The temporomandibular joint has a very close positional relationship to the auditory canal. Patients report that the ringing in their ears has disappeared after successful TMJ treatment.
Tinnitus and ringing in the ears should be treated in an interdisciplinary manner.

Phantom in the ear

#12People with tinnitus hear sounds that do not physically exist. A method that is also used to treat migraines could help: neurofeedback.

Tuesday 27. August 2019 12:05

by Annette Wirthlin

The investigation may take some time: To rule out illnesses and symptoms other than tinnitus, a specialist will carry out examinations. Photo: Mauritius Images

Like the whistling of a kettle. Or the buzzing of a mosquito, only higher and much louder. That’s how Sven Buchli* describes the sound that came out of nowhere one beautiful summer day two years ago and lodged itself in his ear. “I was sitting in the garden at home and suddenly it was there. Intrusive. Drowning out everything,” recalls the program manager of a major bank. “It wasn’t painful, but I felt completely at the mercy of the noise.” He heard everything else as if through absorbent cotton. Sven Buchli was scared and asked himself: “What’s wrong with me?”

The 38-year-old suffers from chronic tinnitus. This is a hearing disorder in which those affected perceive a sound in one or both ears that does not originate from an external sound source. Experts also speak of “phantom perception”. This is caused by faulty processing of information in the auditory center of the brain (see box below).

“I have tried many things in the fight against the tyrant in my ear. “Sven Buchli, patient

“Tinnitus is usually caused by damaged hair cells in the inner ear, triggered for example by a sudden hearing loss, head trauma, a middle ear infection or high levels of noise exposure,” says tinnitus expert Tobias Kleinjung from the University Hospital Zurich. The latter was also the case for Sven Buchli: six months before the incident in the garden, he had attended a loud rock concert. Sometimes, however, ringing in the ears simply occurs during stressful phases of life or for no particular reason.

The brain learns new patterns

“I tried a lot of things in the fight against the tyrant in my ear,” says Sven Buchli two years later in the kitchen of his Zurich apartment. “Some of it helped, a lot didn’t.” His latest attempt, which he has high hopes for, is currently part of a pilot project run by Zurich University Hospital and the Hohenegg Private Psychiatric Clinic using a method called neurofeedback. The patient observes a spaceship flying through a tunnel on a monitor. He wears a cap on his head with electrodes that measure his brain waves. He does not have to do anything – except concentrate on what is happening on the screen.

How tinnitus develops

If individual sensory cells (known as hair cells) in the cochlea in the inner ear die, for example due to high noise exposure, hearing loss occurs at the relevant frequencies. The nerve cells in the auditory center of the brain now receive fewer electrical impulses. The auditory center in the brain tries to compensate for this by becoming permanently active. This continues even when nothing can be heard. This can be measured experimentally in tinnitus patients. Because other areas of the brain, such as those responsible for attention control, stress or memory, also begin to connect with the overactivity, the affected person perceives a disturbing sound. If his auditory nerve were severed, he would be deaf, but the ringing in his ears would remain. Illustration: Axel Kock

“With this method, the researchers are trying to reprogram my brain waves and bring them into line with the pattern of a person without tinnitus.” When Sven Buchli explains the abstract therapy, he sounds like an expert himself: “If the brain activity is good, the computer rewards you with a beautifully flying spaceship. If, on the other hand, there are unwanted, typical tinnitus patterns, the flying object stalls, steers into the tunnel wall and the image becomes cloudy.”

Training makes tinnitus quieter

Neurofeedback is a form of brain training that cannot be controlled voluntarily. Ear, nose and throat specialist Tobias Kleinjung, who is involved in the project, says: “We don’t know how the individual – or rather their brain – manages to control the computer game better and better.” However, there is a training effect – and often a reduction in tinnitus. “We want to find out whether the method, which is well recognized for migraines, for example, is equally suitable for tinnitus patients,” says Tobias Kleinjung. In any case, the 20-minute sessions do Sven Buchli good. “I become calm and the tinnitus actually gets quieter for a while afterwards,” he says. The researchers can also see this in his brain wave curve.

