Tinnitus is the medical term used to describe a noise heard in the ears or head but doesn’t come from any outside source. It’s more commonly referred to as ringing in the ears but can be experienced as a hissing, buzzing, chirping or whistling sound. It can affect one or both ears, be constant or occasional, faint or loud, steady or pulsing. It can range from mildly irritating to very annoying but in more severe cases it can be deeply distressing to experience.

20%

Tinnitus affects around 15 to 20% of the world’s population.

Tinnitus affects around 15 to 20% of the world’s population, with up to 3% of cases severely affecting the quality of life.

When a person has tinnitus, they are hearing sounds that aren’t being made around them and no one else can hear them. Tinnitus can manifest itself in a range of different sounds which can vary from one person to the next, along with the degree of intensity. Some people can learn to ignore their tinnitus and it doesn’t affect much of their life. However, for others, it can interfere with most aspects of their lives.

Tinnitus can be subjective or objective:

Subjective

The most common type of tinnitus is subjective and it is when the tinnitus sounds are only heard by the individual. It is related to conductive and sensorineural hearing loss and occurs as a result of a change in the auditory pathway. Regular body movements such as a jaw clenching, pressure applied to the head and neck and turning the eyes can alter the intensity and frequency of the noise. This is called somatosensory tinnitus and somatic tinnitus.

Objective

This is a relatively rare form of tinnitus that involves noise coming from the ear canal which has been created by structures close to the near. It involves vascular flow from blood vessels which creates an audible and even sometimes pulsating sound. In some cases, the noise can even be loud enough that it’s heard by a doctor or hearing care professional when they are examining the person’s ears.

FAQs about tinnitus

What does tinnitus sound like?

Tinnitus sounds different for each person. Some people have said it sounds like a running tap, the sound of crickets chirping or a car engine running. It’s even been compared to the sound of grinding steel. If you have tinnitus then the noises you hear may occur in time with your pulse which is known as pulsatile tinnitus. You may even hear sounds that are comparable to music or singing.

For many people, the tinnitus sounds they hear aren’t constant and constantly vary. This can depend on the person’s emotional well-being, anxiety and stress levels or whether they have cervical spine issues. You may also find that your hearing has declined or you have become more sensitive to certain everyday sounds.

What is it like to have tinnitus?

For some people, tinnitus can come and go and while mildly frustrating it doesn’t interfere with their lives too much. However, some people experience tinnitus continuously and it can have a serious impact on their lives. When it’s severe, tinnitus can be deeply distressing and can sometimes result in the following problems:

  • Difficulty sleeping
  • Irritability and frustration
  • Inability to relax
  • Feelings of despair or depression
  • Poor concentration
  • Feelings of confusion

What causes tinnitus?

Tinnitus can start very suddenly or gradually develop over time. It can often be a sign of another issue, such as hearing loss or as a result of a person being exposed to excessive noise. Most causes of tinnitus can be categorised as either otologic (which relates to the ear), neurologic, related to medications or caused by infection. But sometimes the cause of the tinnitus is unknown and this is called idiopathic.

Otologic causes

 

  • Exposure to excessive noise which has damaged the inner ears or the auditory pathway – known as noise-induced sensorineural hearing loss
  • Age-related hearing loss or presbycusis
  • Irregular growth of the small bone in the middle ear
  • A build-up of earwax
  • Swelling to the mucosal lining of the eustachian tube that connects the back the nose to the middle ear
  • Sudden sensorineural hearing loss
  • Ménière's disease leading to vertigo and hearing loss
  • Pressure related injury to the ear common with people who dive or fly frequently

Neurological causes

 

Neurological changes within the parts of the brain that influence emotions and in the auditory system can lead to tinnitus. These could be caused by:

  • Injuries to the neck such as whiplash
  • Head injury
  • Acoustic neuroma
  • Vascular tumours of the middle ear
  • Multiple sclerosis

Infections

 

Some infections can lead to hearing loss and tinnitus, such as:

  • Lyme disease
  • Syphilis
  • Inflammation of the middle ear known as otitis media
  • Meningitis

Medications

 

There are many over-the-counter and prescription medicines that have been associated with tinnitus. The medicines are often used in treating cancer, infections, kidney disease, heart disease and to manage pain. The effects can be temporary or permanent. Medications that are most often linked with tinnitus are:

  • Aspirin
  • Non-steroid anti-inflammatory drugs
  • Certain antibiotics
  • Loop diuretics
  • Some chemotherapy drugs
  • Certain antidepressants

Noise-induced tinnitus

 

If you have been exposed to loud noise, whether as a one-off or regularly, then this can make changes to your ear’s outer hair cells that cause tinnitus. It occurs by increasing the sound processing in the central auditory system and can happen even after just attending a loud rock concert. However, the effects tend to be short-term and symptoms should go after 48 hours.

