Editor’s Note: Welcome to the third installment in our month-long exploration of listening in observation of World Listening Day on July 18, 2012.  For the full introduction to the series click here.  To peep the previous posts, click here. Otherwise, prepare yourself to listen carefully as Mack Hagood contemplates how sound studies scholars can help tinnitus sufferers (and vice versa).  –JSA

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One January morning in 2006, Joel Styzens woke up and life sounded different. Superimposed over the quiet ambience of his Chicago apartment was a cluster of sounds: pure, high-pitched tones like those of a hearing test. Loud, steady, and constant, they weren’t going away.  He walked to the bathroom to wash his face. “As soon as I turned on the water on the faucet,” he told me in an interview, “the left ear was crackling… like, a speaker, you know, being overdriven.” Joel was 24 and a professional musician, someone who made his living through focused and detailed listening.

As days passed, he grew more fearful and depressed. For two months, he barely left the house. The air brakes of a city bus or a honking horn were painful and caused his heart to race. His sense of himself, his environment, and his identity as a musician were all undermined. This man who lived through his ears now faced the prospect of a life of tinnitus (ringing or other “phantom sounds”) and its frequent companion, hyperacusis (sound sensitivity sometimes accompanied by distortion). Joel could even identify the dominant pitch of his torment: it was A sharp.

We humanistic and qualitative sound scholars—particularly those of us focused on media and technology—can learn a lot from listening to tinnitus and the people who have it. Scholars of science and technology studies (STS) often utilize moments of technological breakdown to reveal the processes and mechanisms that constitute things we take for granted. Tinnitus and hyperacusis are, in the words of anthropologist Stefan Helmreich, “moments when hearing and listening break down” (629). Because sound scholars understand sound, hearing, and listening not only as the material effects of physics and physiology, but also as culturally and technologically emergent phenomena, we can potentially contribute much to the growing public conversation around tinnitus.

“Tinnitus” by Merrick Brown

And there is a lot at stake. Tinnitus affects 10-15% of adults and is the top service-related disability affecting U.S. veterans returning from Iraq and Afghanistan. Tinnitus and hyperacusis are also fairly common among musicians who work in loud performance and media production environments. It is perhaps ironic, then, that mediated sound and music are audiologists’ primary tools in helping people recover from these conditions.

My own study of tinnitus centers on its articulation with audio-spatial media—devices such as bedside sound machines, white noise generators, and noise-canceling headphones, all used to fabricate a desired sense of space through sound. People with tinnitus are among the most avid users of these devices, carefully mediating their aural-spatial relations as tinnitus becomes more evident in quiet spaces and hyperacusis flares up in noisy ones. During my fieldwork in audiology clinics and conferences, tinnitus support groups, and online forums, I observed that audio media were being deployed as medicine and technologies of self-care. Gradually, I came to the realization that the experience, discourse, and treatment of tinnitus is always bound up in mediation. In fact, I believe that tinnitus signals the highly mediated nature of our most intimate perceptions of sound and self. Below, I sketch just a few of the places I think aural media scholarship could go in conversation with tinnitus and hyperacusis.

The sound of media aftermath

Hearing experts do not consider subjective tinnitus to be a disease, but rather a condition in which individuals experience the normal, random neuronal firing of their auditory system as sound. Although it may be tied to various diseases and disorders, tinnitus itself is benign and does not inherently signal progressive hearing loss nor any other malignant condition.

Image by Flickr User Phil Edmonds

Nevertheless, research shows a frequent association between tinnitus and reduced auditory input, comparable to a sound engineer turning up the volume on a weak signal and thus amplifying the mixing board’s inherent noise. This “automatic gain control” theory neatly explains a classic 1953 study, in which 94 percent of “normal hearing” people experienced tinnitus in the dead silence of an anechoic chamber. Unfortunately, it also helps confirm the fear that the ringing heard after a night of loud music is due to hearing loss, known clinically as “temporary threshold shift.”

