Loud Noise Hearing Loss
A Cure for Tinnitus
Tinnitus is associated with hearing loss that itself results from problems for the cochlea, and much more specifically to the organ of Corti.
This organ is an epithelium that contains the sensory hair cells necessary for hearing, and the decline of hair cells leads to a reduction in hearing. Lacking hair cells can also be thought to set up a persistent imbalance within the cochlea that can be construed by the brain as sound even when no auditory signal is there in the environment. This, in fact, is the concept of tinnitus: hearing a sound that has no external auditory source.
Needless to say, it is not as simple as that. Not everyone with loss of hearing has tinnitus, for reasons that are not clear.
In addition, not everyone with tinnitus has an unnatural audiogram. In these cases, it can be thought that individuals who have audiologically normal hearing but who suffer from ringing in the ears have more subtle damage to one or more restricted parts of the cochlea that are not tested by a regular audiogram. In such cases, ringing in the ears could be due to injury to frequencies above 8,000 Hz, that are not routinely tested, or �microlesions� in small areas of the sensory epithelium, in the middle those that encode normal audiometric frequencies.
If damage to the hair cells in the organ of Corti is associated with tinnitus, this naturally leads to the question: Would the associated tinnitus be cured or improved if the organ were repaired? The answer to this is of course unknown. Animal studies are difficult as it is hard to know for sure whether an animal has tinnitus (see �The Importance of Animal Models�). And at present we cannot repair damage to hair cells in humans and so cannot currently conduct clinical trials in humans with tinnitus.
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Drug Therapy for Ringing in the ears
Drugs for tinnitus can be vetted through clinical trials, but the evidence remains thin regarding their efficacy.
Compared with other treatments of tinnitus symptoms, drug therapy-the use of medications or supplements to relieve tinnitus suffering-is easier to test using randomized clinical trials.
A randomized clinical trial (RCT) is an experiment in which patients with a particular condition receive one of two or more treatments, with the choice of treatment determined at random. Those receiving a placebo become the control group. Sometimes, one treatment (often new) is compared with another (often an older or better-established treatment), rather than comparing it to a placebo. In an RCT, neither the patient nor the doctor can decide which treatment a patient will receive, and �double blinding� means neither actually knows. And if the differences in outcome are large enough, it may be possible to conclude with some statistical confidence that one treatment is better than another, if the numbers of patients in each treatment group are large enough.
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