Perhaps not surprisingly, it’s fairly common for hearing loss and tinnitus to affect musicians. A study found that professional musicians had a 57% greater risk of developing tinnitus compared to other professions. Several of the world’s most famous singers and musicians have experienced tinnitus during their career, for instance:

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

How is tinnitus diagnosed?

Tinnitus can be diagnosed by your doctor or audiologist. If you think you have tinnitus or have any issues with your hearing then you must get it checked out. You can expect the doctor to ask you several questions about your symptoms, your health history and any medications you are taking. For instance:

  • What type of sounds is your hearing?
  • Does it come and go or is it constant?
  • Is it affecting your life and if so, in what way?
  • Do you have any other symptoms such as hearing loss or vertigo?
  • Have you recently been exposed to a sudden change in pressure or loud music?
  • Have you had any trauma or infections in your ear?
  • Have you had radiation therapy to your head?
  • Are you taking any medication?

The doctor will then examine your ears and look for any underlying causes of your tinnitus such as impacted earwax or an ear infection. They may recommend you have a hearing test and some blood tests to check for any conditions such as diabetes or anaemia which are linked to tinnitus.

Your doctor may decide to refer you to an audiologist to carry out other hearing tests. They will be able to discuss the treatments that would be most suitable for you. You may also be sent for an MRI or CT scan so there can be a closer examination of inside your ear and brain.

How is tinnitus treated?

There is no cure for tinnitus or indeed one single treatment that works for everyone. However, several very effective options can help you manage tinnitus and the way your body responds to it. Tinnitus treatment plans are generally specific to each individual, but may include:

 

Sound therapy: Sound therapy is designed to help your brain tune out the sounds of tinnitus. If you have a degree of hearing loss, then this treatment will work best in combination with wearing hearing aids. Sound therapy uses external sounds such as static-like noise or even music to obscure the tinnitus. Over time, the brain will hopefully be able to automatically tune out tinnitus sounds.

Behavioural therapy: This type of therapy tackles how you respond to tinnitus emotionally. Many forms of behavioural therapy have been found to reduce the stress and anxiety associated with tinnitus while also helping to improve your life. Tinnitus retraining therapy (TRT) is a form of behavioural therapy that focuses on retraining your brain responses to tinnitus. This can help you to effectively tune out the sounds. It combines sound therapy, counselling and wearing a noise-generating device such as a hearing aid. Other examples of behavioural therapy include:

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

Experimental therapies

 

There has been increasing investment in researching tinnitus and its treatments in recent years. This has led to some experimental therapies that have so far had some success during clinical trials. Some of these therapies aren’t entirely new as they are already used to treat several other conditions. For example:

 

  • Deep brain stimulation (DBS) currently used for movement disorders such as Parkinson’s disease.
  • Vagus nerve stimulation used for certain cases of hard to treat depression and epilepsy.

Other therapies designed to stimulate the brain to treat tinnitus include:

  • Repetitive transcranial magnetic stimulation
  • Transcranial direct current stimulation
  • Brain surface implants

Studies on animals have revealed that in the brain there are nerve cells called fusiform cells. These send phantom sounds to the rest of the brain. One such study used a device to stimulate the brain with electrodes and earphone on 20 humans. The study found that fusiform cell activity could be controlled using a combination of sound and mild electrical stimulation of the skin. While participants in the study did report that the volume of their tinnitus did return after a week or so, they did notice an improvement in their quality of life for several weeks afterwards.

Breakthrough tinnitus research

Scientists have also discovered a possible link between tinnitus and hyperactivity in the brain and auditory pathways. The study found that when a person with normal hearing wears earplugs, they experience increased hearing sensitivity. But when they wore noise generators, there was a noticeable reduction in their sensitivity to sounds. While this area needs further research, it has exciting potential for the future of tinnitus treatments.

Tinnitus can cause major disruption to a person’s life, but while there may not be a cure there is help available to manage and reduce the symptoms. If you suspect that you may have tinnitus, you must get it checked out as soon as possible. Your doctor or hearing care professional will be able to help you find the best treatment for you and give you the tools to help you manage the condition so it doesn’t take over your life.

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