Tinnitus

Tinnitus is defined as “the internal perception of sound with the absence of acoustic stimulus” (Ref.8). Tinnitus can be in one ear or both, have internal or external triggers, be intermittent or constant, and can include more than one type of sound. Descriptions of tinnitus include: ringing, buzzing, humming, hissing, roaring, blowing, chirping, and whooshing. Tinnitus may be experienced in association with hearing loss and/or vestibular symptoms.

 

Tinnitus is often caused by damage somewhere in the auditory system, even when normal hearing is measured. The damage is frequently inside the organ of hearing (the cochlea) in the hair cells. The hair cells are responsible for sending acoustic or sound information to the brain. Normally, hair cells ‘fire’ or send information to the brain in response to sound, or an acoustic stimulus. When there is damage to the hair cells, they begin to randomly or spontaneously fire, which results in the tinnitus sound. This sound is a phantom sound generated internally due to damage. Tinnitus is sometimes compared to a ‘phantom limb’ which can occur when a person loses a limb. For example, although the hand might be severed, the person can still feel the sensation of moving their fingers despite the hand no longer being present. In a similar way, tinnitus is a phantom sound caused by the loss of hair cells (Ref. 12-15).

 

If tinnitus is accompanied with aural fullness, vertigo, or it is only on one side, the patient will require a hearing test, and a consult with an Otolaryngologist (also known as an Ear Nose and Throat physician) to rule out any other conditions. It is reported that tinnitus affects around 15% of people and between 70 and 90% of those who experience tinnitus also experience hearing loss (Ref. 9). A hearing test can be the first step in investigating tinnitus, as often times tinnitus becomes more bothersome when it is associated with hearing loss (Ref. 10), particularly presbycusis (age-related hearing loss).  The same high frequencies where one perceives their tinnitus are often the frequencies also affected by hearing loss. When hearing loss is present, an effective way to help the tinnitus is to treat the hearing loss by wearing properly fit hearing aids. This allows the patient to hear more sounds, creating a richer and fuller soundscape. Less time will be spent in quiet, reducing the chance of focusing on the tinnitus as well as the negative impact it has. In addition to having access to more sounds in the environment, hearing aids can be programmed to include a tinnitus masker setting, either with more classic maskers such as white noise, or with certain tones or chimes, meant to help the wearer habituate to their tinnitus over time.

 

Noise exposure is another very common cause of tinnitus, whether from short term or long term exposure (Ref. 10). With enough repeated exposure, the damage that causes the tinnitus can also lead to permanent hearing loss. However, it should be noted that tinnitus and hearing loss do not always occur together.

 

Other causes of tinnitus including head trauma, infections, medications, Meniere’s disease and strokes of the central nervous system (Ref. 8). Other potential causes include: temporomandibular joint issues, acoustic neuroma, dysfunction of the eustachian tube, otosclerosis (stiffening of the middle ear bones) (Ref. 10).

 

No matter the cause of tinnitus, individuals affected by it can have a range of reactions to their tinnitus. When there is a negative impact on a person’s life, it is important for them to learn about strategies for coping with their tinnitus. The most common treatments for tinnitus are Tinnitus Retraining Therapy (TRT), Cognitive Behavioural Therapy (CBT) and Progressive Tinnitus Management (Ref. 11). One may have difficulty finding an audiologist who specializes in these treatments for tinnitus; however more accessible strategies are becoming available through technology, including tinnitus maskers built into hearing aids, as well as applications (apps) for smartphones. These apps can guide the user through selecting their own sound therapy, relaxation and meditation routines, as well as provide written information to arm the user with knowledge. This can help the user feel more in control of their tinnitus, understand it in more detail, and have on-the-go strategies at their fingertips (Ref. 11).

 

Although there is no cure for tinnitus, it is important to realize there are steps to take to help manage tinnitus in day to day life.