Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:
Most people with tinnitus also have hearing loss. Hence, hearing aids can be an effective part of any sound therapy. Hearing aids alone can provide partial or total relief from tinnitus. If you’re experiencing challenges with your hearing as well as tinnitus, a combination of a hearing solution with built-in sound generators can often be prescribed. You can expect improved levels of hearing which also helps to minimise the effects of the condition in the same way that sound therapy might.
If you're not sure of what is causing your tinnitus, a hearing care professional can help pinpoint the issue through a series of tests. It can be helpful to take notes of the sounds you are regularly or irregularly experience to help your hearing healthcare professional put together the clues to what may be causing it. Be sure to alert your practitioner of any pertinent medical history, medications or excessive noise exposure that could be playing a role in your tinnitus.
Ocean waves are designed to create a soothing environment, like that of the serene ocean waves. Miracle-Ear hearing aids offer four different ocean wave signals to choose from so that you can find the one that you find to be the most relaxing. Ocean waves are an alternative to static noise and can be found to be a stress-free type of tinnitus treatment. Your hearing care specialist will work with you to find the signal that offers the most relief.
Over the last 40 years of treating patients suffering from tinnitus, there’s been one over the counter medication that has shown the greatest promise. While it doesn’t provide relief for everyone, I continue to see an 87% efficacy rate in my patients. The treatment, which does not require a prescription, is known as Tinnitus Control and is available online at http://www.tinnituscontrol.com
^ Langguth B, Goodey R, Azevedo A, et al. (2007). "Consensus for tinnitus patient assessment and treatment outcome measurement: Tinnitus Research Initiative meeting, Regensburg, July 2006". Tinnitus: Pathophysiology and Treatment. Progress in Brain Research. 166. pp. 525–36. doi:10.1016/S0079-6123(07)66050-6. ISBN 978-0444531674. PMC 4283806. PMID 17956816.
Another thing that tinnitus and sleep problems share? A tendency among people to brush them off, and try to “tough it out,” rather than addressing their conditions. It’s not worth it, to your health or your quality of life. If you’re having trouble sleeping and you have symptoms that sound like tinnitus, talk with your doctor about both, so you can sleep better—and feel better— soon.
Some people experience a sound that beats in time with their pulse, known as pulsatile tinnitus or vascular tinnitus. Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow, increased blood turbulence near the ear, such as from atherosclerosis or venous hum, but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear. Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm or carotid artery dissection. Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be an indication of idiopathic intracranial hypertension. Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits).
Steven Doerr, MD, is a U.S. board-certified Emergency Medicine Physician. Dr. Doerr received his undergraduate degree in Spanish from the University of Colorado at Boulder. He graduated with his Medical Degree from the University Of Colorado Health Sciences Center in Denver, Colorado in 1998 and completed his residency training in Emergency Medicine from Denver Health Medical Center in Denver, Colorado in 2002, where he also served as Chief Resident.
These tests are usually performed instead of a traditional catheter angiography, which is more invasive and, while generally very safe, carries greater risk of complications. Angiography is an imaging technique that involves injecting dye into a small tube called a catheter that has been inserted into a blood vessel. An x-ray is then performed to assess the health of the vessels as well as the rate of blood flow.
CBT could potentially help people with tinnitus deal with fears that their tinnitus might be caused by brain damage or might lead to deafness. During CBT, they might learn that the condition is common and that it is not associated with brain damage or deafness. They might also be exposed to the sound in a safe environment, so that it has less of an impact on their daily life. CBT also involves techniques such as applied relaxation and mindfulness training.
TRT depends upon the natural ability of the brain to "habituate" a signal, to filter it out on a subconscious level so that it does not reach conscious perception. Habituation requires no conscious effort. People frequently habituate many auditory sounds -- air conditioners, computer fans, refrigerators, and gentle rain, among them. What they have in common is that they have no importance, so they are not perceived as ''loud.'' Thus, the brain can screen them out.
Now make your toes as tight as you can, really scrunch them up. Hold them like this for a moment – and relax. Now do the same with your ankles, then your calf muscles, your thighs… work all the way up your body to your head, making sure you tense, hold for a moment, and then release the tension. Once you’ve done this with your whole body, focus again on your breathing – notice the rhythm, it should be even and calm.
