THE IRISH TINNITUS ASSOCIATION




FOUNDATION

    The Irish Tinnitus Association was founded in April 1996 by a small group of people who have Tinnitus and on the initiative of Valerie O'Dea and the current Chairperson is Jean Scott

    From the outset it has been supported by the National Association for Deaf People through its Chief Executive, Niall Keane.

    It is hoped and anticipated that this close relationship will continue. 
    The Association is based in the offices of the National of Deaf People, 35 North Frederick Street, Dublin 1 and is run by a small group of voluntary workers. 


OBJECTIVES 

     
    Foundation the Association set three short-term objectives:
     

    1. To provide information on the condition of Tinnitus.

    2. To establish a country wide data base of names and addresses of those with Tinnitus.

    3. To promote the idea and need for local self-help groups throughout the  country.


 

Having made some progress on the above, the Aims and Objectives 
can be expanded and more clearly defined for the longer term.

    1. The Association aims to be a focal point for giving support an assistance to those who suffer from Tinnitus which is a condition where constant noises are  heard in the ears and head, which do not arise from an external source, and for which, at the present time, there is no known cure.

    2. The Association proposes to achieve its objectives through the dissemination of accurate information about the condition and the approaches which might be taken by sufferers to cope and hopefully gain some relief.

    3. The Association has established a database of names and addresses of people with Tinnitus which extends across the country and it intends to maintain and expand the information.

    4. It recognises the need for the establishment of self-help groups throughout the country, supported by the work of the central Committee.
     

    5. It proposes to raise public awareness of the condition and the extent to which it can be a disability. It seeks to ensure that those with Tinnitus need not feel alone and this is particularly important in respect of the elderly and those who might live in isolated locations.

    6. It proposes to raise the same awareness with the medical profession,  particularly GP's, to ensure that more guidance is given to patients than the current approach of 'nothing can be done, you must live with it.'

    7. It recognises and appreciates the strength, resources and organisational abilities of the long established British Tinnitus Association and to this end it has negotiated an affiliation agreement whereby members of the Irish TinnitusAssociation will receive copies of the quarterly magazine "Quiet".

    8. It intends to produce an Irish Tinnitus Association Newsletter on a regular basis and this started in December 1996.

    9. The Association has the enthusiasm to undertake much basic work and so be a 'community service' if it can achieve adequate funding.  The annual subscription for membership is £10.00.




 
 





Questions About Tinnitus

What is Tinnitus?

Tinnitus is the term for noises which are heard "in the ears" or "in the head" - buzzing, ringing, whistling, hissing , and other sounds which do not come from an external source.  It is a very common symptom, affecting up to one in ten of the adult population.  Children can also experience Tinnitus, but fortunately it is rarely distressing to them.  It can happen to those with average hearing as well as to deaf or hard of hearing people.  It is also quite possible to have a very marked hearing loss without any Tinnitus at all.

In all cases of Tinnitus, appropriate counselling, often combined with relaxation techniques, is essential to alleviate the fears and anxieties that people may have about their Tinnitus.  The worry that Tinnitus may indicate serious disease, or advancing deafness, can usually be met with the reassurance that Tinnitus is harmless and that the common, natural sequence is for people to get used to it so that, in time, it becomes much less noticeable and intrusive.
 

What causes Tinnitus?

There can be many causes, but the two major ones are related to hearing disorders associated with ageing, and exposure to loud noise.  It can also develop following an emotional upset, or an illness, injury or infection which may not be related to the hearing mechanism.  It can also appear as a reaction to or side effect of a drug.  Situations such as this can damage or over stimulate tiny hair cells in the inner ear, sending an irregular, unbalanced stream of nerve signals to the brain, which perceives it as Tinnitus.
 

Is there a cure?

Occasionally the cause of Tinnitus is treatable, for example antibiotics can clear up an infection of the middle ear; springing can remove the wax from a blocked ear to the noise; minor surgery may eliminate some cases of Tinnitus.

Where there is permanent damage to the function of the inner ear hair cells, there is currently no wonder drug or operation which will immediately get rid of the Tinnitus.  There are, however , a number of ways to get significant relief from Tinnitus, and it is nearly always possible with appropriate treatment to reduce the distress that Tinnitus can causes.
The RNID in the UK (Royal National Association for the Deaf) produces two tapes - Tinnitus Stress Management and Tinnitus Surf Sounds - both of which help you to reduce stress and relax your mind and body.  A Layman's Guide to Tinnitus by Robert Slater also suggests a number of ways to reduce the stress caused by Tinnitus.
 

Where can I get expert help and advice?

