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.

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.

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.

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.

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.

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.…

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.

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.

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.

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.

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.

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.