What is Tinnitus
Tinnitus is sound in the head with no external source. For many, it’s a ringing sound, while for others, it’s whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. The sound may seem to come from one ear or both, from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating.
Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. For example, attending a loud concert can trigger short-lived tinnitus. Some medications (especially some anti-inflammatory medication taken in high doses) can cause tinnitus for a short time. When symptoms last for more than six months, the condition is known as chronic tinnitus. The symptoms associated with tinnitus are especially common in people over age 55 and strongly associated with hearing loss.
Most tinnitus is subjective, meaning that only you can hear the noise. But sometimes it’s objective, meaning that someone else can hear it, too. For example, if you have a heart murmur, you may hear a whooshing sound with every heartbeat; your clinician can also hear that sound through a stethoscope. Some people hear their heartbeat inside the ear — a phenomenon called pulsatile tinnitus. Pulsatile tinnitus may be more noticeable at night when you’re lying in bed and there are fewer external sounds to mask the tinnitus. If you notice any pulsatile tinnitus, you should consult a physician, because in rare cases it is a sign of a tumour or blood vessel damage.
The course of chronic tinnitus is unpredictable. Sometimes the symptoms remain the same, and sometimes they get worse. In some cases, the condition interferes with everyday life so much that professional help is needed.
While there’s no cure for chronic tinnitus, it often becomes less noticeable and more manageable over time. You can help ease the symptoms by consulting a professional and discussing options to reduce the impact of your tinnitus. There are several ways to help tune out the noise and minimize its impact.
Tinnitus and hearing loss
Most people who seek medical help for tinnitus experience it as subjective, constant sound like constant ringing in the ears or a buzzing sound in the ear and most have some degree of hearing loss. Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear, impacted earwax, middle ear problems (such as infections and vascular tumours), and ageing. Tinnitus can also be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear.
Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain’s auditory cortex, where it’s thought to be encoded (in a sense, imprinted). One of the most common causes of tinnitus is damage to the hair cells in the cochlea. These cells help transform sound waves into nerve signals. If the auditory pathways or circuits in the brain don’t receive the signals they’re expecting from the cochlea, the brain in effect “turns up the gain” on those pathways in an effort to detect the signal — in much the same way that you turn up the volume on a car radio when you’re trying to find a station’s signal. The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it’s in the low-frequency range.
Most tinnitus is “sensorineural,” meaning that it’s due to hearing loss at the cochlea or cochlear nerve level. But tinnitus may originate in other places. Our bodies normally produce sounds (called somatic sounds) that we usually don’t notice because we are listening to external sounds. Anything that blocks normal hearing can bring somatic sounds to our attention.
If you develop tinnitus, it’s important to seek advice from a medical professional. Physicians can take a medical history, give you a physical examination, and do a series of tests to try to find the source of the problem. They will also ask you to describe the noise you’re hearing (including its pitch and sound quality, and whether it’s constant or periodic, steady or pulsatile) and the times and places in which you hear it. Physicians can also review your medical history, your current and past exposure to noise, and any medications or supplements you’re taking. Tinnitus can be a side effect of many medications, especially when taken at higher doses.
Musculoskeletal factors — jaw clenching, tooth grinding, prior injury, or muscle tension in the neck — sometimes make tinnitus more noticeable, so a physician may ask you to tighten muscles or move the jaw or neck in certain ways to see if the sound changes. If tight muscles are part of the problem, massage therapy may help relieve it.
Tinnitus that’s continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Pulsatile tinnitus calls for medical evaluation, especially if the noise is frequent or constant. MRI or CT imaging may be needed to check for a tumour or blood vessel abnormality.
Your general health can affect the severity and impact of tinnitus, so if you are seeking treatment, this is also a good time to take stock of your diet, physical activity, sleep, and stress level — and take steps to improve them. You may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.
If you’re often exposed to loud noises at work or at home, it’s important to reduce the risk of hearing loss (or further hearing loss) by using protectors such as earplugs or earmuff-like or custom-fitted devices.
Managing the symptoms of tinnitus
In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. No single approach works for everyone, and you may need to try various combinations of techniques before you find what works for you. If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds. This causes the brain and ear to focus on sounds around you rather than your own internal noise.
Here are some proven ways to help decrease the symptoms of tinnitus: