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‘It’s a ringing in my ear…’

Essay | 11 minute read
The understanding of tinnitus is still in its relative infancy, despite the misery it brings to the lives of thousands of people in the UK. A writer investigates the illness, and the medical response to it

‘Now chains through gravel’– From the poem ‘Tinnitus: January, thin rain becoming ice’ by David Harsent

Mine is not like that. It’s more of a metallic-sour dog whistle, rising in panic like the first few bars of a Hans Zimmer score. And for the last year or so it has been a shrill, whining constant, so inevitable now as to be like a prison cellmate, a frightening companion you either make an uneasy peace with or surrender to in exhaustion in the blunt pragmatism of insanity or suicide. It also has its own familiar, its own consort: a soft percussion of water bells that splashes, unannounced, every few days, across the sonic landscape. I like those little bells, but they don’t last.

The British Tinnitus Association, a charity which ‘aims to help those suffering with the condition through a range of support and information’, says that about 1% of the population will at some point experience a tinnitus which ‘has a significant impact on their quality of life’. After months of waiting, I had finally received an appointment to see a specialist at the Ear, Nose & Throat Department at Hillingdon Hospital in Middlesex, and I was seeking some kind of resolution to this question of ‘impact’. What exactly was wrong with me?

And besides, shouldn’t I just get on with life, stiff-upper-lip my way through it, remember that there are millions of people suffering with torments far worse than the inconvenience of insomnia? Wasn’t it my own fault in the first place, for having played Japanese wadaiko drums (yes those big ones) for over ten years without earplugs, or for regularly coming home from a night on the town, the party still swinging in my head, and cranking up Prince albums to level eleven on my headphones?

After all, tinnitus seemed a rite of passage for an artist, a scar to be worn per confessione, as openly as alcoholism or failed marriages. As a tinnitus sufferer I roll with exalted company: Thom Yorke, Barbara Streisand, Pedro Almodóvar, Moby, Bob Dylan… Beethoven, for Christ’s sake. Van Gogh. Goya. And that song I had always loved, before I even knew I had tinnitus – Suzanne Vega’s Blood Makes Noise:

‘Blood Makes Noise

It’s a ringing in my ear

And I can’t really hear you

In the thickening of fear’

Behind the vocals, Vega’s arrangement articulates tinnitus as a smothering clang of metal, something akin to the music of a steel mill punctuated with the heavy thud of distant artillery. Mine is not like that. But I have always thought: that’s cool. Suzanne Vega understands it.

Suzanne Vega, 2018 (Photo by Burak Cingi/Redferns)

Tinnitus’ parasitic relationship with the arts has a deep and vivid history. No-one writes about this with more care than David M Baguley, Professor of Hearing Sciences at the University of Nottingham. In his essay, Tinnitus and hyperacusis in literature, film, and music (hyperacusis is an increased sensitivity and reduced tolerance to sound), Baguley tracks references to tinnitus through Francis Bacon, Rousseau, Thomas Hardy, Martin Amis, Woody Allen. ‘Here I recall those that come to mind and reflect upon the contexts in which tinnitus, hyperacusis, or both are mentioned, and consider what this may tell us about the experiences people associate with those symptoms… Considering these artistic references reminds us as clinicians of the massive heterogeneity of responses to tinnitus, and not to oversimplify the situation.’ Oh, just to be listened to; the plain comfort, the nourishment, of being heard. What we wouldn’t give for a Baguley in every ENT unit in the country. But more of that later.

So common is tinnitus – 30% of us will experience some form of it in our lives – that it has infiltrated the tropes of popular cinema. In The Tinnitus Trope: Acoustic Trauma in Narrative Film, Mack Hagood speculates that near-ubiquitous, post-explosion ringing sound effect (think of any recent action film you’ve seen, rewind in your head to the street explosion – notice how the music drops out to isolate a grating solitary note?) has become shorthand for human vulnerability: ‘By charting the form and history of the tinnitus effect, we can begin to examine why a mixture of piercing and muffled sound has lately become so useful and salient in narrative film… If film audiences share something like [the] interpretation of acoustic trauma, it may be that cinematic tinnitus successfully sonifies contemporary feelings of loss and unease around politics and selfhood.’

But Hagood is also clear that this ‘cinematic tinnitus’ is not really tinnitus at all. ‘In the acoustic trauma associated with a powerful impulse such as an explosion,’ he writes, ‘hearing loss and tinnitus are directly related, but separate, phenomena.’ In other words: most tinnitus subsides over time when triggered by acoustic trauma. There is a cause, and an effect. And a resolution. The fear is temporary.

The utilitarian 1960s concrete and glass slab of Hillingdon Hospital is a sallow block of greys and parallel lines and old antennae, a Walking Dead location scout’s Idea Wall made manifest. The Ear, Nose & Throat Department is buried deep inside, but before my consultation I am led to a windowless box room with old felt on the walls; there is a children’s puzzle on the chair next to mine, all square pegs in round holes. An attendant – I assume this is what he is, though he never actually tells me – fits me with some headphones and asks me to hold a joystick with a button. I am to press the button when I hear a tone. The tones decrease in volume but with a predictable gap in regularity, and I find myself wondering if I have actually heard the tone or am just doing what drummers do in anticipating the next beat.

Sometimes, however, the squeal of my tinnitus smothers the test tone, and I wonder, ‘This is interesting – my tinnitus really does have a consistent pitch… Shouldn’t they be measuring that? Shouldn’t he be asking me questions?’ No, I’m jumping the gun, perhaps later – perhaps the consultant will be given a sheet of this data condensed as a visual schemata and announce, with a flourish, ‘Ah yes! As I suspected – your tinnitus is of the variety #A! I have just the thing…’

I want to embarrass that consultant, Mr. S, by naming him in full here, though such spite would be pointless. I am resentful at him nonetheless – at the asininity of his power, and at his perfunctory and useless pleasantness.

‘When did this start?’

A year ago, I tell him, but the nature of the sound has changed.

‘Do you do any loud hobbies?’

I stare. He is hoping to hear me say I am a musician.

‘I used to be a drummer.’

I spot a smirk of recognition as he writes something in my notes. My heart is sinking. I know now he is not going to ask me about my tinnitus, about its morphology, its nature, its caprice. He is not going to ask me the questions I think he should ask, because he is not interested in my tinnitus at all. Or he is afraid of it, because he knows absolutely nothing about it. I am not sure which is the greater crime.

‘Drink less caffeine. Listen to music before you go to sleep. It will take your mind off it. I will book you in for an MRI scan, just in case.’

I am so stunned by this advice, and the realisation that he is not joking, that it’s a while before I understand his fixed smile means it is now time for me to go.

Photo by Kyle Johnston/Unsplash

Why has the NHS sent me to see a man who has no knowledge of, or interest in, my malaise? Do we treat diabetes sufferers the same way? No, because the cost to the NHS of complications from diabetes runs into billions of pounds, and the links are incontestable. The understanding of tinnitus, by contrast, is still in its relative infancy, despite the misery it brings to the lives of hundreds of thousands of people in the UK. So I am booted back out towards the revolving door of secondary care – I must now speak to my GP again, who will re-refer me back to someone who may or may not actually understand something about my disorder. Again, the crumb of comfort comes from knowing I am not alone. In February this year, the ENT surgeon Don McFerran published Tinnitus services in the United Kingdom: a survey of patient experiences. In his conclusion, he writes:

‘Although the UK has developed a national service for patients with tinnitus, many people find it difficult to access, being blocked at the primary care level or after secondary care diagnostic services. Many of those discharged from secondary care return to their GP within a short space of time, and are re-referred to secondary care, creating an unsatisfactory and expensive revolving-door pattern of healthcare. Despite psychological treatment modalities having the best evidence base for successful tinnitus management, only a minority of tinnitus patients (24 of the 937 surveyed) ever get to meet a psychologist.’

A tinnitus sufferer’s despair can at least be mitigated by the provision of psychological tools which might alleviate the discomfort. These tools are not ‘drinking less caffeine’ (there is no significant scientific evidence supporting this supposed link) or ‘listening to music before you go to bed’ (no, I can’t bloody well ‘take my mind off it’). The British Tinnitus Association recommends mindfulness-based therapies: ‘Rather than expending energy on trying to get rid of tinnitus, we can learn to allow it to be present, and this can lead to a new and less negative relationship to the noises.’ This is echoed by Baguley, who draws a parallel with the meditation techniques of nada yoga, ‘wherein one meditates on an inner sound, dubbed the “sound of silence”’. I might have to work on repurposing my annoying cellmate into a sonic focus for transcendental thought.

Photo by JD Mason/Unsplash

For now, I just want to know exactly why my tinnitus is there in the first place. ‘I think we’re a lot further forward in terms of our understanding of tinnitus,’ says Nic Wray, Communications Manager at the British Tinnitus Association. ‘Modern technology and scanning techniques have revealed that many parts of the brain appear to be involved in the generation and perception of the sounds of tinnitus, which in turn makes it even more of a challenge to identify causes – and potential cures.’ A recent American study has also discovered that in tinnitus sufferers, a region of the brain called the precuneus, which processes attention focus, is more active, making it harder to, well, ‘take your mind off it’.

Wray agrees that my frustrating experience with the NHS is a common one. ‘I think people in general are more prepared to question the medical profession – increased awareness and the availability of information online is probably driving that. People go to their GP because they want help. GP education is key, and it is happening, and we want to hear stories like this happen less and less.’

I am at an impasse with my tinnitus, a ceasefire of sorts; I acknowledge it, accept it, engage with it at times. During a busy working day it fades into the background, like the bass note of a perfume, but if I wake suddenly from an intense dream (the curse and blessing of writers everywhere) it will scream at me until dawn like a furious infant, demanding attention (what does it want?) and making further sleep impossible. I have come to understand that the next small step back to sanity is not necessarily further reconciliation with the tinnitus itself, but to mourn instead the silence that I have lost forever. In an interview with Vice about his own tinnitus, Losers instrumentalist Tom Bellamy laments, ‘I fucking loved silence. Silence really was golden. These days I find it hard to believe it ever existed.’

The actor William Shatner (and, incidentally, the late Leonard Nimoy) developed tinnitus after an explosion on the Star Trek set. Interviewed by howsyourhearing.org, Shatner describes the immediate aftermath. ‘I went to the House Ear Institute early on, and spent time with Dr House, the old man, and we had tears rolling out of our eyes because he too suffered from tinnitus,’ he says. ‘Our tears were tears of loss, because we realised that we would never hear a silent night again or hear the crickets alone … The panic of feeling that “I can’t do anything about it,” and realising that the only time that I will ever hear silence is when I die. That is a sign of your own mortality, really. You’re constantly reminded of the fact that this illness has no cure.’

And that’s what it is like. As Joni sang: ‘Don’t it always seem to go, that you don’t know what you’ve got ’til it’s gone…’

I’m not angry with my tinnitus. I’m heartbroken over the loss of silence. And like all heartbreak, perhaps that wound will eventually close, and I should just try to make some use of it, bleed from it a few drops of creative succour.

‘…The whole place silent and still

except you bring in the tic of cooling timbers, and then the birds in flight.

Now chains through gravel. Make of it what you will.’

The British Tinnitus Association can be reached through their website at www.tinnitus.org.uk