As Joel’s case suggests, when repeated, such threshold shifts lead to permanent damage. Audiologists increasingly see media-induced hearing loss and tinnitus as an epidemic, with ubiquitous earbuds often positioned as the main culprits. I have heard clinicians express dismay at encountering more young people with “old ears” in their offices, and youth education programs are beginning to proliferate. These apparent relations between aural pleasure and self-harm are an intriguing and socially significant area for sound and media scholarship, but they should also be considered within the context of moral panics that have historically accompanied the emergence of new media.

Objectifying phantom sound

For both clinicians and sufferers, one of the most frustrating and confounding aspects of tinnitus is how hard it is to objectify, either as a subject of research and treatment or as a condition worthy of empathy and activism. For both clinicians and sufferers, media are the primary tools for converting tinnitus into a manageable object.

Media marketed to protect musicians against Tinnitus, Image by Flickr User Jochen Wolters

Although media scholars haven’t yet studied it as such, the audiologist’s clinic is a center of media production and consumer electronics retail. Having audio production experience, I felt a sense of recognition on seeing the mixer-like audiometer in the control room of Joel’s audiologist, Jill Meltzer, separated by a pane of glass from the soundproofed booth where her patients sit. It was a studio where Meltzer recorded hearing rather than sound, as she attempted the tricky work of matching the pitch, volume, and sensitivity levels of tinnitus and hyperacusis. Since medication and surgery are not effective treatment options, the remedies for sale are media prosthetics and palliatives such as wearable sound generators, “fractal tone” hearing aids, Neuromonics, and sound machines that help distract, calm, and habituate patients to the ringing. Meltzer and other clinicians consistently told me that they have only two tinnitus tools at their disposal—counseling and sound.

Audiometer and testing booth, Image by the author

The subjectivity of tinnitus is most frustrating for sufferers, however, who often encounter impatience and misunderstanding from family, friends, bosses, and even their doctors. Again, media serve to externalize and objectify the sound. Joel did this through music: “A Sharp,” Styzens’ first post-tinnitus composition, represents tinnitus with chordal dissonance and hyperacusis with a powerful change of dynamics on a guitar. He eventually recorded an entire album that explored his condition and raised awareness.

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Other individuals, in an attempt to communicate the aural experience that drives their sleeplessness, depression, anxiety, or lack of concentration, create YouTube videos designed to recreate the subjective experience of tinnitus.

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The American Tinnitus Association, an advocacy group, has used broadcast and social media to raise awareness and research funding, as we see in this PSA from 1985.

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However, such dramatic uses of media may be in some ways too powerful. In fact, “raising awareness of tinnitus” might be as bad as it literally sounds.

Communicable dis-ease

In the process of externalizing their experience for others to hear, people with tinnitus can make their own perception of the sound grow stronger. They may also generate anxiety in others, encouraging them to notice and problematize their own, previously benign tinnitus.

Neuroscientist Pawel Jastreboff’s groundbreaking and influential neurophysiological model of tinnitus postulates that tinnitus becomes bothersome only when the auditory cortex forms networks with other areas in the brain, resulting in a vicious circle of increasing perception and fear. The implication of this model, now substantiated by clinical research, is that the way people think about tinnitus is a much greater predictor of suffering than the perceived volume of the sound. As Jastreboff told me in an interview, “Incorrect information can induce bothersome tinnitus.” Information, of course, circulates through media. It may be productive, then, to think of tinnitus suffering as a communicable dis-ease, one strengthened in circulation through networks of neurons, discourse, and media.

I think there is both a need and an opportunity in tinnitus for an applied sound studies, one that intervenes in this mediated public discourse, works against moral panic and hyperawareness, and suggests the quieting possibilities that open up when we grasp the constructed nature of our aurality. Listening to tinnitus as a networked coproduction highlights the ways in which our most subjective aural perceptions are also social, cultural, and mediated—perhaps the fundamental insight of sound studies. My hope is that by listening to tinnitus we can speak to it as well.

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*Featured Image Credit: A representation of Tinnitus by Flickr User Jason Rogers, called “Day 642/365–Myself is against me”