Tinnitus is commonly accompanied by hearing loss, and roughly 90% of persons with chronic tinnitus have some form of hearing loss (Davis and Rafaie, 2000; Lockwood et al, 2002). On the other hand, only about 30-40% of persons with hearing loss develop tinnitus. According to Park and Moon (2004), hearing impairment roughly doubles the odds of having tinnitus, and triples the odds of having annoying tinnitus.
Tinnitus also could be the result of neural circuits thrown out of balance when damage in the inner ear changes signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of abnormal interactions between neural circuits. The neural circuits involved in hearing aren’t solely dedicated to processing sound. They also communicate with other parts of the brain, such as the limbic region, which regulates mood and emotion.
Hair cells can be damaged by exposure to loud noise, which could lead to tinnitus. This can occur gradually as a result of exposure to noises over prolonged periods or may be caused by exposure to louder noises over a shorter period of time. If you are exposed to loud noises, you should always wear ear protection. Find out more about the subject on our How Loud Is Loud article and see if your job or lifestyle could be putting your ears at risk,
If you’re struggling with tinnitus and experience anxiety or depression relating to your condition, cognitive behavioural therapy is a form of counselling that helps you to cope and readjust your negative feelings. Tinnitus retraining therapy (TRT) can also be used in conjunction with CBT, harnessing the body's natural ability to tune out sounds and make it part of your subconscious mind rather than at the forefront.
Counseling helps you learn how to live with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.
Tinnitus is usually described as a ringing in the ears, but it can also sound like clicking, hissing, roaring, or buzzing. Tinnitus involves perceiving sound when no external noise is present. The sound can be very soft or very loud, and high-pitched or low-pitched. Some people hear it in one ear and others hear it in both. People with severe tinnitus may have problems hearing, working, or sleeping.
It is important to follow the doctor's directions in obtaining further evaluations and tests for your tinnitus. You may need an appointment with an ear, nose, and throat specialist (otolaryngologist) or an audiologist for further testing. It is important to follow up on these recommendations when they are made to confirm that your tinnitus is not caused by another illness.
A diagnosis of tinnitus is based upon identification of characteristic symptoms, a detailed patient history, a thorough clinical evaluation and complete audiologic testing. These steps will help to differentiate rhythmic tinnitus from non-rhythmic tinnitus. It cannot be overemphasized that tinnitus is a symptom of another underlying condition and not a diagnosis in and of itself. Because of the high number of underlying causes of tinnitus, a variety of specialized tests to detect the specific cause may be necessary. Attempting to identify the underlying cause of tinnitus is the first step in evaluating a person with tinnitus.
The researchers next tested whether tinnitus could be reversed in noise-exposed rats. The animals received VNS paired with various tones other than the tinnitus frequency 300 times a day for about 3 weeks. Rats that received the treatment showed behavioral changes indicating that the ringing had stopped. Neural responses in the brain's auditory cortex returned to their normal levels as well, indicating that the tinnitus had disappeared.
Tinnitus can be caused by a variety of less common underlying conditions or injuries. If you have tinnitus, start your treatment path by seeking out a hearing healthcare professional who specializes in tinnitus diagnostics so they can help identify the underlying cause. If the common causes for tinnitus are ruled out, the practitioner will refer you to another specialist for further evaluation. Listed below are related medical specialties who might be able to help you determine the cause of your tinnitus.
Once the music package (MP3 player preloaded with assigned music tracks and headphones) was ready, participants were briefed on safe listening levels, and were instructed to complete a weekly log book to record their listening duration and frequency. The algorithms which modified the music provided to participants are built into proprietary software that was developed internally by Sound Options Tinnitus Treatments Inc. The modified and placebo music packages consisted of 4 hours of classical music.
Antibiotics, including erythromycin, neomycin, polymysxin B and vancomycin, as well as cancer medications, including mechlorethamine and vincristine, and water pills, including bumetanide, furosemide or ethacrynic acid all have the ability to cause or worsen tinnitus. Some patients will experience tinnitus after using antidepressants or quinine medications.
