My Tinnitus Is Making Me Crazy
Relief from Tinnitus
Tinnitus is associated with hearing loss that itself results from damage to the cochlea, plus more specifically to the body organ of Corti.
This organ is an epithelium that contains the sensory hair cells necessary for hearing, and the loss of hair cells results in a reduction in hearing. Lacking hair cells will also be thought to set up a persistent imbalance in the cochlea that can be interpreted by the brain as sound even when no auditory signal is present in the environment. This, in fact, is the concise explanation of tinnitus: hearing a sound that has no additional auditory source.
Naturally, it is not as simple as that. Not everyone with hearing loss has tinnitus, for reasons that are unclear.
In addition, not everyone with tinnitus has an unnatural audiogram. In these cases, it is actually thought that individuals who have audiologically normal hearing but who suffer from ringing in ears have more subtle harm to one or more restricted regions of the cochlea that are not tested by a normal audiogram. In such cases, tinnitus could be due to harm 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 regular 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 Tinnitus
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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