The Effect of Silence on Tinnitus Perception By: DENISE

OBJECTIVE: The effect of sustained silence was studied on the emergence of tinnitus perception in 120 normal hearing young adult Caucasians and African Americans. STUDY DESIGN AND SETTING: After sitting in a sound booth for a period of 20 minutes, participants were asked to complete a questionnaire documenting whether they perceived sounds in the silent setting and descriptions of the sounds they heard. RESULTS: Tinnitus-like sounds were perceived in 64% of listeners overall. No significant differences in tinnitus perception were observed between males and females. However, there was a significant difference in tinnitus perception between Caucasian and African American subjects, with tinnitus sounds emerging in sustained silence less frequently in African American listeners. Tinnitus emerged quickly in a majority of subjects (less than 4 minutes) and African American subjects who perceived tinnitus heard a greater number of individual tinnitus-like sounds than did Caucasian subjects. Ring (57%), buzz (21 %), pulse (22%), heartbeat (21 %), and hum (14%) were the most common sounds heard, with ring being the most common overall tinnitus perception. CONCLUSIONS AND SIGNIFICANCE: Few investigators have documented at the emergence of tinnitus in normal hearing subjects. Results of the current study found significant differences in tinnitus perception between Caucasian and African American subjects, but found no significant differences when comparing males and female subjects. EBM rating: C. (Otolaryngol Head Neck Surg 2005;132:20-4.) Article: For many people, tinnitus (ringing in the ear) is a common and fleeting experience. However, for more than 12 million Americans, the experience is a chronic condition that can severely impact the quality of life. 1,2 The debilitating effects of chronic tinnitus can include significant sleep disorder, anxiety, and depression. 3-5 Although the exact cause of tinnitus is not known, researchers point to mechanisms in both the auditory periphery 6,7 and the central auditory system. 8 To date, there is no medical cure for tinnitus. However, patients suffering with severe tinnitus can find relief and comfort from their symptoms through tinnitus management protocols. One of the more effective tinnitus management programs currently being utilized by audiologists and hearing specialists is Tinnitus Retraining Therapy (TRT), which employs a combination of audiologic testing, directive counseling, and the use of sound therapy to treat tinnitus patients. 9,10 A core principle of the TRT program is the recommendation to avoid silence. This recommendation is given to tinnitus patients for two reasons. First, the presence of sustained silence may have a direct effect on the functioning and neuronal organization of the central auditory nervous system. This phenomenon may be evidenced in the significant and sometimes rapid and reversible changes observed in the auditory system resulting from sensory deprivation due to conductive and/or sensory hearing loss. 7,11-13 Secondly, the perception of tinnitus is increased in silence as a result of the lack of any other environmental masking sound. In fact, it is widely believed that most normalhearing individuals, when placed in silence for a period of time, will begin to hear tinnitus. 14 Few studies have further examined the general effect of silence on the perception of tinnitus in normal listeners since the original Heller and Bergman study. Additionally, the Heller and Bergman study did not specifically sort out the effects of race and gender on tinnitus perception. Cooper, 15 in reviewing the Health and Nutrition Examination Survey of 1971-1975, reported that bothersome tinnitus did vary due to race and gender, with tinnitus being worse in African Americans. However, it has been our personal observation that tinnitus patients coming to our UNCG Tinnitus Clinic for Tinnitus Retraining Therapy have been predominantly Caucasian. The purpose of the present study is to further investigate the effect of silence on the perception of tinnitus in normal hearing young adults and to control for the variables of race and gender. We hypothesized there would be significant differences in tinnitus perception due to race and gender.