Various techniques can help make tinnitus tolerable, although the ability to tolerate it varies from person to person. Many people find that background sound helps mask the tinnitus and helps them fall asleep. Some people play background music. Other people use a tinnitus masker, which is a device worn like a hearing aid that produces a constant level of neutral sounds. For the profoundly deaf, an implant in the cochlea (the organ of hearing) may reduce tinnitus but is only done for people with severe to profound hearing loss in both ears. If these standard techniques are not helpful, people may want to seek treatment in clinics that specialize in the treatment of tinnitus.
Approximately 50 million Americans have some form of tinnitus. For most people, the sensation usually lasts only a few minutes at a time. About 12 million people have constant or recurring tinnitus that interferes with their daily life so much that they seek professional treatment. For these individuals, tinnitus may result in a loss of sleep, interfere with concentration, and create negative emotional reactions such as despair, frustration, and depression.
The physician may also request an OAE test (which is very sensitive to noise induced hearing damage), an ECochG (looking for Meniere's disease and hydrops, an MRI/MRA test (scan of the brain), a VEMP (looking for damage to other parts of the ear) and several blood tests (ANA, B12, FTA, ESR, SMA-24, HBA-IC, fasting glucose, TSH, anti-microsomal antibodies).
Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.
Muscular tinnitus can be caused by several degenerative diseases that affect the head and neck including amyotrophic lateral sclerosis or multiple sclerosis. Myoclonus can also cause muscular tinnitus, especially palatal myoclonus, which is characterized by abnormal contractions of the muscles of the roof of the mouth. Spasms of the stapedial muscle (which attaches to the stapes bone or stirrup), which is the smallest muscle in the body, and tensor tympani muscle, both of which are located in the middle ear, have also been associated with objective tinnitus. Myoclonus or muscle spasms may be caused by an underlying disorder such as a tumor, tissue death caused by lack of oxygen (infarction), or degenerative disease, but it is most commonly a benign and self-limiting problem.
Somatic tinnitus is caused, worsened, or otherwise related to your body’s own sensory system. Sensory signals coming from various parts of the body are disrupted, causing a spasm that produces tinnitus. Those who have somatic tinnitus usually have it in only one ear. Depending on the root cause your doctor may come up with treatment options to alleviate the symptoms.
CBT involves working with a therapist or counselor, typically once per week, to identify and change negative thought patterns. CBT was initially developed as a treatment for depression and other psychological problems, but it seems to work well for people with tinnitus. Several studies and meta-reviews, including one published in the Korean Journal of Audiology, have found that CBT significantly improves irritation and annoyance that often comes with tinnitus.
Additional conditions that can cause pulsatile tinnitus include arterial bruit, abnormal passages or connections between the blood vessels of the outermost layer of the membrane (dura) that covers the brain and spinal cord (dural arteriovenous shunts), or conditions that cause increased pressure within the skull such as idiopathic intracranial hypertension (pseudotumor cerebri). Sigmoid sinus dehiscence may be associated with pseudotumor, but this connection has not been firmly established. It possible that cases of pulsatile tinnitus associated with pseudotumor may be caused by an undiagnosed SSWA. Head trauma, surgery, middle ear conductive hearing loss, and certain tumors can also cause pulsatile tinnitus. Obstructions within in the vessels that connect the heart and brain can also cause pulsatile tinnitus.
Diseases, illnesses and injuries. There are several medical conditions that can cause tinnitus. These include Meniere’s disease, temporomandibular joint disorders (TMJ), head or neck injuries, brain tumors, etc. Most people don’t know if they have Meniere’s disease until properly diagnosed. This RARE disease brings on dizziness, tinnitus and ear pressure that can last for a short period of time and then disappears. TMJ causes pain in your jaw muscles. With TMJ, you’ll often hear a clicking noise when chewing. TMJ has shown to influence your chances of developing tinnitus, so be sure to treat the condition in order to reduce your chances of getting tinnitus. Head and neck injuries have also been shown to cause tinnitus, so always wear your helmet when you’re out biking and drive safely when you’re in your car.Believe it or not, but tinnitus can be caused by something as simple as an ear infection. Don’t take ear infections lightly they can be devastating at any age. Brain tumors, while equally as rare as Meniere’s disease, can also generate tinnitus symptoms. While you can alleviate your tinnitus immediately with an over the counter tinnitus treatment, you should also seek the help of a tinnitus specialist in your area to determine what the underlying cause of your tinnitus is.