Your GP can carry out initial examination to check for wax, infection, and so on, and may suggest ways of dealing with your Tinnitus.  If you'd like a further examination, he/she can refer you to a consultant, either through a local hospital's Ear, Nose and Throat (ENT) department, or privately.
 

What help is available from ENT departments and Tinnitus Clinics?

Many people will find a thorough consultation, examination and diagnosis from a specialist reassuring. The specialist may recommend and arrange treatment which could, depending on the cause, include:
 

  • a hearing aid - even if there is only slight hearing loss the use of a hearing aid may reduce or mask Tinnitus.
  • a Tinnitus masker (sometimes called a white noise generator) - a device which looks like a hearing aid and generates a quiet, gentle sound of its own.  This gives the ear something else to listen to and diverts the attention of the listener from the Tinnitus so that it moves into the background.  It may be used as part as retraining therapy, altering the brain's perception of Tinnitus. 
  • relaxation therapy, such as stress management and relaxation tapes 
  • counselling - an essential part of any successful Tinnitus management, however undertaken. 
  • medication for the effects of Tinnitus (e.g. anxiety, sleeping problems, depression) 
  • surgery for abnormalities in blood or muscles in or near the ear
What makes Tinnitus worse?

Many people with Tinnitus are not distressed by it - it is simply something which is there which does not affect their lives.  Those who do become distressed generally find their Tinnitus to threaten in some way, seeing it (quite wrongly) as being caused by a serious disease, or a going on forever, getting louder, and finally driving them mad.  These beliefs may lead to monitor and magnify their Tinnitus.

Most people find that their Tinnitus goes up and down - it may be aggravated by stress, loud noise, certain drugs (particularly aspirin and quinine), and excesses of or reactions to some foods and drinks (notably caffeine and alcohol), but it doesn't usually get worse with time alone.
 

How can I alleviate my Tinnitus?

It is important to remove its threatening qualities, and this can often only be achieved by counselling from someone who really knows about Tinnitus.  Anxiety and tension can make Tinnitus much worse, so learning how to relax is important - perhaps by joining a relaxation or yoga class and teaching yourself relaxation techniques.

The RNID has produced two tapes specially designed to help you manage your Tinnitus, relax, and enjoy life to the full and they can be obtained from: National Association for Deaf People.  The cost for the tapes is £20.00.  Included with this pack is A Layman's Guide to Tinnitus

Tinnitus Stress Management teaches you simple and effective techniques to relax your mind and body.  The tape guides you through two 30-minute programmes of easy-to-follow breathing exercises and self-awareness techniques which can be used again and again to combat stress-related Tinnitus.

If you find your Tinnitus gets worse at night, Tinnitus Surf Sounds may help you to sleep better.  Listening to the tape can mask the sound of Tinnitus and enable you to relax.  It has 90 minutes of soothing sounds of waves breaking on the seashore and birds flying overhead.
 
 

Think positively!

Positive thinking and knowing how to master your Tinnitus in the theme of Robert Slater's classic A Layman's Guide to Tinnitus, which has sold over 10,000 copies.  While acknowledging that Tinnitus is not the easiest of symptoms to deal with, this guide suggests a series of simple and practical steps that can, in time, reduce it to a minor and trivial irritation.  The guide also includes an up-to-date list of useful reading.





Is there anything else I can do?

If you find that some things you eat or drink have an effect on your Tinnitus, you could adjust your diet. You should wear proper ear protection - ear muffs or plugs, not cotton wool stuffed in the ears - in very noisy situations (for example, when using power tools or near noisy music, which can damage the ears and make Tinnitus worse).

Having something else more pleasant and interesting to listen to, such as music, TV or radio, can prove a valuable distraction to Tinnitus and help 'mask' its noise.  Many people with Tinnitus say that it 'isn't there' when they're not listening to it - Tinnitus is a very real noise, but if you're not tuned to it can be much less of a problem.
 
 

Will 'alternative' treatments help my Tinnitus?

Some people with Tinnitus have reported that acupuncture, hypnotherapy, homeopathy and other 'complementary' therapies have been of benefit.  Although they probably have no direct effect on the ear, they may result in reduced tension, anxiety and depression, and better sleep - which can have a secondary beneficial effect on the Tinnitus.  Most 'alternative' treatments are only available privately, but some maybe available through your local Health Board.  Check with your GP for services in your area.
 
 

Does Tinnitus affect children?

Although Tinnitus occurs more in people in their middle or later years, it can affect younger people too, including children, who tend to complain much less about symptoms and to accept them more readily.  With any ear problem, in children it is important to seek specialist help - symptoms can often be effectively treated.
 

Does Tinnitus cause deafness?

