What is Tinnitus?
Tinnitus (noises in the ears) is a perception of a sound that is unrelated to an external source of stimulation. Tinnitus is a very common disorder, affecting nearly 29 million adults in the United States. It may be intermittent, constant, or fluctuant, mild or severe, and may vary from a low roaring sensation to a high pitched sound. It may be subjective tinnitus (heard by the patient alone) or objective (heard by the patient as well as by another listener). Subjective tinnitus is common; however, objective tinnitus is relatively uncommon. Tinnitus may felt to come from either or both ears, or from your head.
Tinnitus is a symptom much like a headache, pain, temperature, hearing loss or vertigo. It may or may not be associated with a hearing loss. With tinnitus, the reported sound is usually subjective and difficult to record and appreciate by others.
Tinnitus quality refers to how it sounds to the patient: It may be a ringing, buzzing, cricket, or ocean type of sound. The quality may include multiple sounds or a singular sound.
Tinnitus may be produced in one or more locations, called its site of lesion. The cause of tinnitus may be singular or multiple. A peripheral (i.e., auditory nerve or cochlea) site of lesion includes an issue from the ear to the brainstem. A central (i.e., brain) site of lesion refers to an issue beginning at the brainstem and involving other portions of the central nervous system.
Tinnitus must be considered a symptom not a disease, just as pain is a symptom and not a disease. It may occur with hearing loss, vertigo, or aural pressure or it may occur alone.
A complete cochleovestibular (hearing and balance) evaluation is necessary in all patients with severe tinnitus. Multiple tests are used to determine where the issue is and to rule out any which may require further treatment. There are many causes ear-related causes, such as ear wax in the ear canal or middle ear abnormalities. Otosclerosis (fixation of the stapes bone in the middle ear) can cause tinnitus, as well as fluid in the middle ear. Other common causes include Meniere’s disease or to excessively loud sounds. Uncommon causes may include tumors on the hearing nerve or other problems in the brainstem or central nervous system. In addition, vascular abnormalities in the skull or base of the skull may result in tinnitus.
Measurement of Tinnitus
The pitch one hears their tinnitus at is often where their hearing is poorer. Humans can hear from 20Hz to 20,000Hz, but individuals with tinnitus often don’t hear as well above 9,000Hz. Therefore, it may be harder to tell if you’re hearing a beep during a hearing test, or if it’s your tinnitus. Testing often includes pitch-matching and loudness-matching. This information tells us what pitch you’re hearing, and how loud it is objectively. How well your tinnitus is able to be masked (covered up with other sound) may also be done. Residual inhibition, or when your tinnitus reduces temporarily after noise has been turned off, can also be evaluated.
A Summary of the Causes of Tinnitus
Tinnitus may originate from various locations and causes. The auditory system involves highly complicated inner ear structures and many nerve pathways throughout the brain. It’s difficult to determine exactly where tinnitus is coming from. This is demonstrated by patients who have developed severe tinnitus after having ear surgery or another ear disease. To try and cure tinnitus in the past, the hearing nerve was cut and tinnitus remained, which means tinnitus comes from your brain, not your ears!
Tinnitus could be explained by abnormal neural activity in the auditory nerve fibers, which may occur if there is a partial breakdown of the myelin covering of individual fibers. A defect in the hair cell would trigger the discharge of connected nerve fibers. For chronic cochlear disorders, there may also be increased spontaneous activity in the hair cells and neurons resulting in tinnitus. In the auditory nerve there are two different kinds of afferent fibers: Inner hair cell fibers with large diameters and outer hair cells fibers with small diameters. Thus, loss of signals from the cochlea might trigger tinnitus as a manifestation of a functional imbalance between the two sets of fibers. In addition, other abnormal changes of the cochlear fluids may result in tinnitus.
There is not one type, one site, or one origin of tinnitus, but a multitude of each! It is also unlikely that one hypothesis on the cause of tinnitus could explain every aspect of each person’s tinnitus.
Treatment of Tinnitus
Generally, most patients will not need any medical treatment for their tinnitus. For patients who are greatly bothered by tinnitus, they may use masking such as listening to a fan or radio which help cover the sound of their tinnitus. In addition, there are apps, websites, or speakers that play environmental sounds that can also be effective. Masking is especially helpful if you’re trying to go to sleep and tinnitus is keeping you awake. Hearing aids have this capability also – they can not only treat hearing loss but play masking noises to help prevent your tinnitus from sounding as loud. Maskers are based on the principle that individuals with tinnitus can tolerate outside noise better than they can their own inner head noises.
Biofeedback training is effective in reducing the tinnitus in some patients. It consists of exercises in which the patient learns to control various parts of the body and relax muscles. When a patient can accomplish this type of relaxation, tinnitus generally lessens. Most patients have expressed that biofeedback offers them better coping skills.
Other measures to control tinnitus include making every attempt to avoid anxiety, as this will increase your tinnitus. You should strive to obtain adequate rest and avoid fatigue because generally tired patients seem to notice their tinnitus more. The use of nerve stimulants, such as excessive coffee and smoking, should be avoided. Stimulants can increase how loud you perceive your tinnitus. Tinnitus is not harmful, it will not cause you to go deaf. Statistically, 50 percent of patients may express that their tinnitus with time decreases or is hardly perceptible.
Some medications have been used to suppress tinnitus. Some patients benefit from these drugs and others do not; each patient responds differently to medication, and what may work for one may not work for another. However, no drug will eliminate tinnitus. Also, some drugs may cause tinnitus as a side effect. If you have tinnitus and are on medication, you should discuss your tinnitus with your physician. In many instances, once the drug is discontinued the tinnitus will disappear.