Doctor's Review: Medicine on the Move

August 21, 2017
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Auditory assault

For centuries, most doctors inflicted more injury on tinnitus sufferers than anything else

Few disorders in the history of human health can claim the dubious distinction of being one of the most widespread yet also one of the most overlooked, but tinnitus fits the bill. Depending on the degree of severity, tinnitus can range from an occasional buzzing in the ears to an incessant, lifelong auditory assault. Indeed, the harrowing experience of hearing loud, screeching or ringing sounds that usually have no external source has been enough to drive many people to depression, madness and even suicide.

Tinnitus is so common that virtually all Canadian physicians have had some experience with it. Patients have described the sounds they hear as ranging from buzzing, ringing and roaring to chirping, clicking, hissing, or even booming and thumping. The Canadian Hearing Society reports an incidence of somewhere between two and 20 percent, while the Tinnitus Association of Canada estimates that at least 360,000 people live with tinnitus, with a full 150,000 experiencing the affliction so severely that it disrupts their daily lives. South of the border, some estimates maintain that as many as 50 million patients suffer in what they only wish was silence.

While today we recognize that tinnitus is a legitimate medical concern affecting millions worldwide, the disorder's dark past led many doctors to inflict far more harm on their patients than good, especially when superstition led many to believe that the devil was deliberately at work within the ears of those suffering from the chronic condition.

SOUNDS LIKE ANCIENT EGYPT

Tinnitus is so prevalent that it has probably been around for as long as we've had ears. The term itself is taken from the Latin tinnere, meaning to "ring" or "tinkle." The Ebers Papyrus, not surprisingly, provides the first known account of such things, dating back to around 2500 BCE. For those unfortunate Ancient Egyptians who found themselves with "bewitched ears," the treatments were often worse than the disease. Using a hollow reed, physicians attempted to pour pretty much everything into the hapless sufferer's ear canal, including plain old dirt, oils, herbal concoctions, frankincense and even sap. Recovering must have been a sticky process indeed.

Ancient Assyrian clay tablets from around the beginning of the Common Era reveal that pharmacists had a relatively complex way of classifying the aural problem. Depending on whether or not an individual had the "whispering," "singing" or "speaking" variety, different chants were employed to fight the problem.

The early Greeks and Romans tried to figure out the cause of the problem and applied their cures accordingly. Since those oh-so-troublesome bad humours -- humo-rism was the belief that the body was composed of four humours and that all disabilities and diseases resulted from an deficit or excess of one of them -- were often found to be the culprit, traditional expectorants and treatments were used. These included breath-holding, gar-g-ling and massage. If those stubborn humours refused to leave the body, cucumber or radish juice or even honey and vinegar might be poured into the ear canal. Hippocrates and Aristotle, however, both employed a modern technique to treat tinnitus: mask--ing. By using louder sounds to drown out the ringing, some ancient sufferers presumably found relief.

YEAST INFLECTION


The next millennia offered few improvements. The Welsh liked to stuff freshly baked bread into ear canals to promote a good sweat. The barber surgeons of the Renaissance period had a neat fix too -- they poked a hole in the mastoid to release the trapped wind that was blamed for tinnitus. Undoubtedly an unpleasant process all around, but the desperation inspired by tinnitus led many to seek whatever cure was said to help, no matter how unlikely or painful.

A French doctor named Jean Marc Gaspard Itard (1774-1838) was the first to approach the problem in a scientific manner. He worked with many deaf patients and documented various cases of tinnitus. He acknowledged that in some cases, real sounds were to blame -- increased blood flow, the sound of one's own heart beating or muscle spasms causing clicking -- and differentiated between subjective (only heard by the patient) and objective (heard by the patient and examiner) types of tinnitus. Just as the Ancient Greeks had, Itard used masking to provide relief. Itard, however, was probably best known for being the first to describe Tourette Syndrome and for his failed attempt to rehabilitate, educate and teach language to Victor of Aveyron, the famous feral child discovered in the woods near Toulouse in 1797.

Accounts of tinnitus continued as the centuries progressed. In the early 1800s, perhaps the most famous sufferer was Ludwig van Beethoven. Beethoven be-gan to lose his hearing when he was only 27 years old. He kept his condition very private, but in 1801, he admitted the following in a letter: "My ears whistle and buzz continuously day and night. I can say I am living a wretched life." What started out as hyperacusis and tinnitus worsened into progressive deafness. Like most sufferers, he managed to find ways to deal with the irritation and continued composing music until even after his hearing was completely gone.

The great composer wasn't alone, though the condition was perhaps the most cruel punishment to him. Charles Darwin suffered from it, as did Jean-Jacques Rousseau and Michelangelo, who eloquently described his affliction as such: "a spider's web is hidden in one ear, and in the other, a cricket sings throughout the night."

MÉNIÈRE'S OR SELF-MUTILATION?


For some, it may have even driven them to madness; several historians and physicians speculate that Van Gogh's self-described "auditory hallucinations" were possibly the result of Ménière's Disease -- one of the known causes of the tinnitus -- and that they were responsible for a certain infamous ear-lopping incident. The radical 16th century theologian Martin Luther was also a Ménière's sufferer and was well-known for being short tempered and contrary as a result of his symptoms.

Another more recent chapter of note in the history of tinnitus occurred on a TV soundstage in 1967. Our very own native son William Shatner was filming a Star Trek scene for the episode entitled "Arena." The special effects crew had rigged an explosion and Captain Kirk was standing a little too close to the charge. The resulting incident would leave him with severe tinnitus -- a condition, which, he admits, caused him severe depression at times. Shatner is perhaps one of the most famous modern sufferers of tinni-tus as well as its top spokesperson for research and treatment, but he's not the only one: Bono, Barbara Streisand, Neil Young, Pete Townshend and many other musicians and public figures know the agony it can cause.

Today, tinnitus is said to be the number-one disability reported by Iraqi war veterans, making it a very modern medical problem. The debate as to what causes it rages on, but some known causes are hearing loss, head trauma, noise exposure, impacted wax, infection, tumours, stress and some medications including aspirin in very high doses.

Treatment options, while markedly better than they were in centuries past, still cannot offer a cure, except in cases with a physiological source. Sometimes, surgery is effective. Antidepressants are also known to work in some patients. Implants that drown out the tinnitus sounds with white noise may also help, though many sufferers are left with no choice but to either live with their irritating ears or undergo a sort of re-training process whose effects can be measured in the degree of reduction of symptoms, rather than the elimination of them. In any case, it's certainly better than an earful of boiling oil.

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