Research indicates that Tinnitus does not cause deafness, although they may both have the same cause, particularly noise damage to the ears.  Tinnitus may affect your ability to concentrate, so you could 'miss' conversation.  The needless fear that Tinnitus does cause deafness can make Tinnitus louder.
 

How can I find out more?

The Irish Tinnitus Association (ITA) is a support group for people with Tinnitus. 

Contact them at the Irish Tinnitus Association, 35 North Frederick Street, Dublin 1.
Phone: 01 8723800.

*Deaftech Information Service
NADFS No. ER06
 
 














Tinnitus - Some Pointers

What is tinnitus?
 

* Latin word meaning only "to ring"
* Sensation of noise where there is no external source
* Objective and subjective types
* Not a disease
* 40,000 affected in Ireland
* Can be experienced temporarily or long term - depending on cause
What does tinnitus sound like?
* Can be in one ear, both or in whole head
* Can vary in volume for no reason
* Only increases in volume in few cases
* Clicking, buzzing, humming, throbbing, fizzing, screeching, ringing etc.
What causes tinnitus?

Usually an overstimulation or damage to the inner ear hair cells which then send an irregular stream of signals to the part of the brain which perceives sound (called the auditory cortex). Occasionally related to the hearing mechanism in the ear itself.

There are many other causes of tinnitus, a list of which can be seen below, but just because an individual experiences one of the following, does not mean that they will have tinnitus.

* Ageing
* Exposure to loud noise
* Wax
* Rarely, ear tumours
* Certain drugs
* Ear infections
* Harsh syringing
* Jaw disorders
* Vascular abnormalities
* High blood cholesterol
* Stress, illness, injury
* Catarrh
* Menieres disease
* Personal stereos and discos
* Pre menstrual tension
* Tobacco, alcohol, caffeine
* Some thyroid disorders
* Diabetes
* Allergies
* Dental procedures
* Arthritis
* Zinc deficiency
* Anaemia
* Labyrinthitis
* Colds and viral infections
* Migraine
* Hypertension
* Ostosclerosis
* Some ear surgery


Is tinnitus hereditary?

In some instances it can be.
 

Can I go deaf through tinnitus?

Some deaf people can have tinnitus although some have no tinnitus at all.
People with normal hearing can have tinnitus.
No research to suggest tinnitus can make you go deaf.
 

Is there a cure?
 

* If caused by wax, blockage or infection - often yes.
* Other causes no, but extensive research projects are happening world-wide
* Treatment available which can in some cases alleviate the effects of tinnitus
* Tinnitus is a symptom. Need to know more about underlying problem causing it so no one chemical, drug or surgery technique can be expected to result in a cure.  Methods available to manage the symptoms.
How is tinnitus diagnosed?
* GP.... 
* ENT departments.
* Audiologists..
* Hearing therapists.....
* Types of tests, e.g. tinnitus audiograms
* Limited facilities/knowledge/sympathy in Ireland


What medical/alternative therapies are available?

It is the symptoms which are being dealt with here - not the cause.  Some drugs have several effects - tinnitus reduction not the primary one in many below.  Some of following have worked for some people. None are proven as blanket cure.
Do not attempt any of the following without consulting with your doctor - as some treatments can have dangerous side effects.

* Niacin - pumps oxygen into inner ear
* Lecithin - taken with Niacin
* Gingko biloba - Chinese treatment for increased blood circulation
* Alprazolam (Xanax) & Klonopin
* Lidocaine
* Histamine and anti -histamine
* Vinpocetine - a vasco dilator
* Sodium Fluoride - maybe useful if tinnitus due to cochlear ostosclerosis
* Zinc 
* Diuretics
* Serc (betahistine hydrochloride)
* Magnesium
* Caroverine
* Surgery - for acoustic neuromas, vascular abnormalities and TMJ syndrome
* Diet analysis
* Acupuncture
* Hypnotism
* Ultrasound
* Stress reduction
* Hearing maskers/aids
* Cranial Sacral therapy
* Electrical stimulation
* Oxygen therapy
* Biofeedback therapy
* Auditory Integration Training 
* Sound therapy
* Aromatherapy
* Massage
* Reflexology
* Herbalism
* Cognitive therapy
* Chiropractic
 
 

Where can I get help and advice?
* Current work/aims of Irish Tinnitus Association to gain further interest from medical profession
* Counselling
* Self Help groups
* Inform self (e.g. books)

How can I cope with or alleviate my tinnitus and the effects of it? 
* Think positive
* Acceptance
* Avoid Stress
* Avoid loud noise exposure
* Keep occupied
* Don't sleep during day
* Don't rush around necessarily
* Try masking
* Don't drink too much alcohol
* Attempt not to worry
* Evaluate effects of foods and drinks on your tinnitus
* Attend self help group
* Counselling
* Talk to a friend
* Develop a hobby

How can I talk to others with tinnitus?
We need to reduce down the existing info on self help groups....
 

