Ear Wax Tinnitus
'Put nothing smaller than your elbow in your ear' is a priceless piece of advice in do-it-yourself health care. No one follows it entirely, but people who have ignored it include tinnitus sufferers. Putting a finger into the head through those two openings made solely for the entry of sounds can mean putting in permanent head sounds. Inserting objects, however seemingly harmless like cotton cleaning buds on a stick, can have the same life-long effect. Less believably, but just as devastatingly, instruments inserted medically for the removal of wax can also leave tinnitus behind.
Because of its extreme sensitivity, the ear, as everyone finds out, can itch maddeningly, and it requires great self control not to scratch it as deeply as can be reached. The probing and shaking inside the ear can hasten the changes which usually require the passing of time, disease or accident to come about. Deafness and/or tinnitus can result. The commonest weapons people unsuspectingly use to inflict ear damage are the rolled-up corners of face flannels and cotton buds – the latter sold by chemists who should know better and which some ear specialists say should be banned from sale.
The damage left by the vigorous application of flannels and buds is the high price sometimes paid by anyone wrongly thinking that such practices are necessary to clean inside the ear or to stop itching. Wax can safely be removed in most cases by the use of ear-drops bought over the chemist's counter, and chronic irritations can be stopped with a very effective drug on prescription. Both can help to avoid tinnitus and deafness.
Yet more hazardous to a minority of patients is an instrument lying, unsuspected, in doctors' surgeries and hospitals – the familiar syringe. People in many countries tell sad stories of how their tinnitus started as a result of an ear syringing to clear wax. Their evidence forms a dossier of damning criticism of a procedure regularly carried out. And for everyone who has complained there is an unspecified number who have accepted that it must have been an extremely rare accident that happened to them. Anyone innocently responsible for giving a patient tinnitus in this way can also find it upsetting. One case history records how a young doctor broke down and wept when she realised what she had done to a man she was trying to help.
Syringing produces both pressure and noise to a dangerous extent. This was confirmed by a Sheffield audiologist as recently as 1994, after he had found that no satisfactory study had apparently been made up to then of the possible connection between the application of water under pressure in the ear and the commencement of head noises. He studied previously reported cases, conducted experiments on a replica of an ear made of silicone and published some serious news for the tinnitus world.
A patient with previous but healed damage in the ear could suffer a perforated ear drum due to the action of the syringe. Tinnitus can also be started by the loud sound the syringe makes, where there was already a hearing disorder, even a slight one. One theory is that the efferent nerves of the cochlea in the inner ear are wrongly stimulated, causing the brain to hear tinnitus or to increase it if it is there already. Further, it is believed such triggering can spring from the psychological discomfort and anxiety a person can experience during the syringing.
Most people do not have this trouble when they request this effective way of clearing the ears of wax. Indeed, as wax can be a cause of tinnitus, a syringe can actually stop the sounds in a small number of cases. But the hazards remain. If the syringe is to be used, make sure that it is handled with respect in the surgery. It can often be used rather carelessly by an overworked practice nurse. Before agreeing to it, make sure the doctor is reminded of any history of deafness or tinnitus, which may render you too high a risk for such treatment. It may be necessary to visit a hospital as an out-patient to see how best the wax can be removed and to assess any risk of deafness or tinnitus.
A machine that sucks out wax from the ear is less often used, but can also do great damage. Patients have been known to suffer severe trauma from it and to be left with deafness and loud tinnitus. A middle-aged woman in Hampshire is campaigning to have stricter controls on the use of suction machines introduced, and for patients to be fully warned of what can happen to them. Her constant tinnitus has not diminished since a machine 'sounding like a road drill' was used on her in a private clinic to remove wax.
She is also deaf as a result. As with syringes, the best advice is to discuss the method of suction thoroughly with a doctor – preferably not connected with the private clinic where it may be carried out – and consider your vulnerability, especially in the light of any existing deafness or tinnitus.
Learn if any other method will do.
HYPERSENSITIVE EARS
Although deafness is never welcome when it arrives with tinnitus, people with head sounds can sometimes actually wish for part-protection from the sounds of the world around them. They want to escape from the everyday sounds of a door closing, conversation or the clatter of tea cups.
Everything appears to be far noisier than it should be. A low-pitched voice becomes a shout and other sounds are suddenly unbearable. Someone with tinnitus cannot even therefore listen to the rest of the world for a comforting diversion from his own racket. The condition is also known to those who are only deaf or with otherwise good hearing, but is a particular worry for the tinnitus population. The trouble springs from what appears to be a physical contradiction: a damaged ear, with its own internal noises and perhaps struggling to hear adequately, finds that it is also over-sensitive. A sufferer wishes strongly that there were fewer sounds coming at him.
The condition is known as hyperacusis – a word which has the distinction of being less well known to the public than that of tinnitus! It is caused when the ear assumes the characteristics of a damaged musical instrument – say a piano which has lost its soft pedal and only produces sounds of such loudness they can be heard only with considerable discomfort. Short of living in total silence, however, the sufferer cannot easily close the piano lid, as it were, and walk away from it.
When someone suddenly winces, covers her ears with her hands and asks for less noise in the room, the problem may be hyperacusis. A good ear can hear sounds over about 20 decibels and up to some 110 without immediate discomfort. An imperfect ear affected by hyperacusis can be expected to lose sounds below about 50 decibels but will not easily tolerate those above 80 – the noise of a busy street and above which tinnitus can be caused, as it happens. Such levels can be both distressing and painful. In musical terms, the ear has had its dynamic range reduced.
Hyperacusis can usually be traced to loss of some of the tiny hair cells in the inner ear, especially those picking up high frequency sounds such as a flute, a soft door-bell or the song of a bird. As there are consequently fewer hair cells left in the ear, there is impairment of the intricate system of sorting sounds. This in turn means that too many nerve cells are activated together, thus making the person hear exaggerated sound. Even bad tinnitus and some deafness are not enough to drown or mask the often unbearably loud enhanced sounds. The intake of the extra volume is called recruitment.
As the brain determines the perception of any sound, so too the vital ear-brain link is involved in hyperacusis. In all hearing, thousands of fibres in the auditory nerve carry data about each sound to the hearing part of the brain, the journey taking less than a second. En route the signal is processed, including such actions as extracting and highlighting which sounds need to be noted more than others.
What the person suffering from hyperacusis finally hears depends on the accuracy of the swift processing. The subconscious brain can, simultaneously, use stored memory to trigger an unfavourable reaction to a given signal, disturbing the person for no easily apparent reason. Serious tinnitus, where present, can cause stress and anxiety, thus making the enhanced external noises even more horrific.
Anyone with both problems should request separate treatment for hyperacusis, if it is not offered. Where a masker is being worn partly to counter the head sounds, care must be taken to ensure that the wrong external sounds are not amplified, thus making the recruitment of sound worse.
Many aids can incorporate a feature to 'clip' amplification at the danger level or to provide automatic control of the volume. Just as important, almost, is the choice of ear moulds worn with the aids. Vents in the moulds can determine the amount of unwanted loudness that can escape before it reaches the hearing mechanism in the head.
There are other means of bringing relief. A small white noise generator in the ear can, under careful supervision, help to desensitise the hearing and often defeat the vulnerability to sounds. In a good hospital or clinic this is combined with therapies to reduce the anxiety common in eases of hyperacusis. When a patient is frightened by what he thinks are the dangers of everyday sounds and the fears produce or add to the trouble, counselling is used to expose the fears and allay them. To find out more, you can check out Ear Wax Tinnitus.
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