In neurofeedback, the brain activities of a tinnitus sufferer control a spaceship on a screen: the aim is to teach the brain to make better use of its resources and thus reduce the stress caused by tinnitus. Photo: Ursula Meisser

Experts estimate that 5 to 15 percent of the population suffer from persistent tinnitus at least once in their lives. The fact that there are no more precise figures is due to the fact that not every sufferer visits a doctor. “The level of suffering varies greatly from person to person,” says Tobias Kleinjung. It doesn’t depend on the volume of the perceived sound: “One person feels massively disturbed by a barely perceptible sound, while another lives quite well with a relatively loud ringing in the ears.”

Sven Buchli was suffering greatly. Two days and two sleepless nights after his sudden hearing loss, he had his hearing checked at the tinnitus clinic at Zurich University Hospital. The ear, nose and throat specialist’s first priority is always to “find the cause of any hearing loss and then, if possible, improve it with medication, a hearing aid or an operation,” says Tobias Kleinjung. The doctor diagnosed Sven Buchli with sudden deafness and prescribed him cortisone. His hearing recovered within a short time. But the nerve-racking buzzing in his ears remained. It could not be masked with music or the Wave Noise app on his smartphone. The indoor fountain, which is often recommended as an acoustic distraction, didn’t help either. Only the sound of the water while showering gave the sufferer some peace, at least for a few moments. On the street, the tinnitus was not drowned out by the ambient noise, but became even louder. It dominated his work, every conversation and increasingly drew him into a negative spiral. “I was frustrated and constantly on the verge of depression,” recalls Sven Buchli two years later during a conversation in his kitchen.

There is no panacea

Tobias Kleinjung prescribed him physiotherapy and psychotherapy. One to relieve the stress-related tension, the other to get tips on how to deal with the tinnitus in everyday life. Both helped to a limited extent. “In my desperation, I also tried everything I could find on the internet about tinnitus,” says Sven Buchli: “Craniosacral therapy, acupuncture, radical fasting cures, sport.” He focused his diet on nutrients that calm the nerves and therefore possibly the tinnitus: Vitamin B3, B6, B12, D, magnesium. He cut out alcohol and sugar almost completely because they tend to make you nervous. As a former party animal and workaholic, he cut back on work in favor of his health. Sven Buchli began to meditate and learned mindfulness techniques. “It’s about getting off the carousel of thoughts surrounding the tinnitus,” he says. “The more importance you give it, the more it becomes entrenched.”

“The extent to which someone suffers from tinnitus varies from person to person. “Tobias Kleinjung, ear, nose and throat specialist

Tobias Kleinjung also confirms this: “The only thing that actually always helps are strategies for dealing better with the troublemaker.” There is still no panacea for tinnitus. There are various innovative treatment methods (see below), most of which are being used in studies. However, their effectiveness is controversial because there is no clear scientific evidence to date. Neurofeedback, for example, with which Sven Buchli has had good experiences, is still experimental. “There is currently no method for determining who will potentially respond to the treatment,” says Tobias Kleinjung. It is also unclear how many sessions will be necessary. The therapy is therefore not yet funded by health insurance. Tobias Kleinjung does not like the term “cure” in connection with tinnitus, “because that would mean that there is no more ringing in the ears”. Promising a patient this is dubious, although tinnitus can sometimes disappear for good. The doctor considers a person to have been successfully treated if they no longer experience any restrictions in their everyday life.

Today, Sven Buchli has come to terms with his tinnitus. “If I pay attention to it, it’s still there, but it’s become less important,” he says. “I can work almost undisturbed again, make phone calls, enjoy audio books and generally lead a normal life.” As if on cue, baby cries can be heard from the living room. Sven Buchli smiles. He became a father a few weeks ago.

The tyrant became a companion

In Tobias Kleinjung’s eyes, the most revolutionary tinnitus therapy would be one that can somehow repair the damaged hair cells. “But research is still miles away from that.” Sven Buchli would take this miracle cure immediately if it existed. For now, he is content with the realization “that I can’t influence the tinnitus, but I can certainly influence the way I think about it”.