What makes tinnitus worse ?
* Stress
* Avoid aspirin and quinine
 

Does tinnitus affect children?
It can do and is often associated with other ear problems.

What is masking?
A method of disguising or covering the internally experienced sounds with more acceptable and distracting external sounds. Many people benefit from masking but a few find external noise makes their tinnitus worse.

What if I can't sleep?
* Avoid late meals/indigestion
* Warm bath/hot drink
* Get up if not asleep within 15mins. Do something to relax (read, jigsaws, another hot drink). Return to bed. Repeat process if still unable to sleep.
* Accept and don't fight it.
* Try masking/pillow speaker (These can be obtained from )
The Electronic Centre
16 College Square East
Belfast BTI 
Tel:: 080 1232 327357
Cost from £4.00 Sterling
 
 

ITA INFORMATION SERVICES
NADFS No. TA3

TINNITUS PERCEPTION, RETRAINING AND HABITUATION




How we Hear

Our conscious awareness of sound takes place near the surface of the brain when a pattern of electrical activity travelling up the nerve of hearing from the ear reaches a point just below the auditory cortex.  The hearing nerve has about 10,000 different fibres, and patterns of activity in these fibres are matched with other patterns which are held in the auditory of hearing memory.

Most of what we hear is a sequence of sounds, like speech or music.  There is a continuous process of matching one familiar pattern with the one coming from the ear.  Each time a pattern from the ears is matched with a pattern in the auditory memory we have the experience of hearing a sound.

Putting together these matched patterns starts a process of evaluation.  Another part of the brain close to the hearing centre is involved in the meaning of what we hear, and in interpreting the language.  If it's a foreign language we can hear the sound but may not understand the meaning.
 

The Meaning of Sound

Sound is of enormous importance.  Hearing evolved in animals who were constantly in fear of their lives because of attacks from predators.  The ability of animals to develop extremely acute hearing by which they could detect the very small sounds of an attacker a long way off, contributed to the survival of that species.

Warning signs are threatening and produce anxiety in an animal, prompting appropriate action to avoid attack.  Some sounds can be identified as warning signals, whilst others can evoke a feeling of security or pleasure.  We have this experience every day with sounds that alarm us, such as traffic horns and sounds that soothe us such as music, or the sound of nature.

In our brain the auditory cortex has a large number of connections with another centre called the limbic system which is concerned with emotion and learning.  Each sound that we hear and learn the meaning of, has an "emotional label" attached to it, which may change from time to time according to how we feel in ourselves and the situations.  For example the sound of a neighbour's television set may be unpleasant and intrusive depending on whether it belongs to a well loved friend or relation, or somebody who for other reasons we dislike.

About 85% of those who experience tinnitus do not find it intrusive, disturbing or anxiety provoking.  The reason for this is not so much because the quality or loudness of the tinnitus is different; in fact we have found that tinnitus is a very similar sound in those who are bothered by it and those who are not.  The main difference is that those who find tinnitus troublesome, perceive it as a  threat, rather than something of little or no consequence.  Just as the animal alerted to danger by the sound of a predator focuses solely on that sound in order to survive, so those who consider that tinnitus is a threat or warning signal are unable to do anything but listen to it.  It is part of the mechanism that humans have developed for self preservation, although clearly in this situation it is not working to our advantage!
 

Tinnitus as a Threat

Why is it that tinnitus should be threatening?  It is an emotional link which results in tinnitus 'sufferers' focusing their attention on the tinnitus.  Some people fear that tinnitus means they have some kind of serious illness.  There are patients who worry about the possibility that it heralds a brain tumour, blood clot, or some serious mental illness ("it will drive me mad").  These anxieties are almost always unfounded.  The cause of tinnitus is usually the result of very small changes of inner ear function, or the consequences of ageing, or exposure to noise.

More commonly, people fear that the tinnitus will go on for ever getting louder and continue to spoil their peace and quiet, interfere with concentration at work, quiet recreational activity and ability to sleep at night.  Research shows that this is rarely the case, in the long term.  Unfortunately this fear may be enhanced by professional advice.  Many doctors and other professionals still advise patients that there is nothing that can be done about tinnitus and that it will go on forever.  Other people fear that tinnitus may mean that their hearing is becoming impaired, although the tinnitus is the consequence of a mild hearing impairment rather than the other way around, in any event the threatening qualities of the tinnitus are enhanced.

