$$ Does Tinnitus Always Get Worse

Does Tinnitus Always Get Worse

A Cure for Tinnitus

Tinnitus is associated with hearing loss that itself results from harm to the cochlea, and more specifically to the organ of Corti.

This organ is an epithelium that contains the sensory hair cells needed for hearing, and losing hair cells results in a reduction in hearing. Missing out on hair cells are also thought to set up a persistent imbalance inside the cochlea that can be interpreted by the brain as sound even when no auditory signal is found in the environment. This, in fact, is the definition of tinnitus: hearing a solid that has no additional auditory source.

Needless to say, it is not as simple as that. Not everyone with hearing difficulties 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 the ears have more subtle injury to one or more restricted parts of the cochlea that are not tested by a common audiogram. In such cases, tinnitus could be due to damage to frequencies above 8,000 Hz, that happen to be not routinely examined, or �microlesions� in small areas of the sensory epithelium, in the middle those that encode standard 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. If the numbers of patients in each treatment group are large enough, 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.

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