One to two million people in the Netherlands have a permanent ringing or noise in their ears. With loud music and the constant use of “in-ear” earbuds, those numbers are only increasing. The damage, suffering and costs of tinnitus are great. But political intervention will not come for now.
Three years ago, I got a ringing in my ear.
In the morning I woke up and a high-pitched, wheezing tone had nestled in my right ear, never to leave there. At first I thought of a neglected cold, then I suspected it was due to stress, and finally my family doctor diagnosed me with tinnitus. I was referred to the audiology center where my hearing was tested. I appeared to hear worse with the right than with the left.
Long story short: I had suffered hearing damage sometime during my sixties and the loss of loudness was compensated by my brain with a piercing beep. A kind of test tone. Hello, hello, are you still there?
When I half-seriously, half-cheerfully mentioned on birthdays that I have tinnitus – always nice to talk about illnesses – it suddenly became apparent that many people around me struggle with high and low beeps, humming tones, buzzing tones, knocking and hammering tones and other noise-causing symptoms. I decided to investigate.
Tinnitus, also known as tinnitus, is a primal ailment. You hear, continuously or intermittently, sounds in your head or ear, sometimes in one ear and sometimes in both. The sounds range from beeping, hissing, buzzing to whistling and knocking, and they do not come from your surroundings. It is phantom sound; it is literally between your ears.
Read more about Tinnitus in the Artists Against Tinnitus FAQ here.
The ailment can have a variety of causes, such as Ménière’s disease, MS, a blow to your ear, concussion, meningitis or a tumor, but most often it is based on hearing damage, due to old age or listening to loud sounds for too long, such as loud music at a concert or noise in the workplace. The cilia in the inner ear get damaged by the noise, your brain has to work extra hard, and overactivity occurs.
Read: ‘Why that beeeeeeep between your ears is so hard to treat’. If that leads to tinnitus, the consequences can be lousy to say the least: difficulty concentrating or sleeping, anxiety and depression, it can affect learning performance and “social participation. In other words, it can make you a more unhappy person.
Tinnitus usually does not manifest itself until your 40s; thus, young people get presented the bill later on. In recent years, however, “the beep in the ear” appears to be on the rise among young people as well. The Hoormij Foundation, which deals with people with hearing disorders such as tinnitus, talks about “a sharp increase among young people,” basing its argument, among other things, on a 2019 study showing that 15 percent of Dutch young people experience a squeak in the ear from time to time.
The use of “in-ear” earbuds is seen as an important factor, so is visiting places with loud music. The duration of the excessive noise level is crucial. That “in-ear” earplugs play an important role is evidenced in part by the fact that even one in seven children between the ages of 9 and 11 has incipient hearing damage.
Worldwide, 50 percent of people between the ages of 12 and 35 are at risk of hearing damage from exposure to unsafe sound levels in “recreational settings”: bar, concert hall, festival and disco, in other words. Worldwide, one in three people now experience tinnitus at some time; some cannot get rid of it, 15 percent need medical attention. Hearing damage – that is, all forms of hearing damage – costs Dutch society 10 billion euros a year.
There is really only one upside to the tinnitus issue: you can often learn to live with it. You’ll have to, by the way.
My generation, Generation X (born roughly between 1965 and 1980), did not experience the war, nor did it drink lemonade with a straw, but grew up with amplified music. In the wild years, she was a resident at pop temples such as Paradiso and the Melkweg, strode festivals such as Pinkpop, North Sea Jazz and Rock Werchter before later switching to house, dance and electro, which in turn included festivals such as Awakenings and ADE. Common denominator: noise!
Somewhere deep down in my memory, a concert by the Einstürzende Neubauten, the Berlin creators of noiserock, still reverberates. It was February 19, 1986 at the Effenaar in Eindhoven, I was working there as a program officer. From behind the bar, we provided earplugs to visitors who, with the knowledge of today, I would call wise; some people preferred full volume, which couldn’t have been less than 120 decibels. I was nauseated by the sound, people were fainting. Ironically, the band itself incorporated the theme of tinnitus, a long squeak, into the song Silence Is Sexy.
Composer Stephen Emmer – he wrote the intro music for NOS News and RTL Boulevard, among others – has had tinnitus for 11 years. Echoing the WHO, he calls tinnitus from hearing damage an “epidemic” and founded Artists Against Tinnitus early this year. The website lists a laundry list of treatments, but there is no single prescription.
‘We, people with tinnitus, are wanderers, looking for a solution. At each stage a certain approach fits: first I tried acupuncture, which helped for a while; then I switched to classical cognitive therapy, then I had myself treated with flowers, herbs and candle wax in my ear. In the end, I benefited most from the practical tips in the book First Aid for Tinnitus.
Read more about that book here.by Dr. Olav Wagenaar.’
‘A lot of advice and therapies assume avoidance or flight behavior, but you have to stare the beast in the mouth. So not setting up a gentle murmuring stream or countermelody, but learning to put things into perspective. Get used to it! I am now completely deaf in one ear, but I still hear that beeping sound; it won’t go away. I’m getting better at thinking: it’s not a lion, it’s a little mouse.
Emmer calls on politicians to intervene, and that is about to happen.
