Tinnitus Information

What is tinnitus?

 Tinnitus is the term used for noises or sounds which are heard in one or both ears or in the head which do not come from an external source.  They are often described as a high-pitched ringing but can also be described as a buzzing, hissing, pulsing, whistling, roaring, or various other sounds.  Tinnitus can be very mild in loudness and only noticeable in a quiet room/bedtime or it can become extremely loud and annoying to the point where the sufferer hears nothing else.  It can be present all of the time, can be intermittent, and/or pulsing.  The loudness of the tinnitus often times varies in intensity depending on several factors such as stress, diet, noise exposure, etc.  Tinnitus, like chronic pain, is subjective.  Two people may report similar characteristics yet be affected in a significantly different manner.  The severity of the tinnitus is largely a function of the individual reaction to/or perception of, the tinnitus.  Many tinnitus sufferers have difficulty sleeping and/or concentrating, and many are depressed. 

 As many as 10-15% of the adult population suffer from tinnitus (3 million Canadians) with more than 20% of these seeking help for the condition because it is so severe they are incapacitated (600,000 Canadians).  While tinnitus does not cause hearing loss, it may accompany decreased hearing and other symptoms such as a feeling of pressure in the ear and/or unsteadiness, dizziness or vertigo.  But for many people with tinnitus it occurs alone with no other symptoms.

What causes tinnitus?

 The exact mechanism underlying tinnitus, what it is and where it is, is unknown at this time but research continues around the world.  Some of the causes of tinnitus are:

 Ø      Disorders in the outer ear such as excessive ear wax (cerumen), a foreign body, perforated eardrum, or a hair touching the eardrum.  Often times removal of the problem (wax, hair, etc.) will relieve the tinntius.

Ø      Disorders in the middle ear such as an ear infection, otosclerosis, or a benign tumor.

Ø      Disorders in the inner ear such as damage due to noise exposure, presbycusis (hearing loss from aging), and Meniere’s Disesase, which is also accompanied by episodic dizziness, nausea, ear pressure, and fluctuating hearing loss.  Noise exposure is the leading cause of tinnitus and is very preventable with the use of hearing protection.

Ø      Trauma to the head or neck, such as concussion or whiplash, can cause long-lasting tinnitus.

Ø      Certain medications can cause tinnitus.  They include anti-inflammatory drugs such as aspirin and quinine,  some sedatives and antidepressants, and certain antibiotics and chemotherapeutic agents including furosemide, cisplatinum, streptomycin, neomycin, and kanamycin.

Ø      One of the most difficult causes of tinnitus to diagnose is a vestibular schwannoma (acoustic neuroma) which is a small tumor pressing on the vestibular nerve leading from the cochlea to the brain.  Tinnitus may be the only initial symptom.

Ø      Various other causes such as high or low blood pressure, diabetes, vascular disorders, temporomandibular (jaw-joint) disorders, allergies, syphilis and thyroid dysfunction.

 Although the majority of people with tinnitus have an associated hearing loss, the presence of tinnitus does not mean that one has decreased hearing.

 Always remember that tinnitus is a symptom of a problem so referral to a doctor or audiologist is always recommended.

 Treatments Available For Tinnitus

 It is important to remember that tinnitus is a symptom, not a disease.  The initial treatment should be directed toward looking for a medically treatable cause of the tinnitus, as the tinnitus may be a symptom of a more serious disorder.   All people with tinnitus should have a complete audiological evaluation by a qualified audiologist who in turn can/will refer you to an otolaryngologist for a medical evaluation if it is warranted.

 Many doctors tell people with tinnitus that there is no medical cure for their condition so therefore nothing can be done; go home and get used to it!   This is not true.  Although there may be no cause/cure for the tinnitus, it can often be successfully managed.  There are various treatments available and they do not always work for everyone.  There are varying degrees of relief from one or more of the following treatments:

 Counseling – aimed at reducing the stress and distraction associated with the tinnitus.  It is important to change the person’s perception of the tinnitus.

 Stress Management and Relaxation – there is a high correlation between stress and an increase in the loudness of one’s tinnitus.  Many strategies aimed at reducing stress can be very effective at controlling tinnitus.

 Consideration of Diet – often high levels of salt and caffeine as well as nicotine can cause an increase in the perception of the loudness of the tinnitus.

