Tinnitus, Causes, Research and Treatments
Let's talk about Tinnitus
Everything You Need To Know About Tinnitus
Tinnitus is a frustrating problem that many people across the world deal with everyday. For most of us it is just a transitory annoyance that passes after a few seconds or minutes. However, for many, it is a constant companion, a companion whose impact can be anything from slightly distracting to devesatating. We thought it was a good idea to cover the problem in an in-depth manner, offering all of the information we know in one easy reference. So here goes.
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What Exactly is Tinnitus
Firstly, tinnitus is not a disease in and of itself, it is always a symptom of some other underlying problem. Tinnitus (pronounced ti-ni-tis or tin-i-tus), or ringing in the ears, is the sensation of hearing ringing or other sounds without any external sound source.
The noise is in your head, however, this does not mean you are imagining it. As we said It's often described as "ringing in the ears", although several sounds can be heard, including:
The noise varies, it can be intermittent or continuous, and can vary in loudness. Most people report that it is often worse when background noise is low. They say that they are most aware of it at night when they are trying to fall asleep or in a quiet room. In very rare cases, the sound beats in sync with your heart (pulsatile tinnitus). Pulsatile tinnitus always needs to be investigated thoroughly.
Tinnitus is very common, most people will experience it at some time in their life even if only momentarily. Even for many people with continuous tinnitus, the condition is merely an annoyance. However, in more severe cases, the condition can cause people to have difficulty concentrating and sleeping. It may eventually interfere with work and personal relationships, resulting in real psychological distress.
According to the infographic which was generated by Amplifon (major international retailer of hearing aids), 50% of sufferers find tinnitus moderately or severely distressing yet 93% haven’t consulted a doctor. Still, if their tinnitus is severely distressing them then their general health and well being will surely be affected.
The Effects of Tinnitus
It is in this cohort of people that the effects of tinnitus can be devastating. It can cause a huge amount of stress which in turn feeds the tinnitus. It can cause insomnia which has an effect on mood and relationships, increasing stress which again feeds the tinnitus. Unfortunately we have seen more than a few high profile cases of suicide caused by the impact of tinnitus.
Tinnitus Can Be Treated
Unfortunately many people who suffer with tinnitus are told that there is nothing that can be done, just to get on with it. This isn't true, there are many validated and effective treatments for tinnitus.
None of them are a cure, but they all can help bring relief from the impact of tinnitus. In many cases, no single treatment will do the job, it is most often a combination of several types of treatment protocols that help.
A vicious Circle or Cycle
Much of the treatment of tinnitus is designed to stop this cycle or circle of tinnitus. Treatment is designed to reduce the impact of tinnitus or to give respite from tinnitus in order that a person can recover, relax and again fortify themselves against the sound.
Different types of Tinnitus
There are two different types of tinnitus: objective which is exceptionally rare and subjective.
- Objective – Objective tinnitus is much rarer than Subjective. In these cases, it is possible for a physician to perceive actual sound emanating from the sufferers ear canal. It can arise from muscle spasm or vascular issues that cause clicks or crackling around the middle ear.
- Subjective – Subjective tinnitus is defined as being the cases in which only the sufferer can hear the noises.
When Should You Consult Someone
You should see a medical professional if you continually or regularly hear sounds such as buzzing, ringing or humming in your ears. In particular, you should see a professional if the sound is pulsatile or only presents in one ear.
A simple examination of your ears can rule out simple and easily treatable causes such as an ear infection or earwax build-up.
Once those causes have been ruled out, a more thorough investigation will need to be undertaken. The first step should be a hearing test since most tinnitus is related to an underlying hearing loss.
If hearing loss is ruled out as a cause of tinnitus then you could be referred to a hospital specialist for further tests to discover any underlying cause.
What Causes Tinnitus
The exact physiological causes of most cases of tinnitus are still not known, it seems that most tinnitus is associated with a hearing loss. In cases where there is hearing loss involved it is believed that the centres of the brain involved with auditory processing for the sounds that can no longer be heard begin to become over stimulated or stimulated by some other input.
