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Tinnitus

 Tinnitus refers to any noise or sound in your ear when no other sound is present.
Tinnitus can sound like ringing, hissing, roaring, pulsing, whooshing, chirping, whistling, or clicking.
Tinnitus can occur in one ear or both ears. Almost everyone at one time or another has experienced
brief periods of mild ringing or other sounds in the ear. Some people have more annoying and
constant types of tinnitus. One third of all adults experience tinnitus at some time in their lives.
About 10%–15% of adults have prolonged tinnitus requiring medical evaluation. The exact cause
of tinnitus is often not known. One thing is certain: Tinnitus is not imaginary.

Classification of Tinnitus
Tinnitus can be classified as either Subjective or Objective.
   -  Subjective tinnitus – only perceived by the patient, it is more common
   -  Objective tinnitus – sound produced by non-auditory structures in the ear, head or neck which

      may be heard by an examiner

What should I do if I have Tinnitus?

Since tinnitus is a symptom of a problem, the first thing you should do is to try to find out the

underlyingcause. You should have a medical examination with special attention given to checking
factors associated with tinnitus. A full hearing evaluation can identify hearing loss that may be
associated with the tinnitus. There are many possible causes of tinnitus, such as:
             Impacted wax (external ear)
             Ear infection
             Middle ear tumors
             Meniere's Disease
             Otosclerosis
             Vascular problems (circulation disorders)
             Ototoxic medicines (more than 200 medicines can cause tinnitus)
             Noise-induced hearing loss (inner ear)
             At the central level—the eighth cranial (auditory) nerve and other
                     tumors, migraine, and epilepsy


What treatment options are available for tinnitus?
The most effective treatment for tinnitus is to eliminate the underlying cause. Because tinnitus can be a symptom of a treatable medical condition, medical or surgical treatment may correct the tinnitus. Unfortunately, in many cases, the cause of tinnitus cannot be identified, or medical or surgical treatment is not an option. In these cases, the tinnitus itself may need to be treated. Be sure to discuss with your doctor any treatment options you are considering prior to beginning the treatment. Forms of tinnitus management include:
                 Biofeedback
                 Relaxation therapy
                 Counseling
                 Habituation therapies
                 Tinnitus maskers
                 Sound therapy

Tinnitus is usually managed through a combination of options. Audiologists and otolaryngologists (ear, nose, and throat doctors, or ENTs) routinely collaborate in identifying the cause and providing treatment. A treatment that is useful and successful for one person may not be appropriate for another.

Will a hearing aid help my tinnitus?
If you have a hearing loss, there is a good chance that a hearing aid will both relieve your tinnitus and help you hear. The audiologist can assist with the selection, fitting, and purchase of the most appropriate aid. The audiologist will also help train you to use the aid effectively. Many newer hearing aids also come with tinnitus programs.

    Listen to Dr. Jacobster's tinnitus interview for the Middletown Community Health Center, March 1, 2015
Closed Captioning available

The Tinnitus Assessment

Can Tinnitus Actually be Measured

Tinnitus cannot be measured objectively. Rather, the audiologist relies on information you provide in describing the tinnitus.

In the first part of the tinnitus evaluation, you will be given several questionnaires to complete. You may find them here.  You will be asked questions like:

   -  When did you first notice your tinnitus:
   -  Which ear is involved? Right? Left? Both?
   -  Is the ringing constant? Do you notice it more at certain times of the day?
   -  Can you describe the sound or the ringing?
   -  Does the sound have a pitch to it? High pitch? Low pitch?
   -  How loud does it seem? Does it seem loud or soft?
   -  Does the sound change or fluctuate?
   -  Do you notice conditions that make the tinnitus worse, e.g., when

           drinking caffeinated beverages, when taking particular medicines, or
           after exposure to noise?
   -  Does the tinnitus affect your sleep? Your work? Your ability to 

           concentrate?
   -  How annoying is it? Extremely so? Not terribly bothersome?

In discussing your answers to these questions, the audiologist can give you information that will increase understanding of your tinnitus. Understanding what is happening is often relief in itself.




