Ringing in the Ears Called Growing Peril

Let your ears tell the tale. That ringing may signal lifelong trouble.

So here’s a message, loud and clear. Turn down that iPod! Audiologists are hearing more and more about ringing in the ears, and ringing is a telltale sign of future chronic tinnitus.

It’s not the high decibel level so much as the duration of listening to music at high levels, say the audiologists.

Brian Fligor, Sc.D., director of diagnostic audiology at Children’s Hospital in Boston, said that the average level of a rock concert is 103.4 decibels. Standing near a large truck delivers noise at about 85 to 90 decibels. A dog barks at about 85 decibels. A busy New York street rises to 75 decibels.

In order to hear their iPods, some people ratchet them up to 80 to 90 decibels. The real problem, Dr. Fligor said, is how long people stay plugged in.

“We can safely listen at 85 decibels for up to eight hours, and that’s okay for most people,” he said. “But if we turn the volume up to 88 decibels, our safety level is now only four hours.” Music pumped directly into the ears via headphones at 94 decibels is safe for only one hour, he emphasized.

These portable music devices are extremely popular with 25.6 million sold worldwide just during the first half of this year alone. Dr. Fligor said that people, particularly young people, are wearing them for hours on end, increasing the chance of damaging the inner ear and ultimately raising their risk for tinnitus.

Dr. Fligor published data on the sound produced by portable CD players in the December 2004 issue of the journal Ear & Hearing. On the basis of standards set by the National Institute for Occupational Safety and Health, he found “a maximum permissible noise dose would typically be reached within one hour of listening with the volume control set to 70% of the maximum.”

Although devices like the iPod haven’t been around long enough to see whether they cause hearing loss, Dr. Fligor said, “the writing is on the wall.”

Although hard data are lacking, clinicians are reporting a surge in the number of patients being diagnosed with tinnitus.

Tinnitus affects 32% of the general population at one time or another, according to estimates by the National Center for Health Statistics. More than two million people have debilitating tinnitus that affects their daily functioning, job performance, and personal relationships. Authorities also estimate that 12% of all children, ages six to 19, have noise-induced hearing loss, which could lead to tinnitus.

“The sense is that there are more people with tinnitus, especially younger people,” said Jim Henry, Ph.D., an associate professor of otolaryngology and head and neck surgery at Oregon Health & Science University in Portland. “There are no hard stats to back that up. It’s just an impression.”

That impression might be conservative, other authorities say, because the condition is underreported. Younger people and children may not recognize that their noisy ears are a clinical problem.

“Noise is the most commonly reported cause of tinnitus,” said Dr. Henry, who developed tinnitus 30 years ago after years spent as a teen musician. “People just walk into a rock concert or a night club and they walk out with tinnitus. You see patients like that pretty regularly.”

Movie theaters may also contribute. A study presented at last year’s American Academy of Pediatrics meeting found that children’s movies were just as loud as ear-splitting action films. The decibel level from one action film was more than 96% of the maximum permitted sound exposure, whereas documentaries registered at only 65%.

When a tinnitus patient turns to a physician for help, the doctor may not know what can be done, said Pawel Jastreboff, Ph.D., of the Tinnitus and Hyperacusis Center at Emory University School of Medicine in Atlanta.

There’s a lack of education at both the patient and the provider level, Dr. Jastreboff said. It’s an issue of not recognizing the problem “because doctors aren’t prepared to ask the proper questions.” And when doctors do diagnose tinnitus, they may tell patients there is nothing they can do for them.

Craig Newman, Ph.D., section head of audiology at the Cleveland Clinic Foundation, said there are three simple questions physicians should ask patients to screen for tinnitus:

* Do you hear noise in your ears?

* How often do you hear noise in your ears?

* Is the noise a problem?

Screening children can be more difficult, he said, because they don’t always recognize the ringing in their ears. Behavior problems may indicate an underlying hearing condition, he noted.

There are also treatments to retrain the brain so that it stops focusing on the ringing in the ears and the tinnitus becomes less of a nuisance. One of the newest and most experimental tinnitus treatments is called Tinnitus Retraining Therapy (TRT), which was developed by Emory’s Dr. Jastreboff and studied by Oregon’s Dr. Henry.

TRT involves a combination of counseling and sound therapy, which entails wearing an ear device throughout the day that produces white noise. The theory is that the white noise will distract the brain from focusing on the tinnitus.

“Everything is done specifically to get patients to the point where they’re not annoyed by the tinnitus,” Dr. Henry said. The background noise creates a hearing environment so that the “tinnitus becomes a less noticeable signal to the brain.”

Dr. Henry tested the TRT technique and found it worked. The data will be published in the February issue of the Journal of the American Academy of Audiology. He is also leading a multicenter study comparing TRT with masking in tinnitus patients. Whereas TRT involves wearing an ear device long-term, masking provides short-term relief. Patients place a device in their ear at the time the tinnitus becomes a nuisance and remove it once they feel relief. Masking “is like taking an aspirin for a headache,” Dr. Henry said

Tinnitus patients often doctor-shop in search of a physician who can recognize the condition and is familiar with the latest treatments, Dr. Henry asserted. But as more physicians become aware of the problem and its solutions, fewer patients will need to visit the yellow pages to find someone who can help.

“You never want to tell a patient, just learn to live with it,” he said.

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