Finally many tinnitus sufferers are angry about the treatment, or lack of treatment, or inappropriate advice that they have received.  They may feel guilty for having submitted to treatment which they think is the cause of their tinnitus.  Fear, anger and guilt are very powerful emotions which greatly increase attention on the tinnitus.  In our experience, tinnitus improves when the patient overcome these feelings and stop dwelling on thoughts of injustice and revenge.
 
 

Retraining

Successful tinnitus management is a result of retraining and relearning.  Once the tinnitus no longer presents a threat, however loud it is or however unpleasant it may seem, it can begin to diminish and in many cases may not be heard for long periods of time.  Of course this is all very well to say, and very firmly held beliefs are hard to change.  Retraining the auditory system to think of tinnitus as something other than a threat or warning signal can take months and sometimes even years.  Such retraining should be undertaken by professionals with experience in this field.  For people who also have co-existing anxiety or depression it can be difficult to change their feelings about their tinnitus.

INFORMATION SERVICES
NADFS No. TA2

MÈniËreDISEASE

In 1861, Dr Prosper MÈniËre, wrote a now classic description of the condition which now bears his name.  As the doctor in charge of the Imperial Institute for Deaf Mutes, he realised that what had previously been thought of as a form of apoplexy was due to a disturbance of the inner ear.

'A man, young and robust, suddenly without reason, experienced vertigo, nausea and vomiting.  He had a state of inexpressible anguish and prostration.  The face was pale and bathed in sweat as if about to faint.  Often, and at the same time, the patient, after seeming to stagger in a dazed state, fell on the ground unable to get up.  Lying on his back he could not open his eyes without his environment becoming a whirlpool.  The smallest movements of the head worsened the feeling of vertigo and nausea.'

Meniere's description of the vertigo which accompanies a severe attack of Meniere's disease, cannot be bettered, although many people do not experience this extreme form.  We now know that the condition is caused by an increase in the pressure of fluids in the inner.  The cochlea (concerned with hearing) and semi-circular canals (concerned with balance) are filled with fluid which is called endolymph.  Periodic increases in the pressure of the endolymph (sometimes called endolymphatic hydrops) produce a dramatic disturbance of the hearing and balance at the same time.  In addition to the giddiness or vertigo there is a loss of hearing in the affected ear, together with tinnitus which is generally low pitched or rushing.  After the attack the hearing and tinnitus can improve, and there may be long periods of time when the patient is entirely free of symptoms.
 

Low Incidence

The full-blown condition affects about 1 in 20,000 of the population. It is more common in men than women.  If the condition is untreated the hearing tends to become progressively worse, although in the early stages the hearing often returns to near normal levels.

Although tinnitus can be a distressing part of Meniere's disease, particularly in the later stages, it is usually the vertigo and vomiting which trouble the majority of patients. The attacks are unpredictable, and finding someone lying on the floor, in a public place, being sick, does not always bring out the most charitable feelings in other people.
 

Diagnosis

Many patients with Meniere's disease are successfully diagnosed and treated by their general practitioner. There are, however, many more common causes for vertigo which can be misdiagnosed as Meniere's disease.  Sometimes the term is used quite wrongly as a diagnosis for any kind of balance disturbance.  It is important to make sure that you do have this condition, and not something else, as there are some very specific treatments for Meniere's disease which do not work in other conditions, and vice versa.  Here are some specific features of Meniere's disease:
 

1. It first appears in relatively young people (usually around the age of 30).

2. If your first attack of vertigo is in your 70's then it is likely to be something else.

3. It us usually, but not invariably, associated with hearing symptoms in one ear, for example, fluctuating hearing in the low frequencies, tinnitus and sensitivity to sound.

4. The hearing symptoms should occur at or around the time of the attacks of vertigo.

5. The hearing symptoms are usually experienced in one ear, not equally in both ears.

6. It is quite common to have a feeling of pressure in the affected ear before or during the attack.  Sometimes this is the worst symptom.

7. The attacks of vertigo usually last for two to twenty-four hours. The spinning is often very fast and is often aggravated by moving the head. It is often accompanied by vomiting, and sometimes diarrhoea, although these symptoms may get better as time passes.

8. There are often other "autonomic" effects such as sweating, palpitations and anxiety which can be the results of the release of too much adrenaline associated with the attacks. These symptoms can accompany any severe vertigo.

9. There are periods of "remission" when patients feel quite normal.  These may be as short as a few days or longer than ten years.

If you have many or all of these symptoms, then it is very probable that you do have Meniere's disease.  If you have none of these symptoms then it is still possible to make a diagnosis of Meniere's disease, but only in a specialist hospital department, and usually as a result of further tests and investigations.  If your symptoms of vertigo are very different, then it is important to question the diagnosis of Meniere's disease.