In November 2022, the Health Council sent the results of its study on hearing damage from amplified music to State Secretary Maarten van Ooijen of the Dutch Ministry of Health, Welfare and Sport. The recommendations are loud and clear: the maximum sound level of amplified music should be reduced from 103 to 100 decibels, in conjunction with hearing protection. It doesn’t seem like much, going from 103 to 100 dB, but the decibel scale is logarithmic: 103 dB is twice as loud as 100 dB. About decibels: 103 dB is twice as loud as 100 dB.
The advice echoes that of the World Health Organization (WHO), which predicted in the aforementioned report that hearing problems are exploding worldwide and expects one in four people (now one in five) to have hearing damage by 2050. 700 million people will then need medical treatment, is the forecast. Obviously, these are not all victims of loud, amplified music, nor do they all suffer from tinnitus, but the WHO does make a connection.
It’s actually a fairly mild advice to the secretary of state, since any noise above 80 decibels can already cause harm. A conversation in a crowded pub causes 90 decibels, music on your headphones 95. So in the advisory, the Health Council assumes that people use earplugs that attenuate about 15 decibels, but no one is required to do so.
‘I think it’s ridiculous that 100 dB will still be allowed. An employer must arrange hearing protection for the employee starting at 80 dB, but a concert organizer is strangely not obliged to do so,” says Wil Verschoor, director of Hoormij. ‘The number of people with tinnitus is increasing, but the majority do not go to a doctor and are therefore not registered. In our discussion groups, young people tell us that they have a ringing in their ears after a loud concert; at first the ringing disappears after a few days. But after four concerts the ringing suddenly does not disappear and then they never get rid of it. The panic that arises at such times is enormous; sometimes they wreck their room because at first they don’t realize that the sound is coming from themselves.’
A motion was passed in the House of Representatives last March increasing the pressure on the secretary of state to hurry the noise limitation to 100 dB. Only the PVV, Forum for Democracy and BVNL voted against it.
The motion states unequivocally that “a tidal wave of tinnitus patients” is expected and that the Dutch approach to self-regulation is inadequate. The current covenant also lacks one important party: Royal Dutch Catering Association (KHN). KHN came out in opposition when even more decibels restriction was threatened: it questions the scientific basis and feels that the “experience” of the concert and hospitality visitor disappears if the volume knob has to be turned down.
Composer Stephen Emmer thinks this is nonsense: ‘We have become addicted to hard, harder, loudest. I too have been at the table with the secretary of state; many interest groups like KHN are consulted, whereas this is chefsache and the advice of science should be followed.’ Is that happening? No. Or at least: not yet.
This week, State Secretary Van Ooijen sent a letter to the House of Parliament, on the results of his consultations with stakeholders. Legal limit of 100 decibels? That can lead to unworkable situations, the secretary of state writes. Sometimes people simply clap and cheer too loudly. Little can be done about that, Van Ooijen said.
He further wrote that he is pleased that “Koninklijke Horeca Nederland is investigating how to join the covenant. In other words, KHN is not quite on board yet and there is no agreement on decibels. ‘Such a covenant is nice, but much too non-committal; Het Parool: ‘Cabinet: loud music still not softer in pubs and discotheques’. it should become a law,’ says Wil Verschoor of Hoormij. ‘Abroad, the 100 dB limit has long been regulated by law; there they stick to the WHO guideline.’
Whether the House of Representatives will settle for a polder covenant remains the question. Not for nothing did the March motion state that “if this does not yield sufficient results,” it (i.e., the House, PP) would ask the government “to pass legislation introducing a statutory duty of care for maximum noise standards in the recreational sphere.
Just how fluid the existing agreements are became clear last week when the municipality of Groningen gave permission to the rock band Rammstein to violate noise standards during its upcoming concerts in early July in the Stadspark. The shows do not meet noise standards, producing 103 dB, but the municipality agreed anyway.
RTL News: ‘Volume knob may turn up a bit higher for Rammstein in Groningen’.because ‘Rammstein would otherwise move to another venue’.
How is my tinnitus doing?
The audiology center recommended a hearing aid. The gold-colored worm I was allowed to try out amplifies and produces an almost inaudible counter sound at the same time. A sound masking device. I tested it for a month and it didn’t help. Indeed, I focused even more on the carnival in my ear: beep AND device. Since then, I try to ignore the beep and it helps. Any kind of stress or noise aggravates the symptoms, I know for a fact by now.
Because tinnitus often has no single cause or the cause cannot be traced, stepping into the world of treatment methods is stressful in itself. There is endless experimentation and research, going from psychotherapy to medication. This spring, a new device came on the market in the US: Lenire.
Read more about Lenire here. It delivers electrical impulses to the tongue combined with sound through headphones, training the brain.
The study results are positive, with 79.4 percent of tinnitus patients experiencing a “clinically significant improvement.” There are also caveats and it is unclear whether it does any harm, this bypassing of the brain.
Better prevention than cure is the motto for now. Not everyone with tinnitus gets away with it. In the novel The Shape of Sound by Gregor Verwijmeren, the protagonist is nearly driven mad by the sound in his head; the author himself also suffers from tinnitus. The madness he describes is not inconceivable; there are patients who suffer from it. The story goes that Vincent van Gogh cut off his left ear to get rid of his tinnitus, but so far there is no scientific evidence for this.
[De Correspondent – Petra Possel – 29 Juni 2023] / Photos : taken from the ‘Year of the Ear’ series by British photographer Alexander Coggin.
