The best defense against tinnitus--an inexplicable ringing or whistling in the ears--is in your mind

By JAMES GEARY /LONDON

artin Luther had it. So did Jean-Jacques Rousseau. It tormented Ludwig van Beethoven. And it is ruining Jurgen's life. "Ever since the first day," he says in a dejected voice, "everything seems terrible to me. I can't sleep. I can't work. I have lost all joy in life." Jurgen, a 36-year-old insurance broker, is speaking in Bonn to a small group of fellow sufferers of tinnitus, a ringing, whistling or hissing noise in the head that has no external cause. The severity of the condition--the mechanisms of tinnitus are still so obscure that researchers are not even sure it's a disease--varies: some forms are as loud as jackhammers, while others sound more like rushing water or a swarm of bees. But everyone who has experienced tinnitus agrees that, in the most serious cases, it can be a maddening and psychologically devastating affliction.

Statistics compiled by Tinnitus Action, a London-based organization devoted to increasing public understanding of the condition, show that roughly one person in 10 is affected by tinnitus. For about 15% of sufferers, the noises inside their heads are disturbing enough to shatter their peace of mind, leading to everything from forgetfulness to severe depression and panic attacks. "It's not the volume that matters," says Gerald Fleischer, professor of anatomy and head of the hearing research team at Germany's University of Giessen, "but the inescapable presence of the sound itself."

Scientists don't really know why or how tinnitus happens. The condition is generally regarded as a symptom of something else, possibly a problem of the inner ear and its connection through the auditory pathway to the hearing centers of the brain. One potential trouble spot is the hair cells on the cochlea, the snail-shaped organ of the inner ear that converts sound waves into nerve impulses. These sensitive hair cells can be damaged by sustained exposure to loud noises. Indeed, one common form of tinnitus is the temporary and relatively mild ringing in the ears experienced after a rave or a rock concert. According to Fleischer, tinnitus is "the hair cells' way of saying, 'Help, you're killing me!'"

Other researchers suggest tinnitus is an amplified version of the brain's own background noise, a random crackling and sputtering of neurons that usually goes unnoticed. According to this theory, this neural static somehow slips through the filters in the brain that normally screen out irrelevant noise. As a result, the person is painfully aware of a sound that isn't really there. "It's like the phantom limb pain experienced by amputees," explains Jonathan Ashmore, a professor of biophysics at University College London, who studies the hair cells of the cochlea. "The brain generates its own sound. But because no one else can hear it, it can't be measured objectively."

Most tinnitus sufferers are eventually able to adjust to their condition. But finding a cure, says Carole Hackney, professor of auditory neuroscience at Keele University in England, "is as nonsensical as finding a cure for pain or itching. Tinnitus is a description of symptoms with no single identifiable cause. Because there are multiple causes, multiple treatments are needed." Most physicians advise against unproven and potentially harmful treatments like cortisone injections, drug regimes or hyperbaric oxygen therapy, in which patients sit in a pressurized chamber for 30 minutes breathing pure oxygen. Psychological warfare seems to be the most effective way to drown out the unwanted noise.

Of the 8 million Germans who suffer from tinnitus, about 1 million use psychotherapy to help them cope. The key to defeating the condition, says Dr. Gerhard Goebel, head of the tinnitus ward at Germany's Roseneck Clinic in Prien near Lake Chiem, is in the mind. "We try to teach our patients to stop focusing on the tinnitus," he explains. "Only when the sound has stopped being an alarm signal can someone learn to forget it." Because he believes many cases of tinnitus are stress-related, Goebel recommends relaxation techniques such as yoga and meditation. His own method combines psychotherapy with the use of a device like a hearing aid, which produces white noise to mask the tinnitus. "The masker gives people the possibility to decide when they want to hear the tinnitus," says Goebel. "Once they know they can mask the tinnitus whenever they like, they no longer need to do so. They feel in control again."

And feeling in control is perhaps the next best thing to a cure. "It's important to give people hope that their tinnitus might recede or disappear," says the University of Giessen's Fleischer. "People lose courage if they're told that tinnitus is chronic and there are no therapies." For now at least, it seems the best way tinnitus sufferers can beat their affliction is with a little white noise and a lot of help from their friends.

--With Reporting by Ursula Sautter /Bonn