Imagine living next to a noisy neighbor whose TV plays test tones 24 hours a day—and no matter how far you go to escape, the sound follows you.

That endless aural assault is what millions of people with tinnitus cope with every day. For some, it’s an occasional or temporary problem brought on by an ear infection, allergies, wax buildup, or common medications such as aspirin. For others it’s a relentless ringing, roaring, buzzing, or clicking that never goes away.

“One of the most common causes of tinnitus is hearing loss,” says UAB otolaryngologist Benjamin M. McGrew, M.D. “When the auditory centers of the brain aren’t receiving enough stimulation, they tend to create their own. In the past, some people with severe tinnitus became so desperate that they had their auditory nerve severed, even though it meant deafness. In the majority of cases, the sound remained, which means it originated in the brain itself.”

Patients often report that tinnitus is most noticeable at night when there are fewer competing sounds. In a completely quiet room, even people with normal hearing sometimes notice that their ears start to play tricks on them.

Tinnitus can also be a sign of other health problems. “When patients come to me, the first thing I ask them is whether the sound is continuous or pulsing, in one ear or both,” explains McGrew. “If it’s pulsing, it could be a vascular problem that needs follow-up. If it’s in one ear, it may be hearing loss, infection, or even a tumor, such as a neuroma. Neuromas are not as common as some cancers, but on average I do surgery on two patients a month who have that type of tumor.”

The nonstop noise of persistent tinnitus can make patients so miserable that they’re often willing to try just about anything that promises relief. “There’s a lot of hocus pocus out there, so people need to be wary,” says McGrew. “Two medications that do work for some people are Xanax and Elavil; easing tinnitus seems to be a side effect of their anti-anxiety and antidepressant properties.”

McGrew says that a hearing aid or cochlear implant to increase auditory stimulation helps some patients. “Masking the sound is another possibility—white-noise generators with effects such as ocean waves or rain may work. Even a fan can help.

“A residual effect of masking devices is that the tinnitus sometimes doesn’t return for minutes or even hours,” he says. “Researchers are also reporting progress in retraining the ear and the brain. Combining that with therapy could make the problem less noticeable.”

For patients dealing with tinnitus, the sound of silence would be golden indeed.

— Laura Freeman