Tinnitus can sound like anything from ringing, buzzing, hissing, crickets, clicking...just about anything.
In the Tinnitus evaluation, you will be in a soundproof booth and you will be tested using either headphones or insert earphones. There are several components to the evaluation. You will be asked to judge your tinnitus based on the following:

   -  Pitch (frequency) matching is intended to match the stimulus closest in pitch to your tinnitus.
   -  Loudness matching testing to match the loudness of your tinnitus to an auditory stimulus.
   -  Determination of the minimum masking level (MML) which is the softest  level of sound that just covers up your tinnitus.
   -  Tinnitus suppression (residual inhibition) where you hear a sound for 60 seconds and then judge if your tinnitus has changed.

Tinnitus Management
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Currently, there is no cure for most types of tinnitus. The goal of treatment is to manage our tinnitus and enable you to habituate so that you are not aware of your tinnitus and it no longer has a negative impact on your life. The most effective way to manage tinnitus is through a combination of some type of sound therapy and counseling.

Sound Therapy
Various treatment strategies utilize sound to decrease the loudness or prominence of tinnitus.  Sound therapies can include both wearable (hearing aid-like devices) and non-wearable devices (such as table-top sound machines or even a whirring fan). Often, sound, like white noise, is used to completely or partially cover the tinnitus. Some people refer to this covering of sound as masking.


Cognitive Behavioral Therapy
Cognitive behavioral therapy is a type of counseling that is based on treating a patient's emotional reaction to tinnitus rather than the tinnitus itself. To accomplish this desired change in perception, a counselor will help the patient identify negative behaviors and thought patterns, then alter them. Counseling programs are individually designed for patients and are most effective when coupled with other tinnitus treatments, such as masking or medication.


Drug Therapy
Many drugs have been researched and studied in an attempt to relieve tinnitus. Presently, there is no known drug or medication that has been clinically shown to eliminate tinnitus.

When taking any drug, it is important to discuss the side effects with your physician. For an article on Ototoxic drugs and other supplements that can cause tinnitus,
click here



Tinnitus FAQ


1) First of all, how is it pronounced? Tin-ni-TIS or ti-NITE-is??? 
It’s pronounced either ti-NIGHT-us or TIN-i-tus. Both pronunciations are correct. The word is of Latin origin, from tinnire meaning "to ring or tinkle like a bell."  

2) Exactly what is Tinnitus? 
Tinnitus is the medical term for the perception of sound in one or both ears or in the head when no external sound is present. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, chirping or clicking. Tinnitus can be intermittent or constant-with single or multiple tones-and its perceived volume can range from subtle to shattering.  It is important to remember that Tinnitus itself is NOT a disease, but rather a symptom of something else.  

3) How prevalent is it?
According to the latest census by the CDC, approximately 50 million people in the United States experience tinnitus to some degree. Of these, about 16 million have it severe enough tinnitus to seek medical attention and about two million patients are so seriously debilitated that they cannot function on a "normal," day-to-day basis. 


4) What affect does tinnitus have on someone’s lifestyle?
The affects can range from barely noticing it at all, to severe debilitation, anxiety, depression, and even thoughts of suicide. Most commonly, tinnitus can interfere with concentration, especially in quiet, communication if it’s loud enough, and sleep – being able to fall and or stay asleep.  

5) What role does depression play in tinnitus?
Depression is the “Catch-22” of tinnitus. Although depression does not necessarily “cause” tinnitus, it can make your reaction to it exaggerated. You begin to perceive the tinnitus as going from bad to worse. And that can add to depression. Tinnitus severity is a very personal and subjective thing. A person’s overall personality contributes to their perception and management of their tinnitus. It can be a vicious cycle. 

6) Are there different types of tinnitus?
Tinnitus is divided into Subjective tinnitus and Objective tinnitus. Most people experience Subjective Tinnitus, that is, tinnitus that is only heard by the person. This type of tinnitus can be a ringing, buzzing, crickets, humming….It can be in one ear or both ears, it can be constant or permanent. Objective tinnitus can actually be heard by someone else, such as a doctor. This tinnitus is usually pulsatile – like a heartbeat – and is usually caused by a circulatory problem. Sometimes it can also be a clicking sound and caused by muscular contractions or even the cracking of the jaw.  Some tinnitus can even be caused by certain head movements.  

