While running his team over the 400 miles of the John Beargrease Sled Dog Marathons, Cliff Wang would go days without sleep. If he appeared a bit punchy, he had the coolest excuse in the world.
But when a persistent noise began filling his head and kept him from sleeping for nights on end, he found that it's more difficult to explain "why you're a little nutty." Wang, 51, had developed a severe case of tinnitus, what most of us know as "ringing in the ears."
More than 50 million Americans experience tinnitus on some level, with about 12 million needing some medical attention. For about 2 million of them, the incessant noise sabotages normal life. The range of treatments reflects the individuality of the malady, as well as its resistance to a cure. Surgery, vitamins, drugs, biofeedback, masking, lasers -- the list is long. Many sufferers are told to learn to get used to it.
Among the newest treatments for tinnitus is neuromonics, which aims to help a patient live with it. The premise is to change the brain's habitual response to sound by desensitizing it to the annoying noise. For Wang, of Edina, the neuromonics treatment enabled him to live with the sound he describes as "a splitting sea noise." "We have four kids and I just wasn't functional," he said. "I still have tinnitus, but it doesn't have a hold on me anymore."
Neuromonics isn't a cure, but a means of coping, said Paula Schwartz, an audiologist at Audiology Concepts in Edina who treated Wang. The treatment is a six-month process of special music that retrains the brain's limbic system, which is what manages our "fight or flight" response, she said. Instead of fleeing the noise, the brain learns how to co-exist with the sound.
Results from the most recent of several clinical trials on neuromonics were published last year in Ear & Hearing, the journal of the American Auditory Society. It found that nine in 10 patients reported at least a 40 percent improvement in how the tinnitus disturbed them. After six months, eight in 10 reported a level that was no longer clinically significant. Researchers concluded that the neuromonics treatment "provides rapid and profound improvements to the severity of tinnitus symptoms and their effect on the subject's quality of life."
Relief comes at a price. The six-month regimen, with counseling, costs around $5,500, and medical plans vary in their willingness to cover the expense. The neuromonics program also is offered by Park Nicollet clinics, Allina clinics in Northfield and Faribault, and Hearing Associates Inc. in Duluth.
Dogs and mowers
Since 2006, Wang had been aware of a growing noise in his head related to hearing loss, but it wasn't bothersome until May 2007. Like many people, he took his ears for granted. An artist, he knows he spent long hours banging on metal. A dogsledder, he knows that working with dozens of yelping dogs -- he won the 2001 and 2003 Beargrease races and ran the Iditarod in 2004 -- couldn't have helped.
Suddenly he could no longer go to movies, listen to music, drive, even converse. "You start avoiding noise, which takes you in a whole different direction," Wang said. "I was scared to mow the lawn, scared of the sound as well as the vibration."
Our brain hears sounds all the time and prioritizes them. The wind or a fan may be deemed unimportant, while a siren is reason to be alert. "If a sound has no meaning, it gets filtered out," Schwartz said. "If we attach emotion -- particularly fear or danger -- to a sound, we can't ignore it."
The problem occurs when the brain can no longer ignore a sound that has no meaning. In laymen's terms, Wang said, "Our system goes, 'Crap, what is this?'"
Schwartz said the desensitizing treatment, developed in Australia, uses an FDA-approved device similar to an MP3 player. Specially designed music calibrated to the individual patient mimics a resting heart rate and masks the disturbing noise. Patients listen two to four hours a day for the first two months, the goal being to gain a degree of relief and relaxation, she said.
Once the brain has been conditioned to relax with this music, the masking is reduced, which allows the tinnitus to be heard, exposing the patient to a mix of both sounds. Schwartz said that over the following four months -- the time it takes to lock in a response -- the brain learns how to acknowledge the tinnitus, yet remain calm because of its learned response to the accompanying music.
As Wang said: "It's like the sound is no longer from your ear in, but from your brain out."
Wang probably will never run sled dogs again, and his artistry more often is bent toward his wife's jewelry design business. But changing his life is worth being able to cope with his life. He never strays far from his audio player, but only listens on an as-needed basis. He carries earplugs with him at all times, and is confounded at the volume at which movies are screened. "What are parents thinking, not having their kids wear earplugs?"
From an audiologist's standpoint, Schwartz wishes people would be more protective of their hearing, and is waiting to see the fallout from incessant iPod listening. "Noise is noise," she said, "whether it's World War II or music."
To hear some examples of what tinnitus sounds like, go to www.neuromonics.com/patient/treatment/index.aspx?id=50
Kim Ode • 612-673-7185