What is Tinnitus?
Tinnitus (TIN-eh-tus or tin-EYE-tus) is the word that doctors use to describe sounds that seem to originate in one’s ears or head. Although commonly referred to as “ringing in the ear,” many people experience sounds that are not at all like ringing; reported sounds include a high-pitched whistle or whine, electricity, crickets, roaring or running water, sizzling, thumping, static and many others. If one ear is affected, the sound will usually be heard on one side, but often, when both ears are affected, patients describe sounds as “coming from the middle of my head.”
What Causes Tinnitus?
Tinnitus is a perception of sound created by the sound-perceiving neurons in the brain. The normal job of these neurons is to inform your brain that a certain sound has been detected by the hearing organ in your ear, the cochlea (COKE-lee-uh). Tinnitus is caused when these neurons fire on their own, sending signals to the brain without receiving any input from the cochlea. Usually this happens when there is some kind of relative hearing loss in the ear, and the sound-perceiving neurons are less active than they used to be. This hearing loss can be temporary or permanent, can be so mild as to not be perceived by the patient, and can even be stimulated when the hearing in the affected ear is technically normal, but one ear hears less well than the other. We joke with patients that these neurons are like bored toddlers, getting into trouble and calling attention to themselves when they don’t have enough to do! A certain amount of tinnitus seems to be normal; even healthy ears can occasionally stimulate brief and mild episodes of tinnitus, such as after noise exposure or in a very quiet environment. In fact, up to 60 percent of people with normal hearing will perceive some kind of sound when left in a sound-proof room for several hours. However, if tinnitus is frequent or continuous, is unilateral (heard only in one ear), or is pulsatile in nature (sounds like your heart-beat), the ears should be checked out by your ear, nose, and throat specialist with an ear examination and a complete hearing test.
How Can Tinnitus Be Treated?
Many people think that there is no treatment for tinnitus. This is not true! The foundation of tinnitus treatment is correcting an underlying hearing loss, if this is possible. For instance, tinnitus may be caused by wax obstructing the ear canal or by fluid behind the ear drum. Both of these problems can be corrected by your primary care doctor or otolaryngologist, and this can result in improvement of the symptom. The most common cause for tinnitus is age-related hearing loss, which begins as a decreased ability to hear high-pitched noises. Patients with this condition will often perceive a high-pitched sound (because the neurons responsible for the high pitched information are firing abnormally). Many patients fear that a hearing aid would make their ear noises worse, but the opposite is true: hearing aids that boost the high-frequency sounds will actually reduce the incidence of tinnitus in patients with age-related hearing loss by providing the misbehaving neurons with the stimulation that they have been missing.
There are other tinnitus treatments as well that are very important. Most sufferers know that the noises are worse when it’s quiet around them and worse when they are paying attention to them or “listening” for them. Many people find that some low-level background noise, such as music or white noise, suppresses the tinnitus. This can be helpful when tinnitus interferes with falling asleep. Also, patients are encouraged NOT to “listen” to the tinnitus and, if possible, to distract their attention elsewhere. Listening to the misbehaving neurons just encourages them. Also, tinnitus is made much worse by states of emotional upset, stress, anxiety, and depression. Especially in younger patients, it is also associated with TMJ (temporomandibular joint) problems, which can also be exacerbated by stress. These underlying factors must also be addressed for proper management of tinnitus. This may be accomplished through lifestyle changes such as increased exercise, stress reduction, psychotherapy or meditation and/or medications for anxiety or depression. Also, if TMJ problems exist, a bite-plate from your dentist may help enormously.
If you or someone you love suffers from tinnitus, I encourage you to seek an understanding of why it is there and what options exist for treatment. This begins with a trip to your primary doctor or otolaryngologist (ENT doctor), where a thorough ear exam and hearing test can be performed.
We look forward to helping you in your quest for quiet!