In the age of headphones and portable speakers, silence is rare. For some, though, silence is impossible.

In the United States today, a condition called tinnitus affects 25 percent of the population, and at least 3 million of those affected say they can't function in society as a result. Often described as a ringing or buzzing in the ears, tinnitus is the perception of sound without an external source.

In more severe cases, the ringing is constant and almost impossible to cover up with other noise. It distracts patients from everyday life and can cause anxiety, insomnia, depression and sometimes mental illness.

The most common cause of tinnitus is overexposure to excessively loud sounds. Anything from loud concerts to the subway can permanently damage the parts of the ear responsible for sending chemical signals to the brain, causing incurable and debilitating tinnitus.

Struggling to adjust

For 22-year-old Tina Andersen, tinnitus came from her job as a DJ, which put her in loud clubs and concerts for up to five hours two or three times a month. Though she would hear temporary ringing after a night working, Andersen did not develop chronic tinnitus until October 2013.

“For the first month and a half I couldn't sleep,” Andersen said. “I walked around in the middle of the night because I couldn't stand to be anywhere else, which made me have to give up school for a time.”

Andersen also developed hyperacusis, a condition characterized by over-sensitivity to everyday sounds that is often linked to tinnitus. The American Academy of Otolaryngology estimates that approximately one in every one-thousand tinnitus patients also experiences hyperacusis.

“I wanted to avoid any potentially hurtful sounds, which rendered me oversensitive and afraid of everyday sounds,” Andersen said. “Not being able to walk my dog down a fairly calm street became my reality, resulting in quite an isolation socially and professionally.”

In her work in clubs and bars, Andersen said she saw countless posters and groups spreading information about safe alcohol consumption, as well the dangers of drug use and unprotected sex. But she never saw anything about protecting the ears from loud noises.

“Prior to onset, I knew that tinnitus was a beeping in the ears, but I never thought it could be so bad,” Anderson said. “I followed all the hyped golden guidelines to protecting oneself in the nightlife. I was careful.”

Ear plugs help reduce the risk of noise-induced tinnitus, but in some cases there is no way to expect or protect against it. For Fran Fenton, 21, tinnitus began after a fluid build-up in her ear after a particularly bad head cold.

“I was coughing and had a blocked nose, but I also had some ear pain,” Fenton said. “I thought it was just part of the cold so I didn’t really pay it too much attention. Then one night the ringing started.”

Fenton said at first the worst part was the psychological problems she faced as a result of her tinnitus.

“'T' is awful to deal with,” Fenton said. “You think you are going mad. There is this fear inside you. You think, ‘What if this doesn't get better? What is wrong with me?’ The anxiety was the worst part. I couldn’t eat. Sleep was difficult, too."

The first week was the hardest, Fenton said, but after that her symptoms lessened.

“I am doing a lot better than I was,” she said. “My 'T' annoys me, but to be honest I know it is lower than most people’s. I’m learning to live with the noise.”

More serious cases of tinnitus can be more harmful to daily life. Dan Rowland* has a very serious form of tinnitus, and has constantly heard a sound like a dental drill every day for three years.

“I just woke up one morning and it was there,” Rowland said. “I began losing my sleep, my sanity and with it all my friends, my job, my kids, everything held dear to me and eventually landed in a mental ward, only to find that nobody can help me. I was not crazy like every other patient on the ward, I just had a loud debilitating noise in my head that robbed me of sleep, relaxation, meaningful concentration and most joy in my life.”

Rowland’s tinnitus developed after being exposed to a fire alarm for 10 minutes and then, two months later, going to see a fireworks show.

There are multiple cases of suicide each year by people with tinnitus so intrusive they seek death as a solution.

Irreversible damage

Sound is measured in units called decibels (dB) that are measured on a logarithmic scale.

If a washing machine is 70 dB and an alarm clock is 80 dB, the alarm clock is 10 dB higher and therefore 10 times as loud as the washing machine. The human ear can perceive sounds ranging from 0 dB to 160 dB, though volumes are the far end of the spectrum would instantly burst the eardrum.

Sound enters the ear through the ear canal and then passes through the eardrum, where the pressure waves are translated into physical vibrations. The movement of the eardrum vibrates three bones in the middle ear, which in turn create fluid vibrations. The cochlea, which is the innermost structure in the ear and filled with fluid, reads these vibrations with tiny hair cells that line its inside.

Each hair cell has microscopic cells called stereocilia on its tip, and the fluid vibrations bend these stereocilia, opening the cell and allowing chemicals to flow in. Once inside, the chemicals can reach the auditory nerve, which translates the chemicals into electrical signals that the brain can read.

Excessively loud noises cause the stereocilia to bend too much and snap off from the hair cells. Once broken, they cannot grow back.

