If you are experiencing a ringing, buzzing or other strange noises in your ears, then you likely have tinnitus. More commonly known as ringing in the ears, it is a fairly common condition affecting about one in three Australians at some point in their life.

While it’s often a temporary problem, one in six people will have constant symptoms. For some people, it can be mildly irritating and frustrating, while for other people it can debilitating.

What is tinnitus?

People with tinnitus hear sounds that aren’t being made around them and cannot be heard by anyone else. The type of sounds and intensity can vary from person to person. The noise can be faint or loud and occur one or both ears. For some people, the noise can feel like a sensation inside their head. Tinnitus can come on suddenly and go just as quickly or some people can experience the sounds all the time. Meanwhile, some people can find tinnitus simply an irritation and they learn to live with it. However, for others, it can be very distressing and interfere with their quality of life.

There are two main types of tinnitus:

Subjective

This is the most common type of tinnitus and describes sounds that only you can hear. It’s connected with sensorineural and conductive hearing loss and can be caused by a change in the auditory pathway. Somatic tinnitus or somatosensory tinnitus happen as a result of particular body movements such as applying pressure to the head and neck, clenching of the jaw and turning the eyes which can change the intensity and regularity of the noise.

Objective

This is quite a rare type of tinnitus that can be heard by a doctor when they examine your ears. Objective tinnitus can happen when there is a problem with the blood vessels or muscles or bones in your ear. This can create an audible and sometimes pulsating sound.

FAQs about tinnitus

What does tinnitus sound like?

What tinnitus sounds like can be different from person to person. Some people have said that their tinnitus sounds like a car engine running, a running tap or like the sound of crickets chirping. The sounds people hear and the loudness are different for everyone.

How does tinnitus affect someone’s life?

There’s no doubt that tinnitus can be very annoying and frustrating, but fortunately, however, it isn’t often a sign of a more serious underlying condition. For many people, it comes and goes and they can learn to live with it. But some people experience tinnitus continuously and it can have a devastating impact on their lives. In some more severe cases, tinnitus can be deeply distressing and lead to some of the following issues:

  • Problems with falling asleep and staying asleep
  • Irritability and difficulty relaxing
  • Hearing loss and problems with understanding speech
  • Feelings of despair, frustration and depression
  • Poor concentration
  • Feelings of confusion
  •  

What causes tinnitus?

Tinnitus can happen suddenly or develop gradually. Tinnitus can arise when there is an issue with the auditory or hearing system which is made up of the ears and certain parts of the brain. People who have been exposed to excessive noise can develop tinnitus. It tends to be particularly common in people who have some degree of hearing loss or have some other ear problem. But it can also occur in people who have normal hearing.

Sometimes it’s not known what has caused a person to develop tinnitus and this is called idiopathic. However, most causes of tinnitus are found to be linked to:

  • Otologic (related to the ear)
  • Neurologic
  • Medications
  • Infections
  • Exposure to noise

Otologic

 

  • Presbycusis or age-related hearing loss
  • Noise-induced sensorineural hearing loss
  • Build-up of earwax
  • Abnormal growth of the small bone in the middle ear
  • Swelling to the mucosal lining of the eustachian tube that links the back of the nose to the middle ear
  • Sudden deafness
  • Ménière's disease causing hearing loss and vertigo
  • Pressure related tissue injury that’s known as ear barotrauma and common in people who fly frequently or are divers

Neurological

 

Neurological changes within the auditory system and certain of the brain can lead to tinnitus. These changes can be caused by:

  • Neck issues such as whiplash
  • Head injury
  • Multiple sclerosis
  • Vascular tumours in the middle ear
  • Acoustic neuroma

Medications

 

There are around 200 over-the-counter and prescription medicines that have been linked to tinnitus and hearing loss. These medications are often used for serious infections, pain, heart and kidney disease and some cancers. The effects can be temporary or permanent. Some of the more common medications that have been linked to tinnitus include:

  • Certain chemotherapy drugs, particularly those containing platinum
  • Some antidepressants
  • Salicylates such as aspirin
  • Nonsteroidal anti-inflammatory drugs
  • Aminoglycoside antibiotics such as neomycin and streptomycin
  • Loop diuretics primarily used to treat hypertension and edema

Infections

 

Some infections can lead to tinnitus developing, such as:

  • Lyme disease
  • Otitis media or inflammation of the middle ear
  • Meningitis
  • Syphilis

Noise-induced tinnitus

Either repeated or occasional exposure to loud noise can create small temporary changes to the ear’s outer hair cells. These changes can lead to tinnitus. These changes increase the sound processing in the central auditory system. You may only go to a loud music concert once in a while but the exposure to the loud noise can still cause tinnitus, although you should find the symptoms go within 48 hours.

Tinnitus is the most common symptom of noise-induced hearing loss affecting musicians. A study in Germany found that professional musicians were 57% more likely to develop tinnitus than in any other profession. Some famous musicians who are known to have experienced tinnitus include:

  • Anthony Kiedis from the Red Hot Chili Peppers
  • Singer and musician Moby
  • Trent Reznor from Nine Inch Nails
  • Chris Martin from Coldplay
  • Guitarist and singer Eric Clapton
  • Singer Barbara Streisand
  • Pete Townshend from The Who

When should I see my doctor about tinnitus?

