Tuesday 28 January 2020

'Tinnitus is no longer my enemy'

It took two years of counselling and lessons in mindfulness and meditation for Eamonn McMahon to accept living with the debilitating condition that he believes he got from playing loud music

Eamonn McMahon (44) has suffered from tinnitus for six years. Photo: Colin O'Riordan

Áilín Quinlan

Civil servant Eamonn McMahon will never forget the movie adaptation of Cormac McCarthy's Pulitzer prize-winning novel The Road. He watched the film on January 16 2010 - but McCarthy's searing vision of a post-apocalyptic world prowled by cannibals wasn't what caused Eamonn's life to change forever.

The reason was much less spectacular - a buzzing sound that began in his left ear as he sat in his local cinema.

"At first I thought it was some kind of feedback from the speakers around the cinema," recalls the 44-year-old Dubliner.

He expected the noise, which was more like a ringing or hissing sound to fade away, but it didn't. "I became more and more aware of the ringing, first in my left ear and gradually it started to happen in my right ear, but it still predominated in the left."

In hindsight, he believes that the noise may have been related to the fact that he is a musician - Eamonn plays the bass guitar and enjoys listening to loud music.

About a month after that night in the cinema, he began to find the noise in his head unbearable.

"I realised it wouldn't go away, that it was persistent, and then I started to panic because it was very intrusive.

"My whole mind was concentrated on the ringing in my ears; it took over my life and I became depressed and angry."

Eamon, as he would later discover, had unwittingly joined about 45,000 people in Ireland who suffer from tinnitus, a condition which, on a global basis, affects an estimated one in 10 adults, with around 1pc of the population reporting significant issues such as anxiety, sleep deprivation and depression as a result of the condition.

"Tinnitus can be extremely debilitating for many patients," said consultant ear surgeon at St James's Hospital Brendan Conlon, who is currently leading one of the world's largest ever clinical trials into tinnitus. The research began in St James's Hospital last November, and will run until November, at the Hospital's newly founded Research and Innovation Hub. The purpose of this clinical study is to compare the effect of different settings of an approved medical device on the symptoms of tinnitus, with a view, ultimately, to provide better treatment for those living with the condition.

"This trial will provide us with greater insight into the different subtypes of this condition and potential strategies for delivering more targeted and effective treatments."

Like many tinnitus suffers, Eamonn initially found it difficult to sleep, to eat or even to think about anything other than the noise in his head.

"People thought I was hearing things - it is not something that anyone else can hear so it's not like a broken leg or having cancer because you look fine. People have said that it's only my imagination; that it's only in my mind," he recalls, adding that the noise in his head can range from "a very low hissing sound like air coming out of a tyre, to a high-pitched shrieking like a bus applying its breaks".

After attending a Tinnitus Awareness Week at work, McMahon, then aged 38, felt encouraged to seek counselling from Deafhear.ie, an organisation that provides a range of services to deaf and hard of hearing people and their families.

Some weeks later he started what turned into two years of counselling, or Tinnitus Re-Training Therapy (TRT), which he received free through DeafHear. He also learned the techniques of meditation and mindfulness.

"The counsellors were extremely helpful and understanding. What they did was change my beliefs about tinnitus.

"l learned about the hearing mechanism of the ear and how sound is perceived in the brain.

"TRT changes how we react to tinnitus because it is this, not the tinnitus itself that causes distress, anxiety or depression. We don't have control over the tinnitus but we have 100pc control over how we react to it.

"Therein lies the key to living with the condition - to get used to it so that it becomes another benign background noise."

Tackling tinnitus is very much about self-help, agrees Jean Scott, chairperson of the Irish Tinnitus Association and vice president of the British Tinnitus Association.

"Counselling is essential, combined with relaxation techniques," she says, adding that the condition can result in anxiety or even depression, depending on how loud and intrusive it is.