Taming a noisy world

Because of the stigma and expectations associated with modern-day nightlife and music, clubs and bars are breeding grounds for tinnitus. Especially for the length of time that concert sets last, the volume at which they are played can be incredibly dangerous.

Rick Earl is the technical director for cultural and special programs at Elon University, but before Elon he worked as a sound technician for several different bands. He was in charge of setting up the band’s equipment at different venues and mixing the instruments on the soundboard. He was also in charge of setting the volume for shows.

“Even though 80 or 90 dB can be dangerous, I would usually mix at 100 because that’s what the artists would ask for,” Earl said. “A certain volume is expected at a rock concert.”

When he toured with bands, Earl said even though he had almost total control over the volume in a room, the audience was responsible for their own personal safety because there are measures they could take to protect themselves.

“It’s my responsibility to some extent that everyone in the room is safe,” Earl said. “But there’s some assumed risk when you go into a rock concert. You can get cheap foam earplugs that cut out 30 dB of sound. That’s a huge amount. Wear them.”

Aside from avoiding loud noises all together, earplugs are the best option for preventing damage to the ears. Though there are expensive, custom-made earplugs available, cheaper disposable foam versions can be equally as effective.

Depending on the density of the earplug and the type of material, earplugs usually block 22 to 32 decibels. Most are designed to let enough frequencies through so that the music is not distorted and the concert-going experience is largely the same – just quieter.

There seems to be a cultural resistance to wearing earplugs at concerts that discourages people from protecting their ears, but as more and more high profile acts develop tinnitus, this may change.

The popular electronic artist Grimes cancelled her tour last year after struggling with tinnitus, and Zach Hill of Death Grips experienced similar issues. Before them, greats like Pete Townshend, Neil Young and Eric Clapton all had tinnitus from their work with loud music.

 

“Pete Townshend, who has a lot of hearing damage now, would have giant amps behind him and giant amps in front of him and no hearing protection,” Earl said. “The Who were once called the loudest band in history. All that noise over years and years is really dangerous.”

Though the volume at concerts is restricted by legal limits in the United States and Europe, the level at which speakers play sound is not. Earl said that speakers would not play the same quality music if they were limited to certain volumes.

“It’s about power. You need more than you use,” Earl said. “There’s no law that stops your car from driving at 144 mph, but it’s still illegal to do. It wouldn't drive the same if it couldn't go faster than 65 mph. You need the option to go faster than that, just like you need the option to play speakers louder than you should.”

Headphones, though, can be just as damaging as professional speakers even though they only have a fraction of the power.

“Headphones play music right next to your ear,” Earl said. “Proximity can be just as dangerous as power.”

There are mobile applications to measure the exact output of your headphones in decibels, but Earl said if you cannot hear a person speaking four feet away from you, your headphones are probably playing music at a dangerous level.

Since the stereocilia on the hair cells can't grow back, there is no real cure for tinnitus, and there is no one treatment that works for all cases. There have, however, been reported successes with certain herbal treatments, cognitive therapy, cochlear implants, sound therapy and prescription drug use.

Since there is no way to make the sound disappear, most treatments focus on masking it, or covering it up with sounds that use the same frequencies as the tinnitus or basic white noise.

The most successful treatments often involve counseling or therapy to help patients cope with the anxiety and depression that is generally associated with chronic tinnitus.

Dr. Jennifer Gans is a clinical psychologist based in San Francisco who specializes in the psychological impact of tinnitus and related conditions. She created an eight-week program that teaches patients mindfulness to reduce the stress associated with tinnitus.

“The top three problems with people with tinnitus are depression, anxiety and sleep loss,” Gans said. “The behavioral changes I’m looking for are in these areas.”

Mindfulness has traditionally been used to treat chronic pain, but Gans’ program works exclusively with tinnitus and hearing-related conditions. The program is based on Gans’ previous work with cognitive behavioral therapy and focuses on teaching patients to live with their tinnitus.

“Studies show more activity in the left prefrontal cortex after our eight week mindfulness program. This part of the brain is associated with a feeling of well being, whereas the right prefrontal cortex is associated with negative emotions.”

Gans said a cure to tinnitus is still far out of reach, but that doesn’t discourage her or her patients.

“There’s no cure yet, but I don’t know if that even matters,” Gans said. “I see my work mostly as healing. There are two kinds of tinnitus: bothersome and non-bothersome. I’m trying to get my patients from one category to the other.”

Gans said that awareness and prevention are key in the fight against tinnitus. The world is loud and it is not always possible to turn the volume down. Earl agreed.

“I tell all the students I work with to wear hearing protection,” Earl said. “You wear close-toed shoes, no flip-flops and earplugs. I've made my living with my ears. I protect them.”

*Editor's Note: Name has been changed to protect the source’s privacy.