Dave Fortier was about to finish his first marathon.
“As I was looking at the arches and looking where I was going to be going, that’s when everything changed,” he said.
As the first bomb went off, he saw a huge flash of light off to his left.
“I was knocked sideways," he said. "I ended up on the ground over near the grandstands, with just this muffled noise and this ringing in my ears.”
He could see people screaming. But he couldn’t hear them.
“I did see the second explosion," he said. "I did feel it, but I really couldn’t hear it. It sounded like a distant gunshot.”
At some point, Fortier looked down and saw a pool of blood forming around his foot. He’d been hit by shrapnel. He was taken to the hospital.
"They were sewing me up, and I still remember talking to the doctors about my — about the noise, this ringing, when does it go away?" he said. "And they said, 'Yeah, it should be gone within a couple of days.' And it is still as loud today as it was two years ago."
His hearing is better now, but the ringing stayed. Fortier says it sounds like he’s always next to a fluorescent bulb. It’s especially bad when he’s in a quiet place. At night, he tries to drown out the sound with classical music using headphones.
"The hardest part comes when it does wake you up, it becomes very difficult to get back to sleep," he said. "So it’s broken sleep."
The bombing at the 2013 Boston Marathon caused hundreds of traumatic and very visible injuries that victims continue to cope with. But among the most common is an invisible one. Two years later, it continues to significantly disrupt lives.
That ringing sound is called tinnitus, and it’s not easily fixed.
"This is a pathology that’s rooted in the brain," said Daniel Polley, a research scientist at the Massachusetts Eye and Ear Infirmary. "It is not amenable to surgery. Nor is it really ideally suited with some broad-spectrum pharmaceutical. We need to come up with another approach."
That’s what Boston-area hospitals are trying to do. The One Fund, which has been paying for continued treatment of victims, found that at least 100 of them suffer from hearing damage, including tinnitus. They’re now funding a program at Massachusetts General Hospital that’s teaching meditation and other methods to help reduce the stress of tinnitus.
The fund is also paying for a clinical trial of two more technology-based interventions at Mass. Eye and Ear, led by Polley.
“We believe that the brain is the most sophisticated machine in the universe and we want to take advantage of its own wiring to try to fix itself,” he said.
In order to do that, Polley needs to tap into the brain when it’s most open to being rewired.
"We need to coax the adult brain into an environment where it feels like it’s being challenged, that there’s something at risk that it stands to benefit or might get punished,” he said.
Fortunately, that is exactly what video games do. So they created one. The game is played on a tablet computer. It turns the specific sound of the user’s own tinnitus into the enemy.
“They’re learning to sort of isolate it from the other sounds and suppress it,” Polley said.
Polley shows me how to trace the outline of an invisible shape on the screen using just the sounds I’m hearing. The goal is to reconstruct a broken-up picture, using only sound as my guide.
There’s no guarantee yet the game is going to work. The dozen or so bombing victims who are in the trial so far are also trying out something else that’s been studied a bit more — music therapy.
Polley explains tinnitus is caused by damage to neurons that are associated with certain frequencies of sound. Those neurons become overactive, causing feedback, which is what they’re hearing. The music therapy filters the music people listen to, to omit the frequency of their tinnitus.
“As a result, the other frequencies, not the tinnitus frequencies, are used a little bit more in hearing the music,” Polley said.
That advantages those neurons, and gives them the opportunity to move in and take over, turning down the volume on the over-active neurons that are creating all that noise. It’s not a new idea. There are actually iPhone apps that do this.
Sitting in his Beacon Hill kitchen, bombing victim Steven Reny shows off the music therapy program.
"Now I have a choice between a couple of music programs," he said. "I’ll go into Spotify. And I can listen to any music I like. I’ll put on the headphones. Simple as that, I’m listening to music and getting therapy at the same time."
Reny was with his wife and daughter on Boylston Street two years ago to see his other daughter finish the marathon. The daughter standing next to him got the worst of it, with bad leg injuries. Reny and his wife were also hit with shrapnel.
“My eardrums were blown out by the sound wave of the blast," he said. "I don’t remember hearing it as much as the feeling of pressure in my ears that swept over me."
Ever since that moment, Reny has suffered from significant hearing loss.
“In a loud environment, like in a noisy restaurant, the background noise gets amplified quite a bit and it really drowns out some of the human voices that might even be right in front of you at the table,” he said.
Reny says his own voice now sounds weird to him now when he talks. He also has tinnitus. In order for music therapy to work, he had to get the software to identify the sound he hears.
It's a grating, unpleasant, high pitched tone — if you could, imagine hearing that every day.
“It’s a nuisance," Reny said. "It’s bothersome. It’s a subtle reminder at times, and a more direct reminder of what happened that day. All things that you’d like to put behind you.”
Reny is hoping to turn down the volume on that terrible reminder. And in the process, he hopes his contribution to the study may ultimately help the millions of others who are looking for therapies to reduce their own hearing problems.
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