This over stimulation means that those centres are active with no external sound stimulation. You perceive that activity as a sound. In some cases though, hearing loss is not a factor or, it is not a measurable factor. There are a number of other causes which are widely understood to cause, or worsen, the condition:
- Noise-induced hearing loss
- Wax build-up in the ear canal
- Certain medications
- Ear or sinus infections
- Jaw misalignment
- Cardiovascular disease
- Head and neck trauma
- Stress, anxiety or depression
- Acoustic neuroma
- Ménière's Disease
Noise-induced hearing loss
Exposure to loud noises can damage and even destroy hair cells in the inner ear. Up to 90 percent of all tinnitus patients have some level of hearing loss.
Wax build-up in the ear canal
The amount of wax (officially cerumen) ears produce varies by person, even if you produce a lot of wax, it may not build up in the canal. Sometimes, people over produce wax and it stubbornly remains in the ear canal. This can compromise hearing causing tinnitus or make their existing tinnitus seem louder. If you produce a lot of earwax and it is a regular problem, speak to a hearing care provider about having excess wax removed manually
Some medications are toxic to the ear. Other medications will produce tinnitus as a side effect without damaging the inner ear. The effects, which can depend on the dosage of the medication, can be temporary or permanent. Before taking any medication, make sure that your prescribing physician is aware of your tinnitus, and discuss alternative medications that may be available.
Ear or sinus infections
Many people, including children, experience tinnitus along with an ear or sinus infection. Generally, the tinnitus will lessen and gradually go away once the infection is healed.
Some people have misaligned jaw joints or jaw muscles, which can not only induce tinnitus, but also affect cranial muscles and nerves in the jaw joint. Many dentists specialise in this temporomandibular jaw misalignment and can provide assistance with treatment.
Approximately 3 percent of tinnitus patients experience pulsatile tinnitus; people with pulsatile tinnitus typically hear a rhythmic pulsing, often in time with a heartbeat. Pulsatile tinnitus can indicate the presence of a vascular condition-where the blood flow through veins and arteries is compromised like a heart murmur, hypertension, or hardening of the arteries.
Head and neck trauma
Physical trauma to the head and neck can induce tinnitus. Other symptoms include headaches, vertigo, and memory loss.
Stress, anxiety or depression
It is well known that psychological problems, such as stress, can worsen an existing case of tinnitus – in rare cases, it cause it to start in non-sufferers.
This noncancerous (benign) tumour develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma, this condition generally causes tinnitus in only one ear.
Ménière's is a rare disorder affecting the inner ear, Ménière's disease can cause tinnitus, hearing loss and pressure in the inner ear, but it is usually accompanied by vertigo.
Medications that can cause tinnitus
As we said, a number of medications may cause or worsen tinnitus. Generally, the higher the dose of these medications, the worse tinnitus becomes. If tinnitus is caused by medication intake, it will often disappear when you stop using these drugs. Medications known to cause or worsen tinnitus include:
- Antibiotics, including polymyxin B, erythromycin, vancomycin and neomycin
- Cancer medications, including mechlorethamine and vincristine
- Water pills (diuretics), such as bumetanide, ethacrynic acid or furosemide
- Quinine medications used for malaria or other health conditions
- Certain antidepressants may worsen tinnitus
- Aspirin taken in uncommonly high doses (usually 12 or more a day)
Risk Factors For Tinnitus
There are a number of things or or occupations which can carry a heightened risk of developing tinnitus. Exposure to loud noise is a huge risk factor, if you are exposed to loud noises in your day to day life you should wear good ear protection. Below are a few groups of people who are at risk of developing tinnitus without the correct ear protection, but you can find out more on our How Loud Is too Loud article.
- Loud noise exposure
- People who work in noisy environments
- Cardiovascular problems
People exposed to music
A constant exposure to loud music can leave you at risk of tinnitus. This includes people who play in bands, DJs and concert goers. You should always protect your ears in this environment. If you work somewhere where you are exposed to loud music your employers must supply you with ear protection under health and safety legislation.
As you get older you are more at risk from the different causes of tinnitus such as hearing loss, cardiovascular disease etc.
Smoking causes cardiovascular problems which in turn have an effect on the blood supply to the inner ear. This causes hearing loss and in many cases tinnitus.
For some reason, if you are a man you are more likely to develop tinnitus, again this is probably down to lifestyle and environmental factors like occupation and the sports and hobbies men tend to be involved in (exposure to loud noise).
