Tinnitus: Causes & Treatment Options
What is Tinnitus?
Tinnitus is the term for the perception of sound when no external sound is present. It is a physical condition experienced as noises in the ears or head, usually perceived as a ringing sound (and the condition 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. Its perceived volume can range from very soft to extremely loud.
Tinnitus is not a disease in itself. It is usually a symptom of a fault in a person’s auditory (hearing) system, and is usually associated with a hearing loss, and in particular sensorineural hearing loss. Sometimes tinnitus is present with normal hearing and for no discernible reason. Tinnitus can be extremely debilitating, affecting a person’s ability to work or cope with normal life activities.
People with tinnitus may suffer from:
- Extreme distress
- Tension, irritability or frustration
- Frequent mood swings or anxiety attacks
- Poor concentration
- Sleep problems
If you suspect you suffer from tinnitus, treat it as warning signal that you might be developing a hearing loss and make an appointment to see an audiologist for a hearing test.
How common is Tinnitus?
Research suggests that approximately 17-30 per cent of Australian’s suffer from some degree of tinnitus, varying from mild to severe. 15 per cent suffer constant annoyance as a result of the condition and one per cent reporting severe symptoms that affect the quality of their lives.
What causes Tinnitus?
Worldwide research continues but the actual cause or causes of tinnitus are not yet fully understood. We do know that tinnitus is real, not imagined, and that it is a symptom of a malfunction somewhere in the hearing system, including both the ear and brain. Spontaneous activity in the inner ear, or cochlear, is involved for many people, most likely a result of damage in this area associated with sensorineural hearing loss.
The more common causes of tinnitus include:
- Noise-induced hearing loss
- Age-related hearing loss
- Ear diseases and disorders
- Extreme stress or trauma
- Degeneration of the hair cells in the cochlear
- Ear problems, such as otosclerosis (fixation of the tiny stirrup bone in the middle ear)
- Meniere’s disease (swelling of a duct in the ear)
- Some medications.
Other causes of tinnitus may include:
- Head trauma
- Large doses of certain drugs such as aspirin (always check with your doctor whether the medication they are prescribing has a side effect of causing or exacerbating tinnitus)
- Compacted ear wax
- Middle ear infections
- Jaw misalignment (specifically dysfunction of the joint connecting the jaw to the bone under the ear)
- Perilymp fistula (a hole in the inner ear, allowing fluid to escape)
- Certain types of tumours
- Cardiovascular disease
- Thyroid disorders
Of these factors, exposure to loud noise and hearing loss are the most probable causes of tinnitus. When you first discover you have tinnitus you should consult your doctor, an audiologist and/or an ear, nose and throat specialist to check that you do not have an underlying medical condition.
What can make Tinnitus worse?
There are a number of likely factors which may make existing tinnitus worse:
Working in noisy surroundings, listening to loud music (both at concerts and through headphones), playing musical instruments, and exposure to other loud noises without using special protective equipment increases the risk of developing tinnitus as well as hearing loss. Even a single incident of exposure to an extremely loud noise (such as fireworks or other explosions, or a gun shot fired close to the ear) can result in tinnitus or hearing loss.
Earplugs or other hearing protection often prevents tinnitus that otherwise would be caused by excessive noise. You should always wear hearing protection when subjected to loud noise, even if you do not find the noise uncomfortable. Hearing loss at higher frequencies is often painless, and the most common result is tinnitus.
Stress & Fatigue
There is some evidence that stress makes tinnitus worse. Although stress is part of everyday life, you can take steps to reduce stress levels by using relaxation and stress management techniques that help you stay calm, think positively, and focus your energies outward and away from the tinnitus. Hypnotherapy can help with relaxation, and cognitive behavioural therapy offered by clinical psychologists, can help you to change the way you think about tinnitus, learn ways to focus your attention away from your tinnitus, and control the stress associated with tinnitus.
Medications & Other Substances
It is essential to tell your family doctor about your tinnitus; some common medications cause tinnitus as a side effect or make your existing tinnitus worse. Take special care with medications for arthritis, rheumatic diseases, some antibiotics, and anti-depressants. Excessive use of aspirin can also create issues; ask your doctor about alternatives.
Some foods and substances are also suspected of making tinnitus worse, although this has not been scientifically proven. While you don’t have to avoid them altogether, try easing off caffeine, quinine (tonic water) and alcohol as they can temporarily worsen tinnitus for some people. Carbohydrate-rich meals, like pasta, can have a calming or sedating effect, which can be helpful. However, give yourself time to digest your meal before you go to bed to avoid a disturbed sleep.
And avoid nicotine as smoking narrows your blood vessels which supply vital oxygen to your ears and their sensory cells.
Is there a cure for Tinnitus?
There is no definitive cure for tinnitus, however people affected can learn how to manage their tinnitus to the point where it is no longer a problem for them and they can go back to leading full and productive lives.
Tinnitus does not have to dramatically affect your quality of life. You should avoid focusing too much attention on your tinnitus and take steps to manage the condition. Avoid excessive noise, and find relaxation and stress management techniques that work for you, for example sport and exercise, hobbies, yoga, reflexology, or massage.
Treatment Options For Tinnitus
There are a variety of treatment options available that may help relieve your tinnitus symptoms ranging from physical products like hearing aids, to counselling to help deal with adverse emotional side effects such as depression and anxiety. Discuss with your audiologist what the best course of action is for your specific case of tinnitus.
Good quality and properly fitted hearing aids reduce and even eliminate most tinnitus associated with hearing losses. Hearing aids take away the strain of listening and distract from the tinnitus by bringing you more environmental sounds from the outside world. Click here to view some of the available styles from Oticon and Phonak.
Therapeutic Noise Generators
Therapeutic Noise Generator devices which look like hearing aids and are recommended for people with no hearing loss. These devices produce a blend of external sounds which stimulate most fibres of the hearing nerve, helping to deviate attention away from the tinnitus.
Tinnitus Retraining Therapy (TRT)
Tinnitus Retraining Therapy (TRT) aims to reduce and ultimately eliminate tinnitus perception. It combines auditory therapy (hearing aids and/or therapeutic noise generators), to provide the brain with maximum environmental sounds to reduce tinnitus perception. Directive counselling or cognitive behavioural therapy helps to change negative beliefs about tinnitus, distract you from focusing too much on the condition, and reduce stress.
There are no specific medications for the treatment of tinnitus. Sedatives and some other medications may prove helpful in the early stages for some people depending on the cause of the tinnitus. Vitamin B12 may be helpful and herbal remedies, if taken under medical supervision, may be of some use.
For the vast majority of people there is no specific surgical treatment for tinnitus. However, following successful surgical treatment for some ear problems e.g. otosclerosis, Meniere’s disease, middle ear infection, an existing tinnitus problem may sometimes disappear.