To coincide with Tinnitus Week 2019, the Audiology Department at the Royal Surrey County Hospital hosted a seminar on Tinnitus and Hearing Impairment. It was open to professionals, students and patients alike and was well attended with not an empty seat in the house. The hard of hearing in the audience were very well catered for, with the inclusion of an induction loop for hearing aid wearers and realtime speech to text projected onto a large screen.
The event was opened by the Mayor of Guildford, Councillor Mike Parsons and the speakers where Dr. Hashir Aazh and Dr. R Srinivasa Raghavan.
First up was Dr. Hashir Aazh, with a presentation on his research into the relationship between severity of hearing loss and loudness of tinnitus.
Dr. Aazh’s research was inspired by his clinical practice, where a common concern amongst his patients was about their hearing loss getting worse with age. They were concerned about what effect that would have on their tinnitus, and if their tinnitus got louder, how would they cope?
Dr. Aazh says that it is fairly well established that as hearing loss progresses, tinnitus can also get worse. This is because, as the auditory cortex within the brain stops receiving high frequency messages from the inner ear, it tries to compensate by increasing its own internal activity.
But how strong is this link between severity of hearing loss and tinnitus loudness? And are there any other factors that might better predict the perceived volume of tinnitus?
Dr. Aazh’s research shows that there is a correlation between the level of hearing loss and tinnitus loudness, but that it only accounts for around 4% of the variance in tinnitus loudness. In other words, as a patient’s hearing gets worse with age, it is possible their tinnitus will get louder, but not by very much.
So this suggests that there are other contributing factors at play when it comes to tinnitus loudness.
In the next phase of the study, Dr. Aazh was able to identify that patients with the loudest tinnitus tended to be those who found tinnitus the most annoying. And those who reported tinnitus having a significant negative impact on their day-to-day lives were also amongst those likely to have a louder tinnitus.
Dr. Aazh is suggesting that this “tinnitus annoyance” and the impact it has on a patient’s life is not just a result of having tinnitus in the first place, but also a contributing factor to the severity of the tinnitus itself. A feedback loop is formed.
The positive take away from this, Dr. Aazh concludes, is that there are a number or rehabilitative approaches such as Cognitive Behavioural Therapy, that can help a patient reduce their annoyance and the emotional distress caused by tinnitus, thus reducing the perceived volume of the tinnitus. This is something many people can achieve.
The second presentation of the day was given by Dr. R Srinivasa Raghavan. His talk delivered a general overview on the different causes of tinnitus and how it can be treated.
Dr. Raghavan says that the most common cause of tinnitus is noise damage to the inner ear. However this is not the only cause. The second most common cause is from taking ototoxic medications such as those used for chemotherapy or epilepsy. There are a myriad of other causes too, ranging from earwax, arthritis or even a tumour between the inner ear and the brain.
In Dr. Raghavan’s clinic, he says the first step is to establish what happened to cause the tinnitus. Often, when the trigger has been identified and taken away, the tinnitus can fall silent. However, if taking away the trigger is not possible, just the knowledge of what tinnitus is and how it was caused can help patients learn to live with it.
Dr. Raghavan went on to talk about “micro stress dosages”. This is stress caused by the brain’s lack of resources when parts of the body start to fail. Ageing, deterioration of eyesight and hearing loss amongst other things, are competing for the brain’s dwindling resources. These micro stress dosages add up over time and can lead to tiredness, anger and frustration. When there is a sudden hearing loss with the onset of tinnitus, the brain struggles to cope. Dr. Raghavan says that patients are annoyed and angry, not just because of the tinnitus, but because of the stress as well.
This ties in neatly with Dr. Aazh’s presentation. Dr. Raghavan says that “the cure is within you”, and that there are a variety of talking therapies that can help with the stress.
After a short break there was a Q&A session. One fascinating question that came up was about the study into hair cell regeneration within the inner ear. It turns out that birds can regenerate their hair cells, and scientists have managed to identify the gene that is responsible. The gene is present in mammals, however it is switched off. More research needs to be done to work out how to switch it on.
This was a very informative afternoon and I am grateful to the Department of Audiology at The Royal Surrey County Hospital for organising this event and above all, for helping me to cope with my own struggle with tinnitus.
Written by Andrew Ford 21/04/2019