Where possible, it helps to have some special tests performed to be quite certain that the diagnosis is correct.  A pure tone audiogram measures the hearing in each ear, at different frequencies and is used to diagnose Meniere's disease.  Many who have Meniere's disease suffer from severe discomfort from loud sounds, although their hearing is impaired, and this feature (sometimes called recruitment or hyperacuses) can be measured.

Investigation of the balance disorder is complicated and takes a long time.  One test which is commonly performed is the caloric test.  Each ear is gently irrigated with water (or air), which is at a slightly different temperature from that of the body.  This changes the temperature in the inner ear fluids, causing them to move in one or other direction.  Examination of eye movements during this procedure can show how well the balance mechanism in each ear is working.  In Meniere's disease there is often a reduction in the function of the affected ear on caloric testing.  Many patients have an understandable fear of investigation, as it might produce slight giddiness for a minute or so.  However, it is an important investigation.  It is not distressing if it is performed with care and it yields important diagnostic information which can help in the patient's further management.
 

Management of Meniere's disease

Many forms of treatment are very effective, and may bring about long periods of freedom from the condition.  After a while many patients cease to have disabling vertigo.  But as treatment may be needed over a long period of time, it is important to find a doctor with an interest in the condition, and heed his or her advice about what may be a continuing programme of treatment and care.
 

Dietary factors

Because there is an increase in fluid pressure in the inner ear, most patients benefit from reducing salt intake which can cause fluid retention.  Some specialists recommend keeping the general fluid intake down as much as possible, and also steering clear of caffeine.  Salt substitute can be obtained at chemists and used in cooking, but should not contain any sodium.
 

Medical treatment

No two patients with Meniere's disease are alike, and as the frequency of attacks and course of the condition are very unpredictable, it is often hard to say whether the treatment is being effective.  As there are often emotional factors at work, even the calm assurance of a competent practitioner sometimes produces periods of remission.

Serc (betahistine) probably helps more Meniere's patients than any other drug, and is said to have a direct action on the endolymph production in the inner ear.  Most patients with Meniere's disease will have tried it, and it can be taken for long periods of time without ill-effect.  Betahistine should be taken in combination with a salt-free diet and should be given initially over a period of some months.

Some patients who have severe attacks of vertigo need strong anti-vertigo drugs such as Stemetil.  It is often useful to have these available as a suppository, as tablets may not be absorbed during an attack.  If attacks occur very infrequently it is much better not to take Stemetil-like preparations on a regular basis, but to rely on tablets or suppositories which can be used to give rapid relief as soon as the onset of an attack can be predicted.  Another newer method of taking Stemetil is by a buccal preparation (Buccastem) which is placed inside the upper lip and is absorbed rapidly through the mucous membrane.  Many patients feel a greatly increased confidence if they have a current supply of suppositories or buccal preparation which are effective in rapidly getting rid of the unpleasant symptoms of Meniere's.  There is a very large number of different anti vertigo tablets, many of which may be helpful at one time or another, and successful treatment is often a matter of identifying the drug most helpful to the individual.
 

Hearing Loss

This usually affects only one ear, and while there is one normal ear there may well be no difficulty in hearing in normal situations.  In a minority of patients, Meniere's disease may develop in the second ear.  A trial of a suitable hearing aid should always be offered to anyone with a hearing difficulty, and because of loudness, discomfort or recruitment, this many need to incorporate a device for reducing the amplification of uncomfortable loud sounds and be fitted on an 'open' or well vented-mould.  Occasionally loudness discomfort is a serious problem, and when one ear is affected, a good fitting earplug may be helpful in noisy environments.  Ear plugs should not be used however for sensitivity to normal every-day sounds (see ITA Factsheet - Hyperacusis, Recruitment and Loudness Discomfort).
 

Tinnitus

Although tinnitus is not usually the most troublesome symptom, it is often relatively simple to treat in Meniere's disease.  The tinnitus in Meniere's disease is very easily managed by a suitable white noise generator ("tinnitus maskers") and often by a hearing aid alone.  Patients with Meniere's disease whose vertigo responds to drug treatment may also experience a reduction in tinnitus; this is one of the few examples we have of successful treatment of tinnitus with tablets.  However, drugs such as Serc do not have any effect on the tinnitus (or vertigo) associated with conditions other than Meniere's disease.
 

Surgical treatment

If all hearing has been lost in one ear and vertigo persists, a destructive operation can be performed down the ear canal (labyrinthectomy).  This should not be contemplated when any useful hearing remains in the affected ear, in view of the possibility of second ear involvement.

