Does Tinnitus Hurt
Relief from Tinnitus
Tinnitus is associated with hearing loss that itself results from problems for the cochlea, plus more specifically to the organ of Corti.
This organ is an epithelium that contains the sensory hair cells needed for hearing, and the loss of hair cells leads to a reduction in hearing. Absent hair cells may also be thought to set up a persistent imbalance inside 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 concise explanation of tinnitus: hearing a sound that has no exterior auditory source.
Obviously, 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 really is 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 areas of the cochlea that are not tested by a standard audiogram. In such cases, tinnitus could be due to problems for frequencies above 8,000 Hz, which can be not routinely analyzed, or �microlesions� in small areas of the sensory epithelium, somewhere between those that encode common audiometric frequencies.
This naturally leads to the question if damage to the hair cells in the organ of Corti is associated with tinnitus: If the organ were repaired, would the associated tinnitus be cured or improved? 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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