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Hearing Bells

Hearing Bells

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Published by: Estelle Toby Goldstein, MD on Oct 28, 2009
Copyright:Attribution Non-commercial


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I recently saw a 28 year old young man who was trying to make it in the working world.When I saw him, he had been threatened with losing his job because of poor job performance.His concentration was poor — not because of his depression, but because of tinnitus — the Latin word for “ringing”, as in “a ringing in the ears.” This constant ringing sound inhis ears made it hard for him to sleep.He had been taking bupropion (Wellbutrin) for a depression which had started when hehad gotten off crystal meth, about ten months before.Welbutrin had been an excellent choice of antidepressant for him because he did not wantand would not tolerate sexual side effects of other similar antidepressants. I told him Iwould respect that. It was not hard to determine that his feeling about always hearing thesea had started only a few weeks after starting the Wellbutrin — which had done a verygood job of treating his depression.He was not happy when I told him that I wanted him to switch the Wellbutrin. I told himwe could try using music as masking and/or nutritional supplements if he did not want tochange. We talked a little about the other treatments, and I did remind him whatever other antidepressant we were to try next, it would surely not be something he had to stayon forever.Just for the record, we switched to Lexapro (escitalopram) and the tinnitis went away. Tothe patient’s joy, he did not have any sexual dysfunction at all with the Lexapro and heassured me a few weeks later work was good, he had no signs of depression, and hisgirlfriend was happy too.I have seen several patients with this mysterious affliction over the years, this “tinnitus.”People have told me that they hear everything from a single musical note, to the ocean
like when you hold a seashell to your ear. (This actually is true with any kind of aconcave form you hold up to your ear. Actually the bit about the sea is pretty cute.)I know people buy those machines that make the sound of the sea and it is supposed tohelp you sleep, but you can turn the machine off any time you want. An insistent soundthat you can’t escape from can be torture.There is no precise cause known, and no perfectly effective treatment for tinnitis. It isnot unusual for it to be caused by medications. Since I often see people who are onmedications, I generally start with a medication change.But we are talking here about a condition that may affect as many as 50 millionAmericans, although there seem to be only 10 or 12 million who are bothered by itenough to disturb daily function — work, relationships, even sleep.Causes are many, and include serious head injury and auditory or head and neck trauma,as well as noise-induced hearing loss.Some people claim this is “incurable.” I do not like that word and someone using it whenconversing with me is one of the few things that can cause me to raise my voice in anger.A more accurate expression would be “We do not know how to cure the totality of thisgroup of patients. We can do plenty of things that can help.”There are many types of tinnitus that are so disruptive to life that people have focusedresearch on them. There is
starting to emerge suggesting that the brain stemcells that represent frequencies that a person with a specific hearing loss cannot hear  become overactive, and may thus result in the audible “ringing.”Some fairly sophisticated instruments have been developed which rely on the fact thatother sounds can mask tinnitus and divert attention from it. Although some people justsleep with the radio on so that the noise does not disturb sleep. Here is 
which has been clinically tested.We do know that tinnitus tends to diminish with stress, that it has been frequentlyreported to respond to cognitive behavioral therapy, and that somehow, teaching peopleto pay less attention to the sound, is a useful intervention
We can, I think, do a little better and be a little more specific.Before you can study and treat something, it is helpful to
First, if somebody has an underlying disease that might be associated with the tinnitus,that disease should be treated and the tinnitus is likely to get better. Most common here,at least in what I know and have seen, are allergies and sinus problems and also, thyroid problems.Second, look at the treatment options if no underlying disease can be identified.Some of the most severe cases have had some surgical procedures; this is only done, asfar as I know, for folks with profound hearing loss and results are not very exciting.Some medications have been used, but I would beware and ask the advantages and risksof any medication offered. (Xanax, a benzodiazepine which has been used, is potentiallyvery addictive.) Some people use antidepressants.
 is a mainstream summary.Alternative treatments mentioned here include many forms of relaxation. These are easyto do and certainly cannot make things worse. Natural substances have been studied a bit in this condition.
,an herb used for thousands of years, has brought inconclusive results indouble blind placebo controlled trials (the strictest and most scientific way of testing if asubstance works for a disease.The point is, there are some patients who swear by it. It does seem to increase blood flowto the brain, which accounts for why people find it useful in improving memory. It hasvery specific dangers, including medicines that generally ought not be taken with it at thesame time (like things that have an effect on blood coagulation, or “blood thinners) so becareful with this one.
may be helpful, especially in people who have low zinc levels to start with.Here my medical intuition asks me, if they don’t have enough Zinc, what other stuff arethey missing and what else is going on?Some people improve with B vitamins;
 in particular.There is no one good theory to describe everything, but there seems to be some injury tothe sensory cells that are usually functional in the hearing process, and there may be somediminution in cerebral circulation involved if gingko helps.I once met a chiropractor who swore every case he had seen could go away with acombination of gingko and ginger. I suspect whatever cases he had seen were less severethan what I have seen. And serious scientists and clinicians need to know that inferences,

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