T.J. Linkous lived and breathed music until this May. That's when a severe case of tinnitus turned his life upside down.
<br><br>"The ringing is the focal point of everything. It sounds like a dog whistle in the key of C — very high-pitched. I could stand next to a train and still hear it," says the 30-year-old construction worker, who goes by "Johnny Trash" as the lead singer for his rockabilly band.
Tinnitus is a common symptom for those with hearing loss — affecting about four out of five — in which the brain "creates" different sounds at different volumes inside the head. "Some hear crickets, some high-pitch tones, others bacon frying. It's a neurological problem, not an ear problem," says Deborah Minnis, a Sentara audiologist, explaining that the brain continues to seek the stimulus of high-frequency noise, even after hearing is damaged.
Noise-induced hearing loss afflicts 10 million Americans of all ages, or a quarter of all those with hearing loss. Exposure to noise levels of 85 decibels, such as loud music or heavy city traffic, over an extended time, or one-time exposure to a very loud noise, such as a gunshot, can cause damage to the microscopic hair cells inside the cochlea. The damage is irreversible.
Though there's no cure for the associated tinnitus, there are several relief measures available.
"It's not how loud the noise of the tinnitus is, but how a person reacts to it," says Minnis, who works to reprogram the way people react.
As an example, she compares different ways people perceive a police siren — it can instill fear and elevated blood pressure if someone thinks they'll be pulled over, but otherwise they're able to ignore it. Similarly, she says, if you're in a crowded bus and someone keeps bumping into you, you're annoyed, but if you turn and find out that they're blind, your annoyance evaporates. "We empower the patient to think differently about their tinnitus and thus control its impact. For some, this information counseling is all they need," she says.
Linkous has one of the most severe cases of tinnitus Minnis has encountered. He is using a variety of techniques to manage it. His newly programmed hearing aids provide amplification just in the range — around 4,000 hertz — where his hearing is damaged. "They will bring in lots of soft environmental sounds and decrease the contrast," she says.
Silence is a major enemy of those with tinnitus. That's why, though the "noise" is constant, people report being bothered by it most either when it's quiet or when they're trying to sleep. To counter it, there are ear level noise generators and bedside sound generators, even sound generators in pillows, says Minnis. White noise, generally in the form of static, can help provide relief by masking the inner noise.
For most people with tinnitus, the condition is an irritant or annoyance. For others it can be a major, life-impacting problem. "It can cause depression, anxiety, sleep disturbance and difficulty concentrating," Minnis says. "T.J. was having a terrible time concentrating."
He was also in full-blown anxiety mode, according to his mother, Debbie Linkous. "You get stressed and it makes it worse," she says, adding that sometimes she cried about it for him. "It has been very disabling and debilitating for him." Now, with his hearing aids, he can access a variety of programs with different sounds: one for conversation; one that extends the high and low frequency range; and several labeled as Zen with fractal tones designed with a specific rhythm and pitch. "Certain combinations and speeds (just slower than your heart rate) are more relaxing; also repetition, but it must not be predictable," says Minnis.
The sounds encourage passive listening to help the patient ignore the tinnitus. "It's like the hum of the refrigerator, it's there all the time, but most of the time you don't notice it," she adds. Linkous uses the background white noise in 30-minute stretches, but as a musician he finds the lack of a pattern distracting.
"The hearing aids made an almost immediate difference in his quality of life," says his mother. "He's able to hear sounds he hasn't heard in a long time. I'm hoping the how-to tips, the retraining therapy and the counseling will help him better manage it."
It typically takes at least six months before patients notice a real difference in their symptoms, according to Minnis, who has her patients fill out a questionnaire at the beginning of treatment as a baseline comparison. "It doesn't have to be the focus; it's just like you ignore millions of signals all day long," she says, emphasizing that reducing the fear is a major factor.
For Linkous, she says, "the best thing would be for him to quit his job and give up music. It's a challenging situation."
Linkous describes his hearing aids as life-changing, and after months of depression has resumed going out and playing music. But he has also become a relentless advocate for the use of ear protection, both at work and at music venues.
See the story in Sunday's Good Life section on Nov. 13 for more about "Johnny Trash" and his music.
What: Community education seminar on tinnitus; causes, new treatments
When: 10 a.m. Thursday, Nov. 10
Where: Sentara CarePlex Hospital, 3000 Coliseum Drive, Conference Room C, Hampton
Information and to register: 1-800-736-8272 (SENTARA)
Protect your ears
•Sound pressure is measured in decibels, dB; an increase of 10 means that a sound is 10 times as loud or powerful. A typical refrigerator hum is 45 dB and a typical conversation occurs at 60 dB.
• Starting at 85 dB, sounds can cause noise-induced hearing loss.
• Listening to music on earphones at a standard volume level 5 reaches 100dB and can cause permanent damage after just 15 minutes per day. Audiologist Deborah Minnis cautions that earbuds are dangerous because people tend to be unaware of the volume.
• A clap of thunder (120 dB) or a gunshot (140-190 dB) can both cause immediate damage.
• Use ear protection when target shooting, hunting, snowmobiling, woodworking, playing in a band, attending rock concerts, using lawnmowers and shop tools.
In general, protect your ears by avoiding noises that are "too loud," "too close," or that last "too long." Wear ear plugs (available at hardware and sporting goods stores) in noisy situations.