Grace Mezak can’t remember when she last experienced silence. She often asks people to describe it to her, which she’s learnt is a challenging request. Mezak’s “obsession with silence” began in her final year of high school, when her grandmother was diagnosed with tinnitus.
“That’s how I found out not everybody has ringing in their ears,” she says.
At first, Mezak thought she had “done something wrong”. As a professional musician she had always keenly protected her ears.
“I didn’t play music loudly and used earplugs at concerts. I felt like I had let myself down and felt really guilty,” she says. “To find out that it’s actually my brain doing it made me feel a lot better.”
According to Myriam Westcott, an audiologist and tinnitus therapist based in Melbourne, about 15 per cent of the population are aware of constant tinnitus. “People can hear it as a humming or ringing, whining or whistling, all sorts of stuff.”
Westcott explains that while tinnitus is a benign condition, it can significantly affect someone’s life.
“The reaction to tinnitus can be very intense and very destructive,” Westcott says. “People are worried about: What’s it doing? Can I cope with this? Do I have to live with this? I’ve lost silence. There’s something horribly wrong with me.”
There has been a noticeable surge in tinnitus distress during the pandemic, with Tinnitus Australia reporting “a huge increase in the demand for advice” via their social media accounts and telephone helpline. Similarly, the British Tinnitus Association (BTA) has reported an exponential increase in people seeking help, with web chats increasing by 256 per cent from May to December last year, compared with the same period in 2019. This trend has continued this year, with the BTA receiving 47 per cent more phone calls, web chats, emails and texts compared with the previous financial year.
“That’s certainly been our experience at our clinic,” Westcott says. “Our bookings have gone up over the whole pandemic period.”
Tinnitus is often described as a medical enigma. About one in three people will experience it at some point in their lives, most commonly when someone has acquired a loss or change in their hearing. But, as in Mezak’s case, it can sometimes arise spontaneously and without a clear reason as it did for her when she was very young. Until she was 17, she just assumed that ringing was “normal”.
The current hypothesis is the neurophysiological model of tinnitus, which suggests that the body’s central nervous system is generating the noise. Westcott describes tinnitus as emerging from “quite low down in the brain”.
“Our hearing is such a unique sense. It is very much tied up, in a sort of primaeval way, with warning us of danger,” she says. “Every sound that we’re capable of hearing, which is a lot of sounds, scoots straight through the ear and up to the brain. The brain is literally being deluged with auditory information.”
The brain subconsciously evaluates and filters out unimportant sounds. Important sounds, which may include tinnitus, are highlighted in prominence and volume then are “sent up to a part of the brain where you notice it”.
Brain scans conducted in silence have demonstrated that the auditory cortex is activated in people with tinnitus – the brain appears to be listening to itself ringing, humming, whistling or droning.
“For most people, even if it might have been initially causing distress, over time they will spontaneously habituate to the tinnitus,” Westcott says. “The tinnitus gets judged subconsciously as a boring sound, like any other boring sound.”
Westcott is quick to point out that this doesn’t mean that the tinnitus goes away. She explains that neuroscientists have not found “the switch” to turn off the sound. Even if someone adjusts to the sounds, it isn’t necessarily a permanent state.
“It’s a dynamic process and people can achieve a satisfactory level of habituation. Then there might be some sort of trigger that puts them back a few steps,” she says.
“Tinnitus is notoriously reactive to stress, anxiety, fatigue. For a lot of people, there’s a lot of anxiety about feeling unsafe. The part of the brain that is subconsciously involved in us needing to be safe in our environment is under threat with the pandemic.”
Mezak has noticed that her tinnitus has changed over the past 18 months.
“I’ve found that it’s gotten worse because I’m not around people,” she says. “I’ve been spending more time alone, which is more difficult. It’s all I can hear. It sort of blocks everything else out.”
Like every person I talk to about tinnitus, she stops the conversation short and attempts to replicate the sound. “It’s like that,” she says. “Only higher, more like a dog whistle.”
Later she compares it to the “buzzing of music speakers, you know when you unplug the cord?” as well as an “anti-theft device”.
In 2020, the British Tinnitus Association conducted a survey asking people to describe what they heard in their heads. The descriptions are startlingly specific, as if each person with tinnitus had devoted serious thought to finding the closest real-world comparison: someone vacuuming above your flat; a finger run around the top of a wine glass; the dialling tone of a fax machine; baby birds tweeting in a nest; the sound you hear in psychological thrillers when something very bad is about to happen; pipes singing in an older house after you’ve run a bath.
“It’s a bit like cicadas in the summertime,” Patricia Bromley says when describing her tinnitus to me. “I’ve always got to have something – some music or the radio – to help me ignore it.”
Bromley’s tinnitus started 12 months ago at the end of a busy semester teaching neonatal intensive care nursing online. One evening while watching television she noticed a ringing in her ears. “When you’re a nurse you always think it’s the worst thing, like you’ve got a tumour!”
Bromley went to her GP and then an audiologist. She says that speaking to the audiologist helped her develop management strategies, including playing audio books when she goes to bed each night. “I don’t listen to it. It’s just some noise to override the ringing in the ears.”
Dr Jessica Vitkovic, an audiologist, believes that seeking help and getting the right advice is important for managing distressing tinnitus. She explains that audiologists are well placed to become “almost the case manager” for people with tinnitus.
“They will thoroughly investigate, listen and validate the person’s experiences. They will look at a rehabilitation plan and refer out to other health professionals who might be relevant, such as a psychologist or physiotherapist.”
Vitkovic has been fielding some of the calls through the Tinnitus Australia helpline. “We’re seeing that people are wanting to know more about why their symptoms have increased during the pandemic,” she says. “When they are on the phone with you, they just want to know that somebody gets it. You can almost hear the relief – ‘It happens, you’re not going crazy.’ And ‘there is something you can do’ is a relief in itself.”
This article was first published in the print edition of The Saturday Paper on October 16, 2021 as "Losing silence".
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