A constable was standing in the car-park at the police station where he worked when a roof slate fell on his head. At that moment he became one of the average of 200 people who experience the onset of tinnitus each day. The same fate awaited a youth when kicked in the neck in a rugby scrum. A thirty-year-old mother driving to school to collect her child was involved in a slight accident. She found that the whiplash effect caused by the collision brought with it a mixture of head sounds.
Most people, however, cannot point to a specific incident, but can usually say on what day - perhaps the hour and minute - it began. This exposes a paradox, that although tinnitus still insists on being an enigma wrapped in a mystery, it announces its attachment to an individual unequivocally and with a timing and precision lacking in most other medical conditions - making finding a tinnitus treatment even more difficult.
This distinction would probably remain merely academic were it not for the fact that knowing the tinnitus causes of when and in what circumstances it started can have a bearing on useful treatment. The policeman, for example, could have sustained a slight fracture of the skull, with the tinnitus serving some purpose in revealing the whole picture of the injury. The rugby player and the motorist could have sustained disruption of the neck or shoulder, and treatment for these injuries could well reduce the consequent tinnitus. Anyone new to tinnitus should try to recall any injury, however slight, before the noises commenced and mention the possible connection when seeing a doctor. But treatable physical injury associated with head noise accounts for only a small fraction of reported cases.
The trigger can be a surge of music at a pop concert, well above the decibel safety level, an explosion, a burst of gunfire, or surgery conducted on the ear or close to it. The list is a long one and has never been fully written. Even so it is of more anecdotal than scientific value to be able to pin-point the circumstances when the internal sounds began. It does not, for all its precise timing, help to reveal exactly what happened to the ears and the brain when excessive sounds lasting perhaps seconds left behind them other sounds for life. Did the sonic impact shake the nerves between the ears and the brain so badly that the hearing system was left incapable of accurately conducting messages for conscious, aural perception? Even to ask that is to speculate more than explain. At the same time, it does help some people to know of a link between, say, a blow or a loud bang and their tinnitus. It goes some way to rationalize the baffling business and to anchor their problem in a single explicable event that may have caused it, however mysteriously.
There is a list of things it is well to avoid, from discos and pop concerts to firing-ranges, if no ear protection is worn. One day, taking care of the ears and the dangers of exposing them to excessive noise will be included in health education.
There are many internal sounds without a causal link, however superficial. 'I woke up one day and it had just started' or 'I was sitting quietly reading a book when I heard what I thought were plumbing noises from the next room' are the sort of statements a family doctor hears in the surgery. They vastly out-number stories of kicks, accidents or big bangs. In a perverse way, it could be said that these totally unexplained beginnings of tinnitus correspond most accurately to the totally perplexing nature of the condition itself.
It is to some extent age related. A seventy-year-old stands a greater chance of getting it than a seventeen-year-old. There has been a tendency among some doctors to point to another mystery, the ageing process of the body, and say patients should accept tinnitus as easily and naturally as they accept growing old - fortunately there's a few tinnitus remedies that don't follow that pattern. When pressed to explain the spread of tinnitus through the age groups, they are tempted to round off their theory by saying that parts of the body can age prematurely. If it is possible for a man to be bald at thirty, why not tinnitus thirty or forty years earlier than one could reasonably expect it? The reasoning is rather threadbare, and at best supplies only a part of the answer.
If a physical, external blow can disturb the ear-brain mechanism and bring on tinnitus, can a psychological condition start it in the brain, causing equal disturbance? Can the power of thoughts troubled by distress and anxiety, for instance, shatter internal silence just as external blows or sounds can, from the other direction?
The burden of personal worry, if not somehow released through the sharing of it with others, or diminished by a third party such as a skilled therapist, can bring about physical illness and malfunction of the metabolism. The mind dictates to an extent the course of health, and manifests its power in ways that illustrate persuasively the unique and abiding oneness of mind and body. Research into tinnitus underlines the importance of the brain in the false and disruptive perception of sound that has no external source. It also seems that a mind plagued with anguish, probably unexpressed by the sufferer, is capable of originating the din that no one else can hear.
