|THE IRISH TINNITUS
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
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.
Foundation the Association set
three short-term objectives:
1. To provide information on the condition of
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
4. It recognises the need for the establishment
of self-help groups throughout the country, supported by the work of the
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
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,
What makes Tinnitus worse?
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
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
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
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
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
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
Is there anything else I can
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
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"
What does tinnitus sound like?
* Sensation of noise where there is no external
* Objective and subjective types
* Not a disease
* 40,000 affected in Ireland
* Can be experienced temporarily or long term
- depending on cause
* Can be in one ear, both or in whole
What causes tinnitus?
* Can vary in volume for no reason
* Only increases in volume in few cases
* Clicking, buzzing, humming, throbbing, fizzing,
screeching, ringing etc.
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.
* Exposure to loud noise
* Rarely, ear tumours
* Certain drugs
* Ear infections
* Harsh syringing
* Jaw disorders
* Vascular abnormalities
* High blood cholesterol
* Stress, illness, injury
* Menieres disease
* Personal stereos and discos
* Pre menstrual tension
* Tobacco, alcohol, caffeine
* Some thyroid disorders
* Dental procedures
* Zinc deficiency
* Colds and viral infections
* 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
Is there a cure?
* If caused by wax, blockage or infection
- often yes.
How is tinnitus diagnosed?
* 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
* ENT departments.
* 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
* Alprazolam (Xanax) & Klonopin
* Histamine and anti -histamine
* Vinpocetine - a vasco dilator
* Sodium Fluoride - maybe useful if tinnitus
due to cochlear ostosclerosis
* Serc (betahistine hydrochloride)
* Surgery - for acoustic neuromas, vascular abnormalities
and TMJ syndrome
* Diet analysis
* Stress reduction
* Hearing maskers/aids
* Cranial Sacral therapy
* Electrical stimulation
* Oxygen therapy
* Biofeedback therapy
* Auditory Integration Training
* Sound therapy
* Cognitive therapy
Where can I get help and advice?
* Current work/aims of Irish Tinnitus Association
to gain further interest from medical profession
* Self Help groups
* Inform self (e.g. books)
How can I cope with or alleviate my tinnitus and
the effects of it?
* Think positive
* 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
* Attend self help group
* 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
What makes tinnitus worse ?
* Avoid aspirin and quinine
Does tinnitus affect children?
It can do and is often associated with other
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
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
The Electronic Centre
16 College Square East
Tel:: 080 1232 327357
Cost from £4.00 Sterling
ITA INFORMATION SERVICES
TINNITUS PERCEPTION, RETRAINING
NADFS No. TA3
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.
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
NADFS No. TA2
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.
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.
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
1. It first appears in relatively
young people (usually around the age of 30).
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.
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.
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.
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.
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.
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).
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.
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.
ITA INFORMATION SERVICES
NADFS No. ER10
MENIERES SOCIETY IN ENGLAND
Meniere's Society, 98 Maybury Road, Woking GU21
Membership is £10.00 Sterling a year, including
copies of their newsletter SPIN that is issued quarterly
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
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
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
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
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
NADFS No. ER08