People working with loud machinery
If you work with loud machinery daily then you could be leaving yourself open to developing tinnitus. Always wear ear protection, whether you’re dealing with a jackhammer or a lawnmower.
People exposed to loud bangs
If you’re exposed to an environment of loud bangs, whether at work or leisure, you should always wear ear protection.
People who listen to their headphones
If you listen to music on your headphones then you could be placing yourself at risk of developing tinnitus.
A Cure for Tinnitus
There are many pharmaceutical companies working towards different levels of trials on substances to reduce or cure tinnitus. However, while some have shown promise, there is no cure or medical treatment available for tinnitus. The underlying issue in relation to a cure is that we still don't fully understand the mechanism of tinnitus. Therefore, we have no one attack vector which may produce a cure to explore.
No Pill, No Magic Herb
I want to make this very clear, there is no cure, no magic pill, patch or herb which has been proven to cure or even reduce the impact of tinnitus. Those magic cures on the internet are simply rubbish, snake oil designed to take money from the desperate.
Focusing on The Brain Centres
Much of the research being undertaken now focuses on an area of the brain called the dorsal cochlear nucleus. It is generally believed that some of the neurons in this area start to fire erratically, and this uncontrolled activity eventually leads to tinnitus. Much of the drug research up to now has focused on how those neurons can be returned to their natural state.
No Cure But There is Treatment
While there is no cure, there is effective treatment options for the relief of tinnitus, depending on the underlying cause of the tinnitus, some treatments can be very simple and effective. Others may not completely remove the tinnitus but they can still deliver relief from the psychological impact.
Treatments for Tinnitus
As I have said, there are many validated and effective treatments for tinnitus. The most effective treatment for any case of tinnitus will be based on the underlying cause of the condition. For instance, if your tinnitus is caused by hearing loss, the most effective treatment is hearing aids.
Normally when the hearing loss is treated by amplification, the tinnitus fades. All treatment is really based on breaking the cycle of distress that accompanies tinnitus. Let's take a look at the most used treatments by cause:
- Noise-induced hearing loss: Usually hearing aids and possibly sound therapy
- Wax build-up in the ear canal: Removal of the wax will relieve the tinnitus
- Certain medications: Reducing the dose or stopping or changing the medication
- Ear or sinus infections: Simply treating the infection should relieve the tinnitus
- Jaw misalignment TMJ: Dental treatment or bite realignment may relieve symptoms
- Cardiovascular disease: Treatment of the underlying issue may reduce the tinnitus, however, sound therapy and other therapies may need to be introduced
- Head and neck trauma: Treating the underlying physical trauma via drug therapy, osteopathy, physical therapy, or reatment from a Chiropractor, can remove the tinnitus symptoms
- Stress, anxiety or depression: Treatment of the anxiety may relieve the tinnitus or reduce the impact of it
- Acoustic neuroma: While the neuroma may well be surgically removed, the treatment will involve sound therapy and cognitive behavioural therapy or tinnitus retraining therapy (both explained below)
- Ménière's Disease: This condition often produces hearing loss which needs treatment with hearing aids. In some cases hearing aids are combined with sound therapy to help reduce the impact of tinnitus
If a specific cause for your tinnitus can't be found, treatment will focus on helping you manage the condition on a daily basis. This may involve:
- sound therapy – listening to neutral sounds to distract you from the sound of tinnitus
- counselling – therapy that aims to educate you about tinnitus and help you learn to cope with it more effectively
- cognitive behavioural therapy (CBT) – therapy that aims to help change the way you think about your tinnitus so it becomes less noticeable
- tinnitus retraining therapy (TRT) – therapy that aims to help retrain the way your brain responds to tinnitus so you start to tune the sound out and become less aware of it
Let's take a look at those treatment options in a more in-depth manner
In most cases of tinnitus, hearing aids are an ideal treatment option. Mainly because most cases of tinnitus are related to an underlying hearing loss. Once that hearing loss is treated, the perception of the tinnitus fades. It is important when considering hearing aids for correction of hearing loss pertaining to tinnitus that the devices have a wide frequency capability.
Many modern hearing aids offer amplification up to 10.5 kHz or 11 kHz. This ensures that there is a higher possibility that you are getting amplification in the area of hearing that you need it to reduce the tinnitus. Sometimes though, hearing aids aren't enough, in these cases sound therapy will be offered.