According to ATA, The American Tinnitus Association, 45 million Americans are struggling with tinnitus. In Germany the “Deutsche Tinnitus-Liga” estimates that 19 million Germans have experienced tinnitus, and that 2,7 million Germans have persistent tinnitus, of which 1 million have very severe tinnitus. The British Tinnitus Association estimates that 10% of the UK population suffers from tinnitus. Read more about the prevalence of tinnitus.
The yearlong Dutch trial gave adults with tinnitus a standard package of care or a programme which added cognitive behavioural therapy (CBT) to elements of standard therapy for tinnitus. CBT is a type of therapy that challenges people’s negative assumptions and feelings to help them overcome their worries. Compared with those given usual care, the group receiving specialised treatment reported improved quality of life, and reduced severity and impairment caused by tinnitus.
It is possible that the most common cause of pulsatile tinnitus is sigmoid sinus diverticulum and dehiscence, which can be collectively referred to as sinus wall abnormalities or SSWA. The sigmoid sinus is a blood carrying channel on the side of the brain that receives blood from veins within the brain. The blood eventually exits through the internal jugular vein. Sigmoid sinus diverticulum refers to the formation of small sac-like pouches (diverticula) that protrude through the wall of the sigmoid sinus into the mastoid bone behind the ear. Dehiscence refers to absence of part of the bone that surrounds the sigmoid sinus in the mastoid. It is unknown whether these conditions represent different parts of one disease process or spectrum, or whether they are two distinct conditions. These abnormalities cause pressure, blood flow, and noise changes within the sigmoid sinus, which ultimately results in pulsatile tinnitus. Narrowing of the blood vessel that leads into the sigmoid sinus, known as the transverse sinus, has also been associated with pulsatile tinnitus.
When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, the tinnitus is called nonotic (i.e. not otic). In some 30% of tinnitus cases, the tinnitus is influenced by the somatosensory system, for instance people can increase or decrease their tinnitus by moving their face, head, or neck. This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect.
Take medication for a thyroid disorder, if necessary. Tinnitus can be related to both hyperthyroidism, or an overactive thyroid, and hypothyroidism, or an underactive thyroid. Your doctor can check for swelling or lumps in your thyroid gland, which is in your throat, and order blood screens to test its function. If they find an issue, they’ll prescribe medication to regulate your thyroid hormone levels.
The best supported treatment for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) which can be delivered via the internet or in person. It decreases the amount of stress those with tinnitus feel. These benefits appear to be independent of any effect on depression or anxiety in an individual. Acceptance and commitment therapy (ACT) also shows promise in the treatment of tinnitus. Relaxation techniques may also be useful. A clinical protocol called Progressive Tinnitus Management for treatment of tinnitus has been developed by the United States Department of Veterans Affairs.
When we hear, sound waves travel through the ear into the cochlea, our hearing organ in the inner ear. The cochlea is lined with thousands of tiny sound-sensing cells called hair cells. These hair cells change the sound waves into electrical signals. The hearing nerve then sends these electrical signals to the hearing part of the brain, which analyses them and recognises them as sound.
Cartoon of the middle ear showing muscles that attach to ossicles (ear bones), and ear drum. The stapedius is attached to the stapes (of course -- horseshoe object above), while the tensor tympani is attached to the ear drum. While useful, be aware that there are multiple errors in this illustration from Loyola Medical School. With permission, from: http://www.meddean.luc.edu/lumen/meded/grossanatomy/dissector/mml/images/stap.jpg
Lidocaine, a medication used for the treatment of certain types of abnormal heart rhythms, has been shown to relieve tinnitus for some people, but it must be given intravenously or into the middle ear to be effective. However, the benefits of lidocaine are almost always outweighed by the risks of the drug and it is therefore not recommended and not used for tinnitus.