Ringing, buzzing, whistling, hissing, pulsing, high pitched screeches, or other noise in the ears or head is called tinnitus. It is a medical condition. Typically tinnitus is most noticed and seems loudest in a quiet setting.
It is estimated that 13 to 15% of the population has prolonged tinnitus (greater than 5 minutes). It may occur in one ear or both ears, it may be constant or intermittent. In some cases, tinnitus becomes so bothersome that it affects sleep patterns, ability to work, communicate, and eat. 50 to 70% of tinnitus sufferers also report decreased sound tolerance. This is different from hyperacusis which is a collapsed tolerance for everyday sounds.
The condition is not uncommon and you are not alone in suffering with it.
Tinnitus may be objective – where the tinnitus sufferer and others hear it. The use of amplification may worsen this tinnitus. It is likely due to middle ear spasm. Subjective tinnitus is audible only to the sufferer. If subjective tinnitus is pulsatile it may be arterial (pressure on neck has no affect) or venous (pressure on neck does have an affect).
Causes of Tinnitus: Research continues on finding why some people have tinnitus and others do not. This will be a first solution to a cure. The most common theory on the cause of tinnitus is that it is a result of cochlear hair cell damage. Within the cochlea (the end organ of hearing) outer hair cells serve to inhibit inner hair cell function. As outer hair cell damage increases (such as with increased hearing loss) more spontaneous neural activity increases which in turn likely leads to greater perceived tinnitus.
Associated conditions may include Meniere's Disease, middle ear problems with associated conductive hearing loss, metabolic imbalances, circulatory disturbances such as hypertension, hematologic disorders, chronic muscular contractions, head trauma, acoustic nerve lesions, infections of the inner ear, Bell's Palsy, a malfunctioning eustachian tube, otosclerosis, drug ingestion, excessive use of alcohol, and disorders of the vertebrae. One of the most common causes of tinnitus is exposure to loud noises such as shooting, rock concerts, or chain saw use.
A tinnitus evaluation should include assessment of tinnitus quality; handicapping effect; % of time of awareness; % of time distressed by tinnitus; assessment of sleep hygiene; severity and loudness rating.
Tinnitus questionnaires include the Tinnitus Handicap Inventory; Tinnitus Questionnaire; Tinnitus Reaction Questionnaire; Tinnitus Handicap Questionnaire; and the Tinnitus Functional Index.
Management of Tinnitus: Management of tinnitus will include medical management; definitions of the problem (tinnitus, hearing loss, hyperacusis); client motivation; client education; sound therapies; and follow-up.
If hearing instruments are prescribed your audiologist should not use expansion or noise reduction algorithms. No volume control which would draw client attention back to the ears, and consistent use is imperative. If hyperacusis is present, reduction of hyperacusis will be a priority before tinnitus.
Structured therapies include Tinnitus Retraining therapy; Neuromonics; Cognitive Behaviour Therapy; Mindfulness Meditation; Progressive Tinnitus Training; and Relaxation Therapy. Medications may be prescribed. Good sleep hygiene is extremely important (see www.sleepfoundation.org for information).
The key to living with tinnitus is to remove it from your immediate attention. If you are able to relate your tinnitus as a meaningless and repetitive noise, then it is possible for the body to ignore it.
The goal of sound therapy is to reduce tinnitus audibility by increasing the level of external sounds.
This is meant for clients with normal hearing. The goal is to make tinnitus inaudible/change it’s characteristics to become non-bothersome. There is little data to support use. Refused by up to 50%of clients. Should always be accompanied / offered with counselling.
This therapy attempts to eliminate the negative feelings associated with tinnitus. It aims to habituate the client to tinnitus with the goal to ensure tinnitus does not interfere with client’s life. It begins with a period of habituation and informal counselling (18-24mos) and sound enrichment, followed by directive counselling. 3rd is a phase of sound enrichment followed by outcome measurement. There has only been 1 low-quality controlled study showed it’s benefit over masking.
There are 3 objectives to PATM. 1) soothing sound to produce stress relief (environmental sound), 2) to passively divert attention from tinnitus (music), and 3) sound to actively divert attention from tinnitus (speech). It involves extensive counselling.
This treatment uses a broadband sound stimulus using Neuromonics processor 2 hours/day for 6 months Costs is approximately $4-5000 USD for device and sessions. There is 1 study: mean improvement of 74% after 1 year.
Anecdotally, it is well known that ambient noise can make tinnitus less audible and divert attention to external sounds. Two studies – one showed “strongly positive results” (Trotter and Donaldson, 2008); and a second showed “slight reduction of prominence” (Noble 2008). Hearing instruments would serve to amplify background noise (counselling) and use many programs (quiet and normal), open-fit where possible, low kneepoint, expansion and noise-reduction off, automatic volume control, DSL preferred because it provides greater low-intensity/low-frequency amplification.
No are no studied drug shown to provide replicable, long-term reduction of tinnitus impact in excess of placebo effects (Langguth, 2009).
- Lidocaine/Lignocaine, which is an anaesthetic, provides temporary relief in +/- 50%of tinnitus sufferers. There can be both short and long-term side effects.
- Hypnotics, benzodiazepines and zopeiclone decrease excitability; diazepam – relief of sleep, no benefit to tinnitus; alprazolam – high dose is a last resort; clonazapam – helpful in 32% of patients. These drugs may cause dependency; personality changes, withdrawal affects.
- Antidepressants, include tricyclics (TCAs).
- Anti-convulsants, carbamazepine (unilateral “typewriter tinnitus”); gabapentin; anti-glutamatergies (acamprosate – in alcoholism, decreases tinnitus).
These therapies consist of relaxation (deep breathing 3x3/day; yoga; tai chi); imaging; cognitive restructuring; exposure to exacerbating situations; and self-help groups.
Alcohol exacerbates tinnitus. Vitamin deficiency – zinc, niacin may also exacerbate tinnitus. Herbal remedies: gingo biloba (decreases stress, increases memory – helps rats tinnitus, controversial in humans). Acupuncture: no consistent benefit.
Often discussing feeling evoked by tinnitus is helpful. Many people find that the tinnitus gets better over time with no treatment whatsoever. You should discuss how to make your tinnitus less of a problem for you with your Audiologist. Discussion of stressors in one’s life is often helpful.
i) www.tinnitus.org
ii) www.tinnitus-pjj.com
iii) www.iths.net
iv) www.ata.org
Information gathered from:
Tinnitus Management and Measurement, R. Tyler and J. Stouffler; The American Tinnitus Association; Tinnitus, D. Shrewsbury and W. Meyerhoff, in Diagnosis and Management of Hearing Loss, Meyerhoff
The American Tinnitus Association, Post Office Box 5, Portland, Oregon, USA, 97207, Tel #: 503-248-9985, WWW.ATA.ORG
Glynnis Tidball – St. Paul’s Hospital, Widex Workshop, 2010, Vancouver, BC