"Counselling is essential because it helps you to re-think your way of thinking," she explains, adding that counselling can also help patients find ways of dealing with the noise, such as focusing on another, external, sound:

"Over the years people have told me they have heard whistling, roaring, clicking, bells ringing and rumbling. It can be very intense," says Scott, who has herself suffered from tinnitus for more than 20 years. It began, she recalls, with a rumbling sound like that of a lorry engine.

She finds anxiety or stress can result in an intensification of the problem. "If I am very stressed about something I may have a high-pitched shrieking, or something like a rumbling or ssshhing noise."

Counselling certainly helped Eamonn, who says that thanks to TRT, he gradually came to accept that Tinnitus is a normal phenomenon.

"Today I look on it as something that is just that. I had counselling for two years and it was an enormous help. I also did meditation and mindfulness which helped with the stress," says Eamonn, who suffers from a slight form of hyperacusis (heightened sensitivity to sound) and must wear earplugs in particularly noisy environments.

"I have come to terms with it. Initially you see it as your enemy but eventually you learn to deal with it and to live with it. It is as normal in my life as the glasses I wear. It's so much a part of my life that I have learned not to let it affect me."

It's an increasingly common problem - partly because of the ever-noisier world we live in, observes Dr Nash Patil, consultant ENT surgeon at Sligo General Hospital and president of the Irish ENT Institute.

"Tinnitus is a perception of sound in the absence of an external source," he explains.

There are believed to be a number of causes of the condition, one of which is trauma - such as head and neck injuries - or acoustic trauma which can be over-exposure to loud noise.

"Our urban acoustic landscape is changing," Dr Patil explains, pointing to the fact in today's digital age, noise is coming ever closer to us through personal devices with headphones and ear-buds which bring sound nearer to our eardrums.

"Suddenly a lot of people are listening to sound very close up and that has connotations with damage to the inner ear," he says, adding that he is seeing more younger people complaining of tinnitus. Traditionally the condition has affected people over the age of 40.

"It's not a huge phenomenon but there is a slow, steady increase - there are more people in their 20s and 30s because overall sound levels have increased and also we have this newer phenomenon of sound being delivered on the doorstep of the ear."

Anecdotally speaking, Scott says, the Irish Tinnitus Association has noticed a gradual change in the age of sufferers since it was established 20 years ago.

The organisation has specially trained staff at some 14 centres around the country to advise and support people with the condition in conjunction with Deafhear.ie.

"Our membership is mostly made up of people in their 40s and upwards, but we're seeing more young people now.

Other factors believed to be connected to tinnitus include viral inflammation or infection, and vascular issues as well as a variety of medical conditions.

"The inner ear is very delicate and is supported by a precarious blood supply network. Atherosclerosis, high blood pressure and diabetes can all affect the blood supply to the inner ear," Dr Patil explains.

Tinnitus is also believed to be an early indicator of Meniere's disease, an inner ear disorder that may be caused by abnormal inner ear fluid pressure.

On top of all of that there are also many people who have never been exposed to any of these factors and so have been diagnosed with 'idiopathic' tinnitus, in effect, tinnitus without any apparent cause.

"People also experience a collection of white noise such as the noise of a seashell or the sound of a TV between stations," Dr Patil says, warning that tinnitus can be extremely disruptive. If the onset is gradual, coming on over a period of years for example, it may be easier to adapt to than to simply waking up one day with tinnitus and having to suddenly try to manage the problems caused by the condition in a busy, demanding work environment.

It can cause depression or incapacitation, he says, adding that people can wake up with this noise in their ears, and that some patients have told him they find it difficult to simply function, or to listen to the kids.

Because doctors still have not established a specific cause for tinnitus, he warns, "there is no single magic pill" with which to treat it. Treatments currently include medication to improve the blood supply to the inner ear, and he says, someone who has had a viral infection might benefit from an anti-viral medication.

With acoustic trauma, Dr Patil says, the approach is to treat the symptoms by improving the nerve function or supply of blood to the inner ear, for example. Non-medical treatments such as counselling or cognitive behavioural therapy are available while a number of new technologies are being developed which attempt to ameliorate the effect of tinnitus in various ways.

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