Do you hear a ringing, buzzing, whistling, hissing or other unexplainable sounds in your ears? It may only come on now and again or be constant. Either way, it’s a good chance that you have tinnitus.
6 million
Tinnitus affects around six million people in the UK.
More commonly known as ringing in the ears it’s believed to affect around six million people in the UK. While for some it can be just frustrating, for 1% of people it can be so severe it affects their quality of life.
Tinnitus is the term used for when a person hears sounds that come from inside their body, not from an outside source. If you have tinnitus then you may hear noises that beat in time with your pulse known as pulsatile tinnitus. You may hear sounds that are similar to singing or music.
For many people, tinnitus isn’t constant and can vary significantly from one moment to the next. This variation can often depend on several factors such as your emotional well-being, stress levels, anxiety and depression or cervical spine issues and temporomandibular disorders. For instance, many women experience tinnitus during pregnancy and neck pain sufferers may also experience cervical tinnitus. You may also notice that your hearing has deteriorated or you have become more sensitive to everyday sounds. If the ringing in the ears you are experiencing is associated with bruxism, jaw clicking, teeth clenching and malocclusion, it might be TMJ tinnitus.
This is the most common type of tinnitus. It relates to when the sound is only heard by the individual. It’s linked with sensorineural and conductive hearing loss and is caused by some form of change or disruption to the auditory pathway. Somatic tinnitus or somatosensory tinnitus is when certain body movements such as turning the eyes, clenching the jaw or applying pressure to the neck and head, change the frequency or intensity of the noise.
This is a rare type of tinnitus and involves actual noise coming from the ear canal which has been produced by structures near the ear. The noise may even be loud enough to be heard by a hearing care professional when examining the individual. The noise tends to occur near the middle ear and involves vascular flow from blood vessels which results in an audible and often pulsating sound.
While tinnitus can be frustrating it is rarely a sign of a more serious condition. For some people, it can come and go and only be a minor irritation. However, some people’s tinnitus can be continuous and have a huge impact on their everyday lives. Severe cases of tinnitus can be very distressing and can cause the following issues:
Tinnitus can occur suddenly out of the blue or develop gradually over some time. Tinnitus can be a symptom of an underlying issue, most commonly hearing loss and exposure to excessive noise. Most underlying causes of tinnitus are classed as either otologic (related to the ear), neurologic, medication-related or infections. When there is no known cause or diagnosis for tinnitus, it’s called idiopathic.
Otologic causes
Otologic causes include:
Neurological causes
Tinnitus can be caused by neurological changes within the auditory system and the parts of the brain that influence your conscious and emotions. These changes can be as a result of:
Infections
There are several types of infections that can cause hearing loss, including:
Ototoxic medications
More than 200 prescription and over-the-counter medications used to treat pain, cancer, serious infections and kidney and heart disease have been linked to hearing loss and tinnitus. This can be either temporary or permanent. The most common medications linked with ototoxicity include:
Noise-induced tinnitus
Exposure to loud noise only needs to make small temporary changes to the ear’s outer hair cells to cause tinnitus. This happens by increasing the sound processing in the central auditory system. Even just occasional exposure to loud noise such as attending a loud music concert can cause tinnitus, although this is generally temporary and symptoms should go within 48 hours.
Tinnitus is believed to the most common symptom of noise-induced hearing loss experienced by musicians. A German study found that professional musicians had a 57% greater risk of developing tinnitus than in any other profession.
Some famous musicians, singers and DJs who have experienced tinnitus during their career include:
You should talk to your GP if you experience any problems with your hearing, such as a buzzing or ringing sound in your ears. They will ask you about your symptoms and health history, for example:
They may also ask you if you have been taking any medication that could cause tinnitus such as aspirin or high doses of antibiotics.
Your ears will be examined, both outside and inside, to check for any obvious issues that can easily be treated such as an ear infection or build-up of earwax. They may listen with a stethoscope to see if there is any vascular noise next to to your ear and near the carotid arteries and jugular veins. They may also suggest a simple hearing test and arrange blood tests to check for any conditions that can be linked to tinnitus such as diabetes, anaemia or thyroid gland problem.
In some cases, your doctor may refer you to an audiologist who will be able to carry out some further hearing tests and discuss the treatments most suitable for you. You may alternatively be referred to the ENT department at the hospital. An ENT specialist will examine your ears and carry out further tests to establish what’s causing your tinnitus. On occasions, people experiencing symptoms of tinnitus have a CT or MRI scan to enable the specialist to have a closer examination of the inside of their ear and brain.
There is currently no cure or single treatment for tinnitus that works for everyone. However, research is continuing into finding an effective treatment. If an underlying cause of your tinnitus has been found, then treating the cause effectively could help improve your tinnitus. For instance, removing earwax build-up. However, if the cause of your tinnitus remains unknown, then treatment will be focused on helping you to effectively manage the condition and daily symptoms. This may include:
Sound therapy: This uses external sounds to distract you from the tinnitus sounds. It can be very effective in making the symptoms less noticeable. There are different devices available that use a combination of masking, distraction and familiarisation to ease symptoms. This could be in the form of a tabletop device or small device that fit in the ear and play music, white noise, nature noises or other ambient sounds. This can help to mask your internal tinnitus sounds.
Behavioural therapy: This focuses on your emotional reaction to tinnitus. Several forms of behavioural therapy have been found to reduce tinnitus-related stress, anxiety and depression while improving a person’s overall quality of life. Some of the techniques involved include:
Tinnitus retraining therapy (TRT) is a type of behavioural therapy that can help to retrain the way your brain responds to the tinnitus. This can equip you with the ability to tune out the sounds and become less conscious of it. This therapy can involve a combination of counselling, sound therapy and wearing a noise-generating device such as a hearing aid for several hours a day. This therapy is not effective for everyone as it does take a lot of time, dedication and hard work to be effective.
Experimental therapies
Research into tinnitus and its treatments have produced several experimental therapies that have so far been promising in clinical trials. Some of these therapies are already used to treat other conditions. For instance, deep brain stimulation (DBS) is already used for movement disorders such as Parkinson’s disease. Vagus nerve stimulation is currently used for certain cases of hard to treat depression and epilepsy. Other cutting-edge tinnitus therapies that may soon become mainstream include:
Studies on animals have found that there are nerve cells in the brain called fusiform cells, which send phantom sounds to the rest of the brain. A device that was used to stimulate the brain using electrodes and earphones was tested on 20 humans for around 30 minutes a day for four weeks. The study found that it was possible to control fusiform cell activity with a combination of sounds and mild electrical stimulation of the skin. The volume of the tinnitus did return after one week. However, the patients reported an improvement in their quality of life for several weeks after.
A groundbreaking study of the hearing system by the University of Montreal found a potential connection between tinnitus and hyperactivity in the brain and the auditory pathways. The study discovered that if a person with normal hearing wears earplugs, their hearing sensitivity increases as a result. However, when they wear noise generators, they experience a reduction in their sensitivity to sound. Although there still needs to be further research, this could prove to be a huge step forward in developing new tinnitus treatments.
If you think you may have tinnitus or are having difficulties with any aspect of your hearing health, then you should see your doctor or schedule an appointment with a hearing care professional as soon as possible. They will be able to help you find the best treatment and help you manage your tinnitus symptoms.
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