Timothy Brown, a 55-year-old industrial electrician, didn't pay much attention to the ringing in his ears he heard occasionally last winter. But, come March, when the high-pitched noise turned nonstop and showed no sign of going away, he suddenly could think of nothing else.
"[After] the first few days, I went to the family doctor thinking it was an ear infection," he said. That was ruled out.
"It wasn't a problem, but it lingered two or three weeks and then it became traumatic," Mr. Brown said.
His sleep was disrupted; he could no longer tolerate the level of sound generated when his big family of siblings got together.
"Traumatic" is a word to which millions of people with the same symptoms -- ringing or other noises in the ears not caused by external stimulation -- can relate. What they suffer from is a sensation of various and sometimes indeterminate causes called "tinnitus." The American Tinnitus Association estimates 50 million Americans have or have had tinnitus. Of that number, some 12 million seek medical help, and 2 million of them are debilitated by it, experiencing family problems, job problems, sleep problems or even depression.
There is no cure.
"It's so hard to target a cure if we don't know a cause," says Dr. Craig Newman, a Ph.D. in audiology who is section head and professor of audiology at the Head and Neck Institute at the Cleveland Clinic.
The American Tinnitus Association has a program called Road Map for a Cure. The association is trying to get scientists together to get a better understanding of the causes so they can find a cure, Dr. Newman said.
In the meantime, there are numerous treatments, each of which by itself or in combination with others provides relief for some segment of tinnitus sufferers.
One of the newest falls into the category of sound therapy. It is called Neuromonics and it got federal clearance in January 2005 after becoming commercially available the previous year in Australia, where it was developed.
Other sound therapies seek to cover up the tinnitus with environmental sounds, broadband noise (it sounds like a shower), wind noise, even the ambient background noise that comes with use of a hearing aid.
Neuromonics uses highly customized Baroque and New Age music -- and during Phase 1 of two phases some broadband noise -- to try to retrain the brain to ignore the tinnitus through a process called neuroplasticity.
"It's the newest tool in our toolbox," Dr. Newman said.
Cleveland Clinic became one of the first five medical centers in the United States to train for and start using Neuromonics two years ago after Dr. Newman and other top audiologists got a chance to preview and offer feedback on the treatment.
The Pittsburgh area only recently got its first two practices trained to offer the therapy, according to officials of Neuromonics Inc., of Bethlehem, Northampton County.
They are Pittsburgh Ear Associates, with a main office at Allegheny General Hospital and suburban outlets at Forbes Regional Hospital in Monroe-ville and the Wexford Professional Building in Pine, and AAA Ear & Aid Specialists of Monaca.
Dr. Newman said he was attracted to Neuromonics because of its use of music, which has shown to be useful therapy for pain relief and to reduce autonomic problems like high respiration and high heart rates. Plus, he said, "Patients find music much more pleasant than white noise ... so I think there's a higher patient acceptability because of the sound of music."
During Neuromonics treatment, patients listen to Baroque and New Age music for two hours a day over a period of roughly six months. The music is customized to their levels of hearing ability and tinnitus.
In Phase 1, which lasts about two months, the broadband noise is embedded in the music. It delivers a signal that interrupts the preoccupation with tinnitus and relaxes the patient.
The broadband noise is eliminated from the customized music in the second phase, which lasts about four months. That re-exposes the patient to the tinnitus for brief periods, introducing a process called acoustical desensitization.
In layman's terms, the patient is learning to ignore the sound of the tinnitus. That takes advantage of the brain's neuroplasticity, or ability to change.
The patient holds on to the sound system, called an Oasis, beyond the treatment program to use if the tinnitus reoccurs.
"Our expectation is not that the tinnitus is gone," Dr. Newman said. "They're just not noticing the tinnitus."
It is only after all underlying medical causes have been eliminated or treated that the audiologists and tools such as sound therapy come into play.
At a multi-interdisciplinary clinic like Cleveland's, for example, patients go through a battery of medical tests.
There are medical treatments for conditions such as sleeplessness and depression or a tinnitus-causing growth on the hearing nerve. There also may be physical manipulation for cervicalgenic tinnitus, or cognitive behavioral therapy, biofeedback training and relaxation techniques taught by psychologists.
Some ear, nose and throat practices even offer vitamin therapy.
Cleveland Clinic patients may undergo several therapies concurrently. "For example, we have patients who have sound and behavioral therapy. It's trying to attack the condition from a number of angles," Dr. Newman said.
"All of our patients start with group education sessions and during these sessions of an hour and a half to two hours, there's lots of information about tinnitus, the causes, why it may be distracting ... and options, including sound therapy for tinnitus relief."
Patients are given a chance to try out the sound therapies and, Dr. Newman said, many opt for Neuromonics.
"Many patients will put Neuromonics on and get immediate benefit, which means immediate relief from their tinnitus."
So far, about 40 Cleveland Clinic patients have chosen Neuromonics and the response has been good.
"I can't say [that it has a higher success rate], but there's a higher acceptability rate than with other sound therapies. They're confident, more willing to pursue treatment, though we've seen success with sound generators and hearing aids," Dr. Newman said.
"I can tell you for many people it has changed their life. I get notes from people, even from some in maintenance therapy."
Timothy Brown's life certainly has changed since he began Neuromonics treatment in May after trying relaxation techniques and sleep medication.
The tinnitus is not gone, but the noise has changed from a "high-pitched, constant ringing" into "a fuzzier sound."
"I don't expect it to be gone," said Mr. Brown, who declined to give his hometown except to say he lives near the Warren, Ohio, clinic at which he underwent treatment, the Lippy Group for Ear, Nose and Throat.
"The only way I can explain it is, since my involvement with Neuromonics, it changes my focal point. It changes my focal point from hearing my tinnitus to dealing with activities around me. ...
"If I consciously listen for my tinnitus it's there, or in stressful situations it's there. But during most of the day I'm not even aware of it, and I can sleep now without any medication.
"I would say [there is] 60 percent improvement."
Pohla Smith can be reached at 412-263-1228 or firstname.lastname@example.org . First Published November 28, 2007 5:00 AM