Other operations reduce the pressure of endolymph (for example drainage of the endolymphaticsac) or they may involve cutting the nerve of balance, where intractable vertigo persists.  The endolymphatic sac is a small cul-de-sac coming from the inner ear, which acts as a "kidney" to the inner ear, removing its waste products.  The drainage or  decompression of this sac is often effective at controlling vertigo and sometimes results in an improvement in the hearing and tinnitus, at least in the short term.  This operation can be repeated(sometimes after a few years) if the drainage tube becomes blocked, with subsequent further improvement in the vertigo.  Because true Meniere's is such a rare condition, not all ear surgeons have experience of doing this operation. It is well worth going to a centre where there is a special interest in treating Meniere's disease.
 

HAZELL, FRCS

ITA INFORMATION SERVICES
APRIL 1996
NADFS No. ER10


MENIERES SOCIETY IN ENGLAND

Meniere's Society, 98 Maybury Road, Woking GU21 5HX England. 
Membership is £10.00 Sterling a year, including copies of their newsletter SPIN that is issued quarterly
 
 
 
 

OTOSCLEROSIS

Otosclerosis is the commonest cause of progressive deafness in young adults. A straightforward surgical operation, now widely available, can restore normal hearing in the vast majority of cases.
 

What is Otosclerosis?

In someone with normal hearing the sound passes through the middle ear.  Three small bones, or ossicles, transmit the sound from the eardrum to the cochlea.  The stapes, which gets its name from the Latin word for stirrup, is a bone under half a centimetre in length.  The innermost part of this bone, where it meets the cochlea, becomes fixed in an abnormal growth of bone, rather like a callous which forms after a fracture.  This bone growth prevents the stapes from vibrating normally in response to sound, and produces a conductive deafness.  In the early stages of Otosclerosis, the cochlea and the nerve of hearing are not affected.  This means that freeing the stapes in some way can restore the hearing by removing the conductive block.

Otosclerosis is often inherited, although isolated cases do occur.  Both ears may be affected, although in men it is commoner for one ear to be worse than the other.  Untreated, the deafness becomes progressively worse until late middle age, when profound hearing loss occurs.  It is thought that Beethoven was a sufferer, and that is why he was unable to hear any of his later compositions.
 

How to tell if it is Otosclerosis

The diagnosis will be made by a specialist, but there are some clues which may be noticed by the hearing impaired person or by friends and family.  The speech is usually quiet, where people suffering from nerve deafness tend to shout.  The presence of extra background noise usually adds to the confusion of people with cochlea (or nerve) deafness, but in Otosclerosis this confusion often does not occur.  The sufferer may even hear better in noisy surrounding, possibly because other people's voices are raised in frequency and loudness.  Otosclerosis tends to affect the low frequencies more than the high frequencies.  In cochlea deafness the opposite usually occurs.

Diagnosis of Otosclerosis by an ear specialist is not usually difficult.  Examination of the ear will reveal a normal, healthy looking eardrum.  Hearing tests with forks and audiometric tests will show a conductive deafness.  This means that hearing in the normal way through the ear canal is not as good as the ability to hear a vibration through the skull.  Sound vibration produced by tuning fork pressed on the head will be heard more loudly.  This is because the sounds bypass the fixed stapes and reaches the normal cochlea directly.  Attached to the stapes is a tiny muscle which contracts when very loud sounds are heard.  Using an impedance audiometer, it is possible to detect the contraction of this muscle.  When the stapes is fixed, as in Otosclerosis, this muscle contraction cannot be detected, helping to confirm the diagnosis.

What about a hearing aid?

Hearing aids help with all kinds of conductive deafness, including Otosclerosis, they are sometimes more successful than with nerve deafness, where there may be more distortion of amplified sound.  However, a hearing aid will not cure the deafness, and, as it is progressive, successively more powerful hearing aids may be needed.  They are a great help in the early stages for those not wishing to undergo surgery.
 

What sort of surgery is available?

As early as 1878, surgeons were trying to free the fixed stapes in a 'mobilisation' operation.  However, without microscopes or antibiotics, these attempts were often disastrous to the ear and even to the patient.  In 1938, Lempert in the United States popularised the operation of fenestration.  This involved opening the mastoid bone through the ear and creating a small window into the organ of balance.  Although early results were good, the window usually closed over and deafness returned.  Also the cavity inside the ear could become infected.  However, a number of people today have had the fenestration operation in the past and still hear well.

In 1952, Rosen, also in the United States, reintroduced the mobilisation operation.  This operation simply freed the stapes where it was fixed by bone; again, although the initial results were good, the stapes soon became fixed by more bone growth.  In 1958 Shea and House started to remove the diseased stapes and replace it with a small polythene tube.
 

