Imagine going through your daily life with a constant buzzing or ringing sound in your ears. More commonly known as ringing in the ears, tinnitus is the perception of noise or sound in the ears without there being any external sound.
An estimated 9.2 million Canadians with tinnitus have experienced in the past year.
The noises come from inside a person’s body, and in most cases cannot be heard by anyone else. Tinnitus is not a disease, but it is often a symptom of some other underlying issue. That’s what an estimated 9.2 million Canadians with tinnitus have experienced in the past year. For some people, tinnitus can be something that occurs for a short while and is just mildly irritating. However, for other people, it can a life-altering condition with extremely debilitating symptoms. Their tinnitus symptoms can vary considerably from one moment to the next. This variation often depends on a person’s emotional well-being, stress levels, anxiety and whether they have cervical spine issues.
If you have tinnitus, you may also experience a deterioration in your hearing or you may have become more sensitive to certain sounds.
Subjective tinnitus is the most common type of tinnitus and refers to only the individual being able to hear the sounds. It is related to conductive and sensorineural hearing loss and occurs as a result of a change to the auditory pathway. It also encompasses somatic tinnitus and somatosensory tinnitus which is when movements such as jaw clenching, putting pressure on the head and neck, or turning the eyes can affect the intensity and frequency of the tinnitus symptoms.
This is a much rarer form of tinnitus and refers to when there is actual noise coming from the ear canal that can be heard by another person such as a doctor or hearing care professional during an examination. The noise often occurs close to the middle ear and involves vascular flow from the blood vessels – this is what makes it an audible and sometimes pulsating sound.
For many people, tinnitus is frustrating and irritating but something that comes and goes and they just learn to live with it. But for others, tinnitus can be continuous and offer no respite. It can be life-altering and deeply distressing, causing some of the following issues:
Tinnitus can happen suddenly or develop over time. There are a variety of potential causes of tinnitus, but the most common cause is damage to the very small sensory hair cells in the inner ear. Damage to the inner ear and the resulting lack of sound being able to reach the brain’s hearing centre, means the brain tries to fill in the gaps. The brain then interprets what isn’t externally audible. Most underlying causes of tinnitus are classed as otologic (related to the ear), neurologic (linked to the brain and nervous system), certain medications or infections.
Sensorineural hearing loss is commonly linked with tinnitus and often caused by noise-induced hearing loss as a result of continuous exposure to loud sounds. You don’t have to be exposed to loud noises for a long period for it to lead to tinnitus. Even just occasional exposure such as a loud music concert can be enough to cause temporary changes to the ear’s outer hair cells. These changes increase the sound processing in the central auditory system which can potentially cause tinnitus symptoms. However, in most cases, the symptoms should go within 48 hours.
But prolonged exposure can have a longer-term impact. If you have ever been to a loud rock concert, then it may not be surprising that tinnitus is the most common symptom of noise-induced hearing loss experienced by musicians. A study found that professional musicians had a 57% greater risk of developing tinnitus compared to any other profession. Several world famous musicians are known to have been affected by tinnitus during their careers. They include:
Other potential causes of tinnitus include:
Before you can explore treatment options, you need to have your tinnitus diagnosed. You will likely require a thorough examination of your hearing along with a complete hearing evaluation to help to find out what could be causing your tinnitus in the first place. Your doctor or hearing care professional will likely ask you:
Your answers to these questions will help your doctor or audiologist be able to evaluate your condition. You can also expect to be asked about your medical history. If it’s possible to pinpoint the specific cause of your tinnitus, such as an external activity or specific medication you are taking, then treatment could consist of reducing, treating or eliminating that factor as a first step in managing your tinnitus.
In some cases, you may be referred for a CT or MRI scan to provide a closer look at the inside of your ears and brain.
There is no cure currently for tinnitus nor is there one single treatment that works effectively for everyone that has tinnitus. If the underlying cause of your tinnitus has been identified then treating that cause can help considerably in improving your tinnitus symptoms. For example, if impacted earwax has resulted in your tinnitus symptoms then the next step will be to remove the earwax build-up. However, it’s not always possible to find out the cause of a person’s tinnitus, so treatment must concentrate on helping to manage the symptoms. This may include:
Cognitive Behavioural Therapy (CBT)
This is used to help identify and change any negative thinking and feeling towards tinnitus which can unconsciously influence a person’s perception of their symptoms and the effects it has on their life. Stress and anxiety have been found to intensify symptoms so CBT is very useful in helping to reduce the distress caused by tinnitus.
Tinnitus Retraining Therapy (TRT)
This is a type of behavioural therapy that combines sound and counselling to help retrain the way a person’s brain responds to tinnitus. The aim is to minimize a person’s awareness of their symptoms to help retrain their neural networks in the brain responsible for detecting tinnitus.
Masking devices and white noise machines
Masking devices are worn in the ear similar to hearing aids. They produce a low, white noise that helps to suppress the sounds of tinnitus by distracting the brain. White-noise machines also produce several different sounds and are particularly useful at night to help minimize the sounds of tinnitus to help a person sleep. Tinnitus symptoms can seem more intense at night when it’s quiet.
If you have been diagnosed with hearing loss and experience tinnitus symptoms, then hearing aids can help you to manage the symptoms. Several hearing aid models are already equipped with tinnitus therapy features such as a built-in masker that will produce sounds to help suppress the tinnitus symptoms.
There has been increasing investment in recent years into researching tinnitus and exploring potential new treatments. This has led to several experimental therapies that have proven to be promising during clinical trials. Some of these therapies are already widely used to treat other conditions. Deep brain stimulation (DBS) is used for movement disorders such as Parkinson’s disease. Meanwhile, vagus nerve stimulation has been used as a therapy for epilepsy and depression. Both of these therapies could have the potential to help people with tinnitus in the future. Other therapies that have the potential to treat tinnitus by stimulating the brain include:
There have been several studies on animals that have identified nerve cells in the brain called fusiform cells that send phantom sounds to the rest of the brain. While a study on 20 humans used a device to stimulate the brain using electrodes and earphones found that a combination of mild electrical stimulation to the skin and delivering sounds could control fusiform cell activity. While participants in the study did report that the volume of their tinnitus symptoms did return after a week, they did experience an improvement in their overall quality of life for several weeks afterwards.
A study by the University of Montreal into the hearing system took this a step further, finding a potential link between tinnitus and hyperactivity in the brain and auditory pathways. Researchers discovered that if a person with normal hearing wears earplugs for a certain length of time, their sensitivity to certain sounds increases. But when they wear noise generators, this sensitivity to sound is reduced. There still needs to be more research in this area, but it could be an exciting breakthrough for the future of tinnitus treatments.
While in most cases, tinnitus isn’t a sign of a serious underlying condition, it is best to schedule a consultation with your hearing care professional or doctor to discuss your symptoms and determine the possible causes of your tinnitus and potential treatments that could help you manage the symptoms.
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