 Support Groups for Tinnitus – can offer emotional support by sharing experiences and useful strategies for dealing with tinnitus.

 Auditory Habituation (TRT) -  this is a type of therapy whereby a noise is presented via “noise generators” into both ears at a soft enough evel such that the brain perceives both the noise and the tinnitus.  Eventually, over a period of 18-24 months, the brain may relearn a pattern that will de-emphasize the importance of the tinnitus (habituation).

 Amplification – if a hearing loss is present along with the tinnitus, which it often is, hearing aids can be very effective in relieving tinnitus as well as helping you hear better.  

Masking – the use of an external electronic device to produce sound which can cover up or mask the tinnitus can sometimes be very effective in providing relief from tinnitus.  Occasionally, through the use of masking, the tinnitus can be inhibited for short and sometimes long periods of time when the masking sound is removed (residual inhibition).  There are different types of maskers:

 ·        Tinnitus masker – is a hearing aid like electronic device which produces noise to help mask over the tinnitus.

 ·        Tinnitus instrument – a combined hearing aid plus a masker in one for people who have both a hearing loss and bothersome tinnitus.

 ·        Commercial noise generators – various types of electronic devices which produce different forms of masking sounds to provide relief from tinnitus.  Especially useful at night time when trying to get to sleep, ie. relaxation music with bedside maskers, CD player used in conjunction with a pillow speaker.  There are many systems of masking sounds/maskers on the market today that are made specifically for tinnitus sufferers.  Sometimes something as simple as a small fan can be an effective masker.

 Medications – there are no single medications that work on all tinnitus patients.  Much more research is needed in this area before an effective medication is found.  Certain anti-depressants and anti-anxiety medications have proven quite successful for the treatment of the stress/anxiety surrounding tinnitus.   As well some herbal medications have seen some success in the relief of tinnitus, ie. ginkgo biloba.

 Alternate approaches – some tinnitus patients have reported benefit from treatments such as hypnosis, acupuncture, chiropractic treatment, ear candling, naturopathy, etc., but have not been proven scientifically.

 Educate yourself about tinnitus – ask your local audiologist, visit your local library, or if you have access to a computer there are 100’s of websites on the internet dedicated to the treatment of tinnitus.

What is TRT?

 TRT stands for tinnitus retraining therapy, habituation therapy or sound therapy. It is not a cure and does not make your tinnitus go away. It basically involves training the person to ignore the sounds of their tinnitus just as you ignore the sounds of a fridge or car noise, etc.  The therapy also involves extensive counseling and education about their tinnitus.. The person is fit with small devices (noise generators) that look like hearing aids. These devices delivery low level sounds into the person’s ears and over a long period of time (i.e., up to 2 years) they learn to ignore their tinnitus sounds. This is a very important part, because the sound never leaves the person – the person is just not as bothered by the sounds. If the person has a significant hearing loss then hearing aids would relace the noise generators for delivering sound therapy. This therapy requires extensive training and should be done only in consultation with an Audiologist trained in TRT.

What is residual inhibition? Is it new?

 Residual inhibition is a well-known and researched phenomenon. It is used to describe a procedure whereby a person with tinnitus is exposed to a sound very similar to their tinnitus in a very controlled manner. For very few people, this procedure may reduce the sounds that they hear or make them disappear altogether. But the relief is only temporary.  That is, the procedure has to be repeated once the person’s tinnitus comes back. So it is not a cure. Certainly more research is needed before a specialist can commit to offering this to everyone with tinnitus.

What will work for my tinnitus?

 There is no cure for tinnitus, but it can be managed successfully. But before trying any treatment, a person with tinnitus should get a referral to an audiologist. The audiologist will perform a complete audiological evaluation, which usually will involve a referral to an Ear, Nose and Throat doctor to rule out any medical causes for the tinnitus. Often times there is nothing that can be done medically. However, there are a variety of treatments available and a qualified audiologist can outline them after a complete assessment.

I saw an Audiologist 6 months ago about my tinnitus. How come I am not in therapy(TRT)?

 A large number of people who have had a formal audiological evaluation combined with a short counseling session for their tinnitus do not require such intensive therapy. The initial evaluation/counseling tends to focus on providing the patient with reassurance, correct information, answering questions and taking the mystery out of the tinnitus. After the assessment and counseling, most people can “handle” their tinnitus. If you require further information, please contact your local audiologist to discuss your results.