What is tinnitus?
Tinnitus is the term for a sound that occurs in an individual’s ear(s) or head but is not present in the environment. For most patients with tinnitus, the sound is only heard inside their head, and cannot be heard by others. The onset may be gradual or sudden. Many people connect the origin of their tinnitus to a specific event or a health-related sickness. Descriptions of the perceived sound range from ringing, whistling, beeping, screeching, roaring, crickets, ocean, steam/ air, hissing, clicking, to a pulse or heartbeat. More than one sound can be heard simultaneously. Some people hear musical tinnitus. Durations are reported as constant or intermittently present and lasting for seconds to hours or days. Some patients with tinnitus report a constant intensity throughout the day, while others report an increase in intensity first thing in the morning and late at night or when stressed or sleep-deprived. Some individuals report a correlation with ingestion of certain foods or drinks, or when exposed to noisy environments.
How Common is Tinnitus?
The incidence of tinnitus in the United States is approximately 30 million people. About 10 percent of the population will report experiencing tinnitus all of the time, and approximately 1 percent state that it affects quality of life. 44 percent of people with tinnitus have minimal hearing loss or have thresholds in the normal range of hearing sensitivity. 1 in 4 people states that their tinnitus is loud, while 1 in 5 describes the tinnitus as disabling.
Are Tinnitus and Hearing Loss Related?
The relationship between hearing loss and tinnitus can appear a bit confusing. There is no consistency for presence of hearing loss with tinnitus or even the degree of hearing loss and the perceived intensity of the sound. In other words, someone with a severe hearing loss will not necessarily have severe tinnitus, or tinnitus at all. Many people with tinnitus may have hearing sensitivity in the normal range. Many people with hearing loss will report having no tinnitus, although the presence of hearing loss is correlated with tinnitus for 90% of those with tinnitus. In patients who do have tinnitus and hearing loss, the tinnitus often improves or resolves when the hearing loss is treated.
What Causes Tinnitus?
Tinnitus is a symptom, not a disease. There are many potential causes, and often the specific cause for the individual cannot be determined. The causes include noise- or music exposure; natural aging process; sudden impact noises, such as firearms, incendiary device, or an automobile accident; a reaction to a medication; injury to the neck or head; and stress/ emotional distress.
The current thinking is that tinnitus is the symptom most noticed when there has been a change to the auditory nervous system, most notably to the inner ear (a loss of hair cells or sensory cells) and brainstem areas responsible for changing sound into electricity and sending it up to the sound processing center of the brain. Some scientists feel that tinnitus is a form of auditory hallucination that arises in this auditory cortex.
How do Patients Respond to Tinnitus?
Some patients learn how to ignore their tinnitus so that it becomes a minor health issue. For others, the tinnitus can be worrisome and even disabling. In many patients, tinnitus is associated with anxiety and stress. These patients report their tinnitus as a major symptom often accompanied by sleep deprivation, anxiety, depression, concentration difficulty, mood swings, and distress.
How is Tinnitus Evaluated?
Tinnitus evaluation typically begins with a visit to an Ear, Nose, and Throat (ENT) physician and a hearing assessment with an audiologist. The ENT physician will evaluate and treat relevant aspects of medical care for the person with tinnitus including any primary anatomical abnormalities that could be contributing. The audiologic assessment is integral to understanding unique aspects of each patient’s auditory challenges and tinnitus. It includes pure tone audiometry to evaluate the integrity of perception of sound in the major frequencies necessary to hear and understand spoken language. Speech audiometry is also performed to document speech clarity. Immittance measures check the middle ear health. Tinnitus evaluation is for assessing the tinnitus frequency, intensity, and ability to be masked. The Tinnitus Handicap Inventory, a questionnaire, is also completed by the patient, at intervals to determine the degree of difficulty and later the effectiveness of an approach.
What Treatment Options are Available for Patients with Tinnitus?
Tinnitus is unique in each patient, and requires a personalized treatment plan. There is no one-size-fits-all approach. Fortunately, treatment options for tinnitus have evolved over the past decade, and a variety of new treatments are now available for patients.