Surgery today

The modern operation of stapedectomy is now widely performed and is relatively simple procedure.  In the UK a general anaesthetic is usually given, and the operation is always done with the aid of the operating microscope.  The surgery is performed down the ear canal so that there are no visible signs afterwards.  The eardrum is turned forward, and after the removal of a small amount of bone the legs of the stapes are removed with extremely fine instruments.  A small piston is then placed between the oval window of the cochlea and the incus, the next bone in the ossicular chain.  The piston is made from a wide variety of different materials; teflon and stainless steel are among those commonly used.  The operation takes about an hour.
Dr. Bernard Causse, a French ear surgeon, has popularised a modification of the stapedectomy operation which seems to have reduced the chances of inner damage, although it has not abolished them.  It also reduces the likelihood of giddiness after the operation.  In the Causse operation, a very precise hole is made in th estapes footplate with a microdrill (some surgeons use a laser).  This reduces trauma to the inner ear or bleeding into it.  The hole is covered by a very fine vein graft into which a piston of exactly the right length is placed and attached to the incus.  In skilled hands, this technique produces minimal damage to the inner ear and the inner ear fluids are sealed off immediately after the operation reducing greatly the risk of inner ear fluid leak, one of the causes of failure of stapedectomy. 

There is still argument between those using the Causse technique ("stapedotomy") and those using the original operation where the inner ear is left open, in which there is not infrequently some post-operative giddiness as a result of the leakage of inner-ear fluid.  Using either approach, an improvement in hearing will occur in 95 per cent of patients.  However, Dr. Causse reported on a series of some 6,000 consecutive operations without hearing loss, using the closed technique.

When stapedectomy was a new operation, there were many patients needing surgery.  As a result, many surgeons became very skilled at this procedure and performed the operation regularly.  Nowadays the condition is much less common and some surgeons perform the operation on an occasional basis only.  It is not a simple operation and there is frequent discussion within the profession that perhaps this operation should be restricted to certain centres where it is done on a regular basis.  In any surgery, it is wise to select a surgeon who has a special interest in the field, and who undertakes the procedure on a regular basis with good results.  Your surgeon should be prepared to discuss these issues with you, and if his or her interests and expertise are in another area of otolaryngology, you may be referred to a colleague who specialises in this operation.

After the operation, any giddiness or unsteadiness usually clears within a few days.  Because there is some blood clot in the middle ear and also often a dressing in the outer-ear canal, it may be a while before the full improvement in hearing is noticed, sometimes as long as three-six weeks.

Are there any risks?

No operation is entirely free from risk, despite modern anaesthetics and surgical skills.  There is a very good chance of stapedectomy resulting in improved hearing.  However, a small number of cases do result in deterioration in hearing due to damage to the cochlea.  Because stapedectomy is such a common operation, it is not difficult to find someone who has had an unsuccessful stapedectomy with loss of hearing which may be associated with an increase of tinnitus, or ear noises.  However, most surgeons and patients feel that the risk is an acceptable one; few other operations can offer such good odds.  Sometimes bruising can occur to a small nerve concerned with taste which runs under the ear drum.  As a result, some patients experience a metallic taste on the side of the tongue for a month or two after the operation.  It settles down in the long term.

Will my hearing deteriorate?

There are many people who had stapes surgery thirty-five years ago or more.  These patients are carefully followed, and the vast majority still have useful hearing.  It does seem, in some respects, that the operation halts the disease.  Everyone experiences some loss of high frequency hearing in later years, and these changes can also be seen in older people who had stapes surgery some time ago.  It is usually possible to correct this later loss in hearing with low powered hearing aids.

Second ear surgery

One of the other arguments is whether or not the operation should be done on the second ear, where both ears are affected.  Because of a further small risk (less than one per cent) of late hearing loss, some authorities feel that the second ear should not be operated on.  If anything should go wrong with the first ear at the later date, it is still possible to hear something, using a hearing aid in the unoperated ear.  However, many experienced surgeons, including those in the United States who originated the operation, are prepared to operate on the second ear.  It is a decision that needs to be made with great care, and the patient must be aware of the risks involved.  If an operation on the second ear is not advised, then it must be realised that the hearing in this ear may eventually reach the point where it cannot be helped by a hearing aid. Every case has to be assessed on its merits.
 

Do's and Don'ts

DO try a hearing aid if you are not sure about surgery and you have a relatively slight loss.

DO ask your general practitioner for a second opinion if you are not completely happy about the advice you have received.

DO discuss the technique that will be used and the results that may be expected with the surgeon who is going to perform the operation.

DON'T consider surgery unless you have a very clear idea of all the risks and benefits that are involved.

DO go ahead and have the operation once you are entirely happy, the most likely is restoration of normal hearing which can dramatically improve your life quality

*INFORMATION SERVICES
NADFS No. ER08