What is tinnitus?
- Tinnitus is the perception of a sound when no external sound source is present. It is often described as having a ringing quality, although other descriptions such as chirping, roaring, buzzing, clicking, or hissing are also common.
- Tinnitus is experienced by over 50 million people in the United States, with a small portion of these individuals experiencing a significant impact on their quality of life.
- One type of tinnitus, objective tinnitus, which is uncommon, is caused by observable physiological phenomena that are muscular or vascular in origin and can often be observed by others.
- A second type of tinnitus, subjective tinnitus, is the perception of a sound in the absence of an external or identifiable physiological source. This type of tinnitus cannot be heard by others and is much more common than objective tinnitus.
What causes tinnitus?
- The exact cause of tinnitus is not fully understood; however, it is very commonly associated with damage to the hearing system. As we age, damage to the hearing system can accumulate from the natural aging process, noise exposure, certain medications, or genetics. This damage reduces the amount of sound that the brain has access to. Tinnitus is often compared to phantom limb pain, in which an individual “feels” pain in a limb that has been amputated. With tinnitus, part of the hearing system has become damaged, but the brain still “hears” phantom sounds from the damaged regions.
- It is thought that the brain compensates for this damage by either creating its own sound to “fill in the gaps” or by increasing the sensitivity of hearing regions that have not accumulated a significant amount of damage. Often, but not always, the brain learns to ignore the tinnitus, especially when there are other things to focus on.
- However, for some people, tinnitus is very bothersome, and the brain is unable to ignore the sound. Tinnitus is a complex condition and is not solely confined to the hearing system. The limbic system, the part of the brain that is involved in emotion and memory, can prevent an individual from being able to ignore their tinnitus, especially if the tinnitus is perceived as a threat. When the tinnitus has a negative connotation, it can create a constant hypervigilant state and prevent habituation.
- Other health conditions that can be associated with tinnitus can include impacted ear wax, excessive caffeine or alcohol intake, exposure to loud sounds, hormonal changes, Meniere’s disease, diabetes, high blood pressure, smoking, obesity, temporomandibular joint dysfunction (TMJ), and more uncommonly, acoustic neuromas, which are tumors on the hearing or balance nerve.
How do we evaluate tinnitus?
Tests used to evaluate tinnitus commonly include:
- A detailed case history
- An examination by a physician to rule out certain medical conditions
- Distortion product otoacoustic emissions, which tests the function of hair cells in the inner ear
- Acoustic reflex thresholds, which tests the function of the muscles in the middle ear
- A hearing test, which can include extended high frequencies
- A test to determine what the tinnitus sounds like and how loud it seems
- Loudness discomfort levels, which evaluates for increased sensitivity to loud sounds
- Residual inhibition, which determines if the tinnitus can be temporarily suppressed with a masking sound
How do we treat tinnitus?
- At this point there is no universal cure that can make tinnitus go away; however, there are things that can be done to help reduce the impact of tinnitus.
- Hearing aids- Often, whenever we provide the brain with extra sound, the loudness of the tinnitus can be reduced. Providing extra sound to the brain also helps to draw the individual’s attention away from the tinnitus.
- Sound therapy- Sound therapy works by playing soft sounds, such as random tones or white noise, just below the volume of the tinnitus. This can help an individual become habituated to their tinnitus. Sound therapy can be used alone or simultaneously with hearing aids.
- Cognitive behavioral therapy- While this treatment does not attempt to eliminate the tinnitus, it can help reduce the impact of the tinnitus on quality of life, especially for those whom it significantly bothers.
- Tinnitus Retraining Therapy- This treatment combines extensive counseling and sound therapy to help reduce the impact of tinnitus on the patient and help them habituate to it over time.
- Medications- Many different medications for tinnitus have been studied; however, none have been shown to reliably eliminate tinnitus symptoms and there are no medications approved by the FDA for the treatment of tinnitus.