Sound therapy as a treatment has been around for a very long time. In 1903, a Doctor named Spaulding used a piano to match the frequency of tinnitus in his patients and played the frequency until it became inaudible to them. However, the In 1993, Jastreboff and McKinney introduced the theory of ‘habituation of the disordered auditory system’ using low level sounds (sound enrichment) to regulate a person’s tinnitus.
Sound therapy is based on the principle of distraction and it is still one of the more effective treatments available to us. Sound therapy is used in combination with education and counselling designed to reduce the emotional reaction to tinnitus and stress associated with it. For many with the condition, being in quiet is when the tinnitus is most noticeable. In essence, listening to other sounds can lessen the impact.
Most hearing aid brands would now offer some sort of sound therapy integrated in their hearing aids. Widex offers their own proprietary sound therapy system called Zen which is based on Fractal tones (sounds that never repeat). There are also many smartphone apps offering sound therapy, some designed by hearing aid brands, some designed by other people involved in the treatment of the condition. You can read more about them below.
There are devices that are just devoted to sound therapy called maskers, some are ear worn, some are designed for the bedside table, there is even a pillow designed to emit masking noise.
It is worth mentioning that counselling can be very effective in combination with other treatments. Good counselling can help to reduce the impact of the condition on people.
Cognitive behavioural therapy (CBT)
CBT is designed to change how you think about and react to your tinnitus. It uses techniques such as cognitive restructuring and relaxation to deliver that change in response. People undergoing CBT usually keep a diary and perform "homework" to help build their coping skills.
CBT is generally a short term treatment, weekly sessions for two to six months. In general the end effect is that the sound of tinnitus may not have changed but people find it significantly less taxing, and correspondingly their quality of life improved.
Tinnitus retraining therapy (TRT)
Tinnitus Retraining Therapy is designed to habituate the auditory system to the tinnitus signals, which makes them less noticeable or less bothersome. The main components of TRT are one to one counselling which explains how your hearing system works and how we believe tinnitus develops. This is combined with sound therapy.
An ear level sound therapy device is used to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.
Tinnitus Treatment Apps
There are many tinnitus treatment apps available for Smart phones based on sound therapy. Most of the hearing aid brands have introduced a sound therapy app that can be used either in conjunction with their hearing aids or as a stand alone assistant. There are many other companies outside the hearing aid brands that have also introduced sound therpy products such as Restored Hearing.
Widex Zen App
Widex released their Zen app this year, Widex say that this app includes a wide range of relaxing and soothing sounds including relaxation and sleep exercises. The App is free to download on Google Play and The App Store, the app is relatively intuitive and easy to use. It provides you with a player with preloaded sounds which include Zen sounds. The Zen sounds presented on the playlist are intended to provide a relaxing sound background for people to listen to in quiet.
ReSound Relief App
The ReSound Relief for tinnitus management app was released quite a while ago. Resound say that anyone with tinnitus can benefit from the ReSound ReliefTM app as part of a tinnitus management program. It offers a combination of sound therapy and relaxing exercises that aim to distract you from focusing on your tinnitus. Again, this app can be used in combination with Resound hearing aids or as a stand alone product.
Phonak Tinnitus Balance
Phonak say that the app is intended to be part of a tinnitus management program provided by a qualified hearing care professional familiar with the diagnosis and management of tinnitus. It enables you to choose sounds from the list of default sounds within the app: Soothing sounds such as a campfire, chimes, or sailing Background sounds such as the harbor, ocean, and rain Interesting sounds such as a blackbird, farmyard, or cicadas Alternatively, you can also select sounds from your own smartphone music library.
Restore Hearing Sound Relief App
Sound Relief is a 5 minute audio treatment which uses a combination of low frequency sounds to achieve a therapeutic benefit using the physics of sound. Listened to in the same way one would music, delivered via headphones to alleviate tinnitus.
Posted by Geoff
Geoffrey (Geoff, anything else makes him nervous) Cooling has been involved with the hearing aid industry for over ten years. He has worked in private practice dispensing hearing aids and as a manufacturer's rep. He has written two books and they are both available on Amazon. He loves technology, passing on knowledge and is legendary for many other things, primarily the amount he curses, his dry and mischievous sense of humour and his complete intolerance of people who are full of themselves. Please feel free to connect with him