Tinnitus Sound Therapy
If some patients, Tinnitus Sound Therapy (TST) treatments are quite effective. There are many varieties of TST; however, the most successful appear to be those that incorporate sound to gently help the brain to habituate to the tinnitus. TST may also help to generate neural changes that counteract the awareness of tinnitus. Although complete resolution of the tinnitus is not always possible, reduction in the degree to which a patient noticed the tinnitus is typically able to be achieved.
Over time, with TST, tinnitus can become less present. Much like a candle in a dark room is highly noticeable, a candle in a well-lit room is barely noticeable. An auditory correlation would be hearing a solo musical instrument versus hearing that instrument when it plays in an orchestra. When concentrating, one can still hear the instrument but it is much less noticeable. By presenting very gentle sound to the ears through tinnitus sound therapy, the brain can eventually learn to pay less attention to the tinnitus.
In patients who have hearing loss as well as tinnitus, TST is easily incorporated in tiny digital hearing instruments. These hearing instruments are highly shapeable for style and sound. A barely-noticeable ocean sound can be presented through the instruments. Not only is it soothing to listen to the hearing instruments with the ocean sound present during waking hours, but also these soothing sounds target the tinnitus for after-use hours to reduce noticing then as well. The reduction in tinnitus noticing typically occurs gradually over time.
Levo System for Tinnitus
A new nighttime tinnitus sound therapy, the Levo system, can be worn while sleeping, to provide tinnitus sound therapy. In the form of a specialized iPod, the wearer uses it nightly to target their tinnitus. Reduction in tinnitus intensity should be noticeable in the first month, with further benefits out to three months. Many users continue the use of the Levo system at night in order to maintain their habituation benefits. A recent study done by researchers in the Veterans Administration system found this to be an effective means of tinnitus habituation. Given the favorable data on the efficacy of the Levo system for patients with tinnitus, Becker ENT recently partnered with Otoharmonics to make this new Levo technology available for our patients.
Most people find that keeping steady quiet sound or music present in their listening environment will help mask their tinnitus while awake and make it less noticeable. Apps on smart phones, as well as dedicated sound generators can present soothing music, nature sounds, or white noise through the air or via earphones. Some people find that audio books can provide a measure of sound relief and distraction.
Other supporting practices to help reduce the noticing of tinnitus include mindfulness exercises. These include yoga, other forms of physical exercise, wearing hearing protection in noisy settings, maintaining a healthy diet, and avoiding sound- or food triggers.
Is it Possible to Prevent Tinnitus?
One way to reduce the possibility of getting tinnitus is to keep a distance from noise or wear appropriate hearing protection. It is essential to wear hearing protection during all noisy activities such as when using heavy equipment and power tools, riding a motorcycle, using a snow blower or leaf blower. Musicians and music lovers should wear musician plugs during practicing, rehearsals, and concerts. The type of music does not change the risk of music-induced hearing loss. Musician plugs evenly attenuate the intensity level of all music and lyrics, keeping the ears safer while maintaining the wearer’s listening pleasure. Lyrics and conversation are preserved during use. Hunters can wear specialized hearing protection for use while hunting. Concert-goers and musicians, as well as hunters, must wear hearing protection at every exposure to effectively prevent hearing loss and subsequent tinnitus.
It is difficult for music lovers to know if their earbuds or speakers are playing at a dangerous level that may cause permanent inner ear hearing loss and tinnitus. In general, if others can hear the music of the earphone wearer, it is too loud. If you cannot carry on a conversation over the music through earphones or speakers, it can be potentially damaging.
If someone already has tinnitus but engages in noisy activities or music, it is still appropriate to choose the correct hearing protection to help to prevent further hearing loss and tinnitus. An audiologist can help guide you to the correct device if you are uncertain.
It is important to remember that tinnitus is a symptom of changes in the auditory system. Research in tinnitus understanding and methods of management are ongoing. Tinnitus sound therapies offer hope and help. The physicians and audiologists of Becker ENT are proud to provide personalized evaluation and management for each patient.