7) What are some of the more common – and maybe not so common – causes of tinnitus? The most common cause of subjective tinnitus is hearing loss, or some type of damage to the auditory system. This damage can be caused by wax, middle ear problem, growths, certain ototoxic drugs or, most commonly, noise. Other causes can be system wide such as high cholesterol, high blood pressure, certain viral or bacterial diseases such as Lyme Disease, thyroid disease, sinus problems, fibromyaglia, TMJ, allergies.…  


8) You mentioned Ototoxic drugs. Exactly what are those?
Ototoxic drugs are medications that are harmful or damaging to the ear. They can cause hearing loss, balance disorders, and/or tinnitus. They can be antibiotics, diuretics, blood pressure meds, psychotropic drugs. etc. The effects depend on dosage and duration and can be permanent or temporary. It is important to discuss your medications with your physician if you experience any side effects or worsening of symptoms. It is very important NEVER TO STOP OR CHANGE A DOSE without speaking to your doctor.  

9) If someone thinks they have tinnitus, what should they do?
Well, the first thing they should do is talk to their physician. Tinnitus should not be ignored. Remember, tinnitus is a SYMPTOM, not a disease, so you should always rule out a medically treatable cause of the tinnitus. Unfortunately, most physicians don’t know much about tinnitus and will usually just brush you off and tell you to just live with it.. Next step should be to see an audiologist who specializes in tinnitus, who can take a complete history and do a complete audiological and tinnitus evaluation. You will consult other medical professionals as well, such as an otolaryngologist, possibly a neurologist, or even a psychologist or psychiatrist.   

10) What is a Tinnitus Evaluation?
There are several parts to a Tinnitus Evaluation. An Audiologist does the Audiological evaluation to determine any hearing loss. Then the Tinnitus itself is evaluated for pitch, loudness, masking and residual inhibition, that is – can the tinnitus be suppressed by any other sounds? There are also various questionnaires to be completed such as the Tinnitus History, Tinnitus Handicap Inventory and the Tinnitus Function Index. All these questionnaires help in determining how the tinnitus affects lifestyle, how it affects communication, how depressed the tinnitus patient is, etc. Also part of the evaluation is a complete physical exam including bloodwork, possibly even CT and MRI scans if indicated.  

11) Are there any other hearing problems that can accompany tinnitus?
Yes, very often people with tinnitus also claim they are sensitive to certain sounds that these sound “hurt” their ear, or that normal sounds are unbearably loud. Others complain that they actually avoid certain sounds because they elicit such a negative response, such as fear, pain, etc. Hyperacusis is defined as a collapsed tolerance to normal environmental sounds such as a baby crying or turning the pages of a newspaper. Misophonia is an actual hatred of certain sounds because of the intense emotional response. Hearing someone eating with their mouth open, sneezing, coughing, sniffling or chewing….You can feel enraged when someone makes repetitive noises like tapping, clicking a pen, typing on a keyboard, eating crunchy foods or making other sounds.  

12) What treatment options are available for tinnitus?
If there is no medical treatment available, assuming any medical reason has been ruled out, there are several options for treatment. The most successful ones involved some type of sound therapy, such as hearing aids if there is a hearing loss, or a sound machine…that makes the tinnitus less noticeable. We don’t want to mask or cover up the tinnitus, but rather we want you to “habituate” or get used to the tinnitus so you no longer notice it. The second part of treatment of treatment involves some type of counseling, or cognitive behavioral intervention to alter your response to the tinnitus. This can also involve meditation and relaxation techniques. Very important is to avoid pills or drugs or treatments that claim an immediate and complete cure. If it’s too good to be true, it is. And we don’t really “cure” tinnitus at this point, we “treat” it.  

13) Is there any way to prevent tinnitus?
Well, since the leading cause of tinnitus is hearing loss, the best thing to do is take care of your hearing. Avoid noise, keep healthy, try to avoid or limit certain medications, exercise, avoid or limit stress.  

14) Are there any resources for the public to learn more about tinnitus?
The best resource is the American Tinnitus Association ATA.org. There is a wealth of info on their site as well as a list of professionals who evaluate and treat tinnitus.You can edit text on your website by double clicking on a text box on your website. Alternatively, when you select a text box a settings menu will appear. Selecting 'Edit Text' from this menu will also allow you to edit the text within this text box. Remember to keep your wording friendly, approachable and easy to understand as if you were talking to your customer.




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