If you suspect that you may have tinnitus, then you should talk to your doctor. This is particularly important if the sounds are getting worse, affecting your concentration or sleep or you think you may have pulsatile tinnitus. The doctor will likely want to check your ears and ask you several questions about your symptoms and health history. For instance:

  • Does the sound come and go or do you hear it constantly?
  • Does it happen in one ear or is it in both?
  • Is it affecting your day to day life and if so, how?
  • Do you have any other related symptoms such as hearing loss or vertigo?
  • Have you been exposed to a sudden pressure change or loud music?
  • Have you previously had ear infections or trauma to the ear or central nervous system?
  • Have you had radiation therapy on your head?
  • Are you on any medication?

The doctor will examine your ears to see if there are any obvious causes of your tinnitus that could be easily treated such as impacted earwax or an infection. They may also use a stethoscope to listen if there is any vascular noise near your ear. Your doctor may suggest you have a hearing test and arrange for you to have blood tests to rule out conditions such as anaemia, thyroid gland problems or diabetes that could cause tinnitus.

In some cases, your doctor may refer you to an audiologist who will carry out further tests and discuss the treatments that would be most suitable for you. Some audiologists organise specialist tinnitus clinics to help people manage their tinnitus and will fit hearing aids or therapeutic noise generators if they are required. Alternatively, it may be recommended that you have a CT or MRI scan so that the specialists can have a closer look at the inside of your ear and brain.

What are the treatments for tinnitus?

While there is currently no cure for tinnitus, the underlying cause of the tinnitus could be treatable. For example, if impacted earwax is causing your tinnitus then removing it should relieve the symptoms. But if the cause of your tinnitus is not known, then your options for treatment will be largely focused on helping you cope and manage the daily symptoms, for example:

 

Sound therapy: Using external sounds this type of therapy is used to distract you from the sounds of tinnitus. It can help to make the tinnitus sounds much less noticeable. There are different types of devices available and they use a combination of disguising, distraction and familiarisation to alleviate the symptoms. Some devices will fit in your ear and play white noise, music or some type of ambient sound. This technique can be effective in helping you to disguise your internal tinnitus sounds.

Behavioural therapy: This type of therapy concentrates on your reactions to tinnitus. Behavioural therapy can be effective in reducing tinnitus-related anxiety, stress and depression and improve your quality of life overall. Some of the techniques involved in behavioural therapy include:

  • Mindfulness-based stress reduction
  • Acceptance and commitment therapy
  • Progressive tinnitus management
  • Tinnitus activities treatment
  • Cognitive behavioural therapy

Tinnitus retraining therapy (TRT) is another form of behavioural therapy that can help to re-programme your brain in the way it reacts to the tinnitus. This can help you tune out the sounds and become less aware of it. It combines counselling, sound therapy and the use of a noise-generating device such as a hearing aid. However, this therapy will only work if you invest enough time, dedication and a lot of hard work.

How to avoid tinnitus getting worse?

There are also some things you can do to avoid your tinnitus from getting worse.

  • Wear headphones or earplugs if you are using equipment that generates noise or you will be in a loud environment, such as a concert.
  • Try to relax by having a massage, taking up yoga or involving yourself in social activities that distract you from the sound.
  • Reduce your nicotine, caffeine and alcohol intake as for some people these can temporarily worsen tinnitus.
  • Wear good quality and properly fitted hearing aids if you have hearing loss to reduce or eliminate tinnitus symptoms linked with hearing loss.

Are COVID-19 and Tinnitus linked?

Yes, COVID and tinnitus appear to be linked, as indicated by a significant study conducted by Anglia Ruskin University, alongside the American and British Tinnitus Associations. The study revealed that 40% of participants reported worsened ear ringing from COVID, with some individuals without pre-existing tinnitus developing the condition as a result of the virus.

Lockdown measures and social distancing were also found to potentially contribute to the intensification of tinnitus symptoms due to reduced exposure to regular noise and limited access to healthcare.

Further research is needed to explore this connection, especially in the context of long COVID.

Experimental therapies

There is ongoing research into finding an effective treatment for tinnitus. This has led to several experimental therapies being developed that have proven promising in clinical trials. Some of these therapies are already known for treating other conditions. Deep brain stimulation (DBS) is used to help certain movement disorders such as Parkinson’s disease. Vagus nerve stimulation is already used as a treatment for certain cases of epilepsy and hard to treat depression. Other experimental therapies that could soon become mainstream tinnitus treatments include:

  • Repetitive transcranial magnetic stimulation: This uses a magnet to target and stimulate certain parts of the brain.
  • Transcranial direct current stimulation: A non-invasive brain stimulation treatment that uses direct electrical currents to stimulate the brain.
  • Brain surface implants: Devices placed on the brain to stimulate it.

Breakthroughs in tinnitus research

Scientists believe there could a possible connection between tinnitus and hyperactivity in the bran and auditory pathways. Researchers found that when a person with normal hearing wears earplugs, their hearing sensitivity increases. But when they were noise generators instead, there is a reduction in their sound sensitivity. There still needs to be further research into this area, but it could be a huge step towards developing new treatments for tinnitus.

If you think you could be experiencing symptoms of tinnitus or are concerned about any aspect of your hearing, then you should schedule an appointment with a hearing care professional or seek advice from your doctor. They will be able to work with you to find the best solution for your tinnitus while helping you manage the symptoms.

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