Imagine, if you can, a world without silence. Nothing but constant noise. Hard as you may try, you’ll probably catch yourself escaping to a place of tranquility eventually. Even for city dwellers, who hear the constant competition of car horns mixed with the persistent optimism of birds chirping, silence still finds itself among the ambient purr of nighttime. Tinnitus sufferers enjoy none of this daily respite. For them, the world is a swirling mix of static and screeching, roaring and ringing, never to be turned off, or at the very least, turned down.
The condition affects roughly 50 million Americans every day. Among veterans, it is even more common than post-traumatic stress disorder (PTSD). Yet there are no medications to cure tinnitus or even to treat it directly. This makes caring for the condition immensely more challenging for health care professionals, who must rely on roundabout methods to suppress symptoms, rather than attack the root problem. Fortunately, mounting evidence points towards psychiatric help as a growing avenue for success in reducing the condition’s severity and duration.
Tinnitus is most basically classified as a constant ringing of the ears; however, the condition plays host to a wide range of sounds, all of which may arise for different reasons. People may report ringing, roaring, buzzing, screaming, screeching, or static. Some hear flat tones, while others hear dynamic and distinct sounds, such as a whistling tea kettle or a hissing snake. The condition stems most often from acoustic trauma to the ear, resulting in a loss of hair cells — tiny cochlear receptors that send electrical signals to the brain. If excessive sound kills these cells, neurons begin to misfire and send the perception of sound even when none is present.
The ensuing condition can range from mild buzzing — the occasional mosquito lingering in your ear — to unbearable agony. Robert De Mong, a tinnitus sufferer for six years, began in the first group but eventually experienced a violent shove into the second.
“I just wanted to go into a cave and either get well or die,” he told PBS News Hour. “If I had a light switch, and I could have clicked that light switch and been dead, I would have done it. I would have done it. But suicide is a complicated thing. I didn’t have a gun, I didn’t have the medicine to do it, I didn’t like heights. So how do you take yourself off the planet?”
After checking himself into the emergency room and receiving several hours of observation, a doctor eventually gave De Mong a referral. But it wasn’t to a physician, or an ear doctor (called an “otologist”), or even a tinnitus specialist. It was to a psychiatrist. And despite insisting to the psychiatrist that his problem was the ringing — what else could be causing his insomnia? — the doctor diagnosed De Mong with depression. He began taking sleeping pills and the antidepressant Effexor. His insomnia subsided. Then his depression, and finally, his tinnitus.
“If you’ve got ringing in the ears, the first thing you should do is see a psychiatrist,” he told PBS. “She saved my life.”
Scientists have been exploring the link between tinnitus and depression for decades now. But interestingly, the findings don’t automatically paint depression as a result of the tinnitus; the conventional wisdom holds that both are co-dependent on one another. One 1989 study found that “self-reports of tinnitus loudness and severity, somatic and psychologic symptoms, and psychosocial dysfunction all showed significant improvement with treatment,” and that “these results suggest that what initially appears to be an irreversible otologic disability in these patients may be in large part a reversible psychiatric disability.”
Josef Rauschecker, a professor of neuroscience at the Georgetown University Medical Center and tinnitus expert, believes science must move toward understanding why tinnitus doesn’t always lead to hearing loss — only in about 30 percent of patients, he says. The answer may be found in this underlying link to depression.
“We’re saying, 'Well, there’s an underlying disorder maybe having to do with serotonin depletion or whatever that causes the insomnia and the tinnitus,'” he said. “So they are both effects of the same affliction, in a way. You can’t really say one is the consequence of the other. They’re mutually dependent.”
In other words, if Rauschecker can conduct a study of SSRI (selective serotonin reuptake inhibitor) antidepressants and successfully show that tinnitus’ volume gets turned down, the link to depression will be nearly cemented.
Another strategy that has seen some effectiveness is a practice is called cognitive behavioral therapy. It involves mindfulness and what clinical psychologist Jennifer Gans calls “moving into” one’s tinnitus — embracing it like an icy road that causes you to skid.
If you embrace the tumult, she told PBS, “there’s this moment of skidding with it where all of a sudden, you reestablish balance, eventually. And so that is essentially what I see as what’s helpful for tinnitus — it’s not pulling away from it.” De Mong has enrolled in Gans’ eight-week class and says the strategies were torturous at first; the mindfulness only intensified his pain. But through concerted effort, he says, his reaction to the tinnitus has softened.
While it hasn’t completely gone away, De Mong says he no longer feels as though someone is literally drilling into his brain. “What I do today from that program is breathing exercises and mindful living,” he said. “To be mindful that I’m talking to you, mindful that I’m in a comfortable room, mindful that I’m not hungry. That I’m alive.”