'It's like I was in depression': No cure for most tinnitus sufferers but condition can be managed, doctors say

SINGAPORE: Tinnitus was not a ringing in the ear or a high-pitched tone for Ms Tan, 51. It was like hearing someone tap on a microphone randomly at any time of the day.

The public sector employee said the interruptions were “very irritating” and affected her work and social life.

“When you’re doing work and you’re reading emails ... then you also have to think, and this thing suddenly (pops up). It’s very annoying,” she said, mimicking the sound that plagued her for months.

“I was really in a bad shape, it's like I was in depression,” said Ms Tan, who declined to give her full name.

She was diagnosed with middle ear myoclonus, a type of tinnitus where clicking or knocking sounds are heard because of the twitching of tendons and muscles in the ear.

WHAT IS TINNITUS?

Tinnitus is a condition where a person perceives sounds that are not coming from the external environment and can usually only be heard by the patient.

It is common and affects at least 750 million people around the world, said Dr Goh Xue Ying, a consultant at National University Hospital (NUH) who specialises in ear, nose and throat (ENT) issues.

“But only a fraction (of) these patients have tinnitus that troubles them significantly,” he said.

The condition is common in Singapore as well, afflicting at least 12,240 Singaporeans aged 60 and above.

Among 72,000 of them who went for hearing screenings between 2018 and 2020, 17 per cent said they heard "ringing in the ear", the Ministry of Health said in response to a parliamentary question on Jan 9.

Population studies worldwide found that tinnitus is more common in older people and peaks between 60 to 69 years of age.

Ms Joanna Tang, an audiologist at NUH, said there was an increase in tinnitus patients seeking help after Singapore’s “circuit breaker” period in 2020. These patients may have had tinnitus for years, but only noticed it when working in a quiet environment at home, she said.

In severe cases, however, tinnitus can have serious consequences on daily life, said Dr Charmain Zhao, a consultant at Raffles ENT Centre.

“It can result in reduced quality of life, insomnia, anxiety and depression if patients are unable to cope with (or) get used to the tinnitus,” said Dr Zhao, who specialises in otorhinolaryngology, the surgical and medical management of ENT conditions.

Ms Tang said it can also be difficult for family members to see a patient in distress. 

“Patients who are bothered by their tinnitus also tend to experience a feeling of hopelessness as they may be told or read online that ‘there is no cure’ for tinnitus,” she said.

But tinnitus management can give patients relief and control over the condition, she said. “So there is always hope!”

RISK FACTORS

Experts told CNA that tinnitus can be triggered by a variety of situations including exposure to loud sounds, high cholesterol, ear infections, tumours or head and neck injuries.

Migrant workers may be at risk because of loud noise at their workplaces. Tinnitus linked to age-related hearing loss may also be on the rise given Singapore’s greying population, said Dr Zhao.

“Exposure to sudden or prolonged loud sounds is the most common factor related to tinnitus onset,” she added.

Ms Tan believes her tinnitus was because she used to blast music on headphones when she was a teenager. 

Another person with tinnitus who declined to give his full name, Mr Chang, 30, similarly said loud music from when he used to dance and even at church services may have caused his condition. 

In cases where there is an underlying disease or injury, treating it can help to resolve tinnitus, doctors said.

However, other forms such as continuous tinnitus mostly “occur spontaneously” and medication cannot completely eliminate it, according to Dr Barrie Tan, an ENT specialist at Gleneagles Hospital.

TREATMENT OPTIONS

In Ms Tan’s case, she was relieved to find out that her condition could be surgically treated. She tried oral medication before opting for surgery when the problem persisted. 

At the time, she told Dr Tan of Gleneagles Hospital: “I really can’t tolerate this, I can’t live with this.”

“Everybody was worried for me because suddenly I became very closed off,” she said.

“I’m actually a very happy-go-lucky kind of person that, you know, always talks and laughs. And then suddenly it’s like, so miserable and then always hiding in the room.”

The procedure took about three hours under general anaesthesia, and the recovery was “not that easy”, but it was worth it, said Ms Tan.

Dr Tan said the surgery for middle ear myoclonus involves cutting tendons so that they stop causing “unwanted twitching movements of the middle ear bones".

“This is immediately beneficial and patients wake up from the surgery immediately without any further pulsatile, clicking tinnitus,” he said.

If the tinnitus is not due to an active disease or issue, medical therapy is limited, NUH’s Dr Goh said.

Therapeutic sounds, however, can “help the brain learn how to effortlessly ignore the tinnitus over time”, said audiologist Ms Tang.

“Even if the tinnitus does not go away completely, it will no longer be a problem for the patient,” she said.

Dr Zhao said hearing aids can help patients with both hearing loss and tinnitus, and white noise such as a fan or static television sounds can counter the sound of tinnitus as well.

The process of helping patients get used to their tinnitus is called habituation, said Dr Tan of Gleneagles Hospital.

“Patients who have habituated may not be aware of the tinnitus being present unless they actively pay attention and listen out for it,” he said.

The main strategy is “masking” therapy, where an ambient sound is introduced to override tinnitus. Over time, the brain gets used to the tinnitus sounds.

Many smartphone apps and other devices are also available and can help to manage tinnitus, Dr Goh said.

IS TREATMENT NECESSARY?

That said, not every person with tinnitus will pursue treatment.

Mr Chang first noticed his tinnitus when he was in university, but was only diagnosed about two years ago, when he saw an ENT doctor after experiencing some dizziness. 

He described it as a constant, very high-pitched tone that is evident to him most of the time, even when he’s speaking on the phone or when there’s construction nearby. “But the tinnitus in itself doesn't affect me that badly, which is why I never really took notice of it,” he said.

Dr Tan said many patients just want to be sure there is no serious underlying condition causing the tinnitus. They may also be worried that their hearing will worsen.

“When reassured that most times, the hearing will not deteriorate, they do not continue with the prescribed habituation therapies,” he said.

Ms Tang said she has seen younger adult patients who are not bothered by their tinnitus, but are seeking answers about the long-term prognosis.

“There are a lot of videos and articles online with false or misleading information and therefore patients need guidance in what to believe and what to disregard.”