Tinnitus has existed for centuries but is still not fully understood

NOT so long ago I went to the cinema to watch the Christopher Nolan headscratcher Tenet.

Aside from the confusing storyline, what struck me the most about the film was how extremely, ridiculously loud it was. So loud in fact that, as I walked out, I was aware of actual hearing loss and a ringing in both of my ears the way they used to when I walked out of a club during my student days.

Fortunately for me, after a while this subsided. But for many people, especially those who are exposed to loud volumes more consistently, the ringing noise can be more persistent.

Tinnitus, as it’s known, affects 13 per cent of adults in the UK (7.1 million people) in some way.

The name is derived from the Latin verb “to ring” — tinnire — as is the fantastic word tintinnabulation, meaning the ringing, jingling or tinkling of bells.

But although ringing does seem to be the most common way to describe the sensation of tinnitus, it can be described by sufferers in many other ways including humming, buzzing, hissing, whistling or even screaming. Considering its subjective nature, therein lies one of the difficulties for medical professionals to conclude on the underlying cause as well as to assess whether or not interventions have had any positive effect.

The Who are a famously loud band. In 1976 they played a gig at the Valley in London that was deemed to be the loudest live performance at the time by The Guinness Book of Records.

Considering a lifetime of similar such gigs, it is little wonder that Pete Townshend is one of the more famous sufferers of tinnitus. He is among an incredibly long list of others including Chris Martin, Ozzy Osbourne, Sting, Eric Clapton and the actor Gerard Butler.

While hearing loss does go hand in hand with tinnitus to a certain extent, particularly in those who have been exposed to loud sounds for long periods (not just musicians but construction workers and those who even work in noisy offices), tinnitus can still occur without any reduction in hearing.

Much of this relates to the underlying cause. And while we know lots of things that might trigger, worsen or cause tinnitus, the actual underlying pathology is still up in the air.

While Tenet was only released in 2020 and the Who have only been around for 50 years or so, it doesn’t mean our ancestors were completely immune to developing tinnitus.

The first written accounts are thought to come from ancient Egypt where, in order to treat the bewitched ear, an infusion of oil, frankincense, tree sap and soil was dripped into the offending ear in the hope of recovery.

Later on, during the Renaissance, clinicians sought to explain the symptoms with the hypothesis that wind had become trapped within the mastoid bone just behind the ear.

To allow it to escape, they allegedly trephined the bone (bore a hole in it) to allow the air to escape. Not very successful, one suspects.

These days, we think of tinnitus much more in terms of an abnormal perception of sound from within the brain. Those suffering from it are thought to have developed an imbalance in their sound processing due to an increase in firing rates of neurons, for example, or in synchronisation of neural discharges. There remains a lack of consensus on this.

What we are clearer on are the triggers that lead to tinnitus. The most common trigger is loud noise, thus, there is often an association with hearing loss, though this is by no means always the case.

But there is a plethora of other precipitating factors, including recurrent ear infection, sinus congestion, wax blockage, stress and tension, medication side effects, vitamin deficiencies (particularly B12), thyroid hormone imbalances and, in rare cases, more severe medical issues such as strokes, vascular issues or even tumours on the auditory nerve (vestibular schwannomas).

While cases caused by wax build-up can be easily addressed, resulting in resolution of symptoms, tinnitus can sometimes be more long term.

Those that experience the symptoms continuously for more than six months are less likely to see a full resolution.

For the luckier ones, it may only be a mild background noise but for the more unfortunate sufferers it can be incredibly intrusive, leading to significant mental health issues in the longer term. Once it gets to that stage, there is no cure.

However, while there is not a definitive treatment, there are still things that can be done to minimise symptoms.

People with tinnitus often experience the ringing more at night when the surrounding environment is quieter. Introducing background noise can cancel the sound out therefore and is often one of the best ways to combat tinnitus.

For those with hearing loss, a hearing aid can sometimes help and, for those in whom it is particularly bothersome, counselling or cognitive behavioural therapy can help to refocus attention elsewhere over time. This approach tends to have some of the best evidence behind it.

If you develop a sudden tinnitus for no obvious reason (i.e. a loud concert, weekend spent jackhammering the driveway) and that lasts for 30 days without resolving, it is best to get this checked with your GP in case they need to rule out any secondary causes.

One-sided tinnitus without an obvious cause should be taken note of.

One in three people experiences tinnitus at some point in their lives. Fortunately, for most of us, it will be self-limiting and mild. Only in very rare cases is it a sign of something more serious but if in doubt it is best to check.

And while some things leading to tinnitus are out of our control, exposure to noise is not one of them. Protecting our ears is important. That means ear protection if you work in a noisy environment and avoiding loud environments for sustained periods of time.

Thankfully, Tenet is no longer in cinemas (perhaps they should have called it Tinnit) but investing in some decent ear plugs for any future scenarios of a similar nature may not be a bad idea.