But it is more challenging for hearing than other senses to develop tolerance.
Gruttadauria said that people who have no hearing loss can wear devices that look like hearing aids, but instead of amplifying, they mask the tinnitus sounds.
“Most people can be helped,” he added. “It’s not something that should be ignored. You want to make sure it’s not an indicator of something more serious. There is help.”
Jill Bernstein, doctor of audiology and assistant director of Hearing Evaluation Services of Buffalo in Amherst, said that by offering local resources as needed, such as professionals to address psychological issues, tinnitus experts can fully address the more severe cases of tinnitus.
“We have questionnaires that are standardized across the US about how bothered they are by their tinnitus,” Bernstein said. “Depending on those answers, we might make a referral to therapy.”
As part of how they address tinnitus, her office uses relaxation strategies and a variety of mechanism like apps. A large part of what Hearing Evaluation Services does is educating patients. Since stress and anxiety can worsen symptoms, Bernstein said that it is important to educate patients so they feel empowered by their knowledge.
“Helping them understand it can reduce the stress and anxiety to reduce their symptoms,” she said. “They can habituate to the tinnitus. Habituation is our goal. It means they’ve gotten used to it and it’s not bothersome.”
Christina Stocking, doctor of audiology with UB’s Speech Language Hearing Clinic, also said that gaining more information decreases patient stress.
“The first thing we do for all our patients is informational counseling so they understand what’s happening and what’s causing it and take away the fears people have,” Stocking said. “They often think they’re going deaf or losing their mind or that it’ll get worse and worse. We give them hope it can get better and get managed.”
A growing body of evidence indicates that mental health initiatives such as cognitive behavioral therapy, tinnitus retraining therapy and practicing mindfulness and meditation can help manage the response to tinnitus.
“If you change how you think about it, you can change the effect it has on your life,” Stocking said.
She encourages patients to resist searching the internet for information, unless they view the sites of reputable health organizations. They should seek a medical professional specializing in tinnitus for information and treatment.
“Oftentimes, patients go to their doctor and they do an exam and say that nothing’s wrong and to just learn to live with it,” Stocking said. “It’s easier said than done. Telling someone to ignore it or to learn to use strategies are two different things.”
For more information from American Tinnitus Association (www.ata.org), Hearing Loss Association of America (www.hearingloss.org), American Speech and Hearing Association (www.asha.org), American Academy of Audiology (www.audiology.org) and the National Institute of Deafness and Other Communication Disorders (www.nidcd.nih.gov).