Psychological research has looked at the tinnitus distress reaction (TDR) to account for differences in tinnitus severity. These findings suggest that at the initial perception of tinnitus, conditioning links tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. This enhances activity in the limbic system and autonomic nervous system, thus increasing tinnitus awareness and annoyance.
Tinnitus is a non-curable, invisible and debilitating hearing disorder that can take on many different forms – ringing, hissing, buzzing, and even the sound of crickets. Almost everyone has experienced brief periods of mild tinnitus, but for many, this sound can be permanent. Over 360,000 Canadians report suffering from chronic tinnitus, and almost half of those are severely affected.1 In the US, over 16 million tinnitus sufferers seek treatment every year.2 Tinnitus is the number one disability claim for US veterans3 and has also become the top disability claim for current and former male RCMP members.4 This persistent sound can have a serious impact on quality of life; leading to sleep deprivation, depression, anxiety, and even suicide. What adds to the challenges faced by tinnitus sufferers is a lack of knowledge, support and options available to them. Unfortunately, there are currently too few health care professionals providing services to tinnitus sufferers who are seeking ways to manage their tinnitus. Unfortunately, the phrase “learn to live with it” is still heard far too often by those that seek help for tinnitus.
Individuals with tinnitus describe perceiving a wide variety of sounds including ringing, clicking, hissing, humming, chirping, buzzing, whistling, whooshing, roaring, and/or whirling. These sounds may be present at all times, or they may come and go. The volume, pitch or quality of tinnitus sounds can fluctuate as well. Some people report that their tinnitus is most obvious when outside sounds are low (i.e. during the night). Other individuals describe their tinnitus as loud even in the presence of external sounds or noise, and some describe it as exacerbated by sounds. Tinnitus can affect one ear or both ears. It can also sound like it is inside the head and not in the ears at all.
Meniere’s disease isn’t directly connected to tinnitus, but people with Meniere’s often experience it, at least temporarily. Meniere's disease is an inner ear disease that typically only affects one ear. This disease can cause pressure or pain in the ear, severe cases of dizziness or vertigo and a ringing or roaring tinnitus. While Meniere’s isn’t fully understood, it appears that several relief options for tinnitus can also help with this disease. Patients are often advised to reduce stress and lower their consumption of caffeine and sodium.
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.
As of 2014 there were no medications effective for idiopathic tinnitus. There is not enough evidence to determine if antidepressants or acamprosate are useful. While there is tentative evidence for benzodiazepines, it is insufficient to support usage. Usefulness of melatonin, as of 2015, is unclear. It is unclear if anticonvulsants are useful for treating tinnitus. Steroid injections into the middle ear also do not seem to be effective.
Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.
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.
Until recently, most tinnitus patients had little reason to believe doctors would ever be able to completely cure or reverse the affliction. Drug therapies had consistently failed, and so had more invasive procedures — including some surgeries to remove the auditory nerve that transmits sound from the ear to the brain, according to past research. (1,2)
^ Jump up to: a b c Han BI, Lee HW, Kim TY, Lim JS, Shin KS (March 2009). "Tinnitus: characteristics, causes, mechanisms, and treatments". Journal of Clinical Neurology. 5 (1): 11–19. doi:10.3988/jcn.2009.5.1.11. PMC 2686891. PMID 19513328. About 75% of new cases are related to emotional stress as the trigger factor rather than to precipitants involving cochlear lesions.
However, the multidisciplinary approach based on CBT is not a “cure for tinnitus”, as implied in some papers, but rather a system for managing its symptoms and effects on people’s lives. The differences in outcomes between the treatment and usual care groups were quite small, with the multidisciplinary approach giving a small improvement in quality of life compared with usual care, and moderate improvements in tinnitus severity and impairment. Also, less than 70% of participants completed the trial to 12 months, and this could have affected the reliability of the study’s overall results. Furthermore, as the patients in the study were only followed for 12 months, it is uncertain whether this approach can help in the longer term.
White noise machines. These devices, which produce simulated environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night.
Many of the press headlines mentioned that listening to the sound of the sea could help tinnitus, with the Metro claiming this could cure the condition. However, sound therapies that try to neutralise tinnitus using soothing sounds, such as waves or birdsong, are not new, but are part of standard treatments for this condition. Also, the report in the Lancet did not state what kind of sounds were used as therapy. Sound therapy was not the only treatment approach used, but was given as part of a specialised treatment programme delivered by expert health professionals.
The important thing to remember about tinnitus is that the brain’s response to these random electrical signals determines whether or not a person is annoyed by their tinnitus or not. Magnetoencephalography (MEG, for short) studies have been used to study tinnitus and the brain. MEG takes advantage of the fact that every time neurons send each other signals, their electric current creates a tiny magnetic field. MEG allows scientists to detect such changing patterns of activity in the brain 100 times per second. These studies indicated tinnitus affects the entire brain and helps with understanding why certain therapies are more effective than others.
High-pitched ringing. Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However, if there's hearing loss as well, tinnitus may be permanent. Long-term noise exposure, age-related hearing loss or medications can cause a continuous, high-pitched ringing in both ears. Acoustic neuroma can cause continuous, high-pitched ringing in one ear.
In addition, a healthy lifestyle can reduce the impact of tinnitus. Avoid physical and emotional stress, as these can cause or intensify tinnitus. You may be able to reduce your stress levels through exercise, meditation, deep breathing, or massage therapy. If you suffer from high blood pressure, consult your doctor for help controlling it, as this can also impact tinnitus. Finally, get plenty of rest to avoid fatigue and exercise regularly to improve your circulation. Although this won’t eliminate the ringing in your ears, it may prevent it from worsening.
Age-Related Hearing Loss: Also known as presbycusis, age-related hearing loss results from the cumulative effect of aging on hearing. This permanent, progressive, and sensorineural condition is most pronounced at higher frequencies. It commonly impacts people over the age of 50, as all people begin to lose approximately 0.5% of the inner ear’s hair cells annually starting at age 40.
Masking. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off. A specialized device isn't always necessary for masking; often, playing music or having a radio, fan, or white-noise machine on in the background is enough. Although there's not enough evidence from randomized trials to draw any conclusions about the effectiveness of masking, hearing experts often recommend a trial of simple masking strategies (such as setting a radio at low volume between stations) before they turn to more expensive options.
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.
A disorder of the inner ear, Ménière’s disease typically affects hearing and balance and may cause debilitating vertigo, hearing loss, and tinnitus. People who suffer from Ménière’s disease often report a feeling of fullness or pressure in the ear (it typically affects only one ear). The condition most often impacts people in their 40s and 50s, but it can afflict people of all ages, including children. Although treatments can relieve the symptoms of Ménière’s disease and minimize its long-term influence, it is a chronic condition with no true cure.
One group of 247 patients received standard (usual) care for tinnitus. This included audiological checks, counselling, prescription of a hearing aid if indicated, prescription of a “masker” if requested by the patient (a device that generates neutral sounds to distract from the noise of the tinnitus), and counselling from social workers when required.
While there may be a wide range of causes, an important underlying factor for the development of tinnitus is brain plasticity.5,7 This property allows the brain to change and adapt, and it is essential to how we learn. Unfortunately, in some cases, such as with hearing loss, the auditory part of the brain may be altered as brain plasticity tries to compensate for the abnormal auditory inputs. This response leads to changes in brain activity in the auditory system (e.g., the auditory cortex) that can create a phantom percept: tinnitus. As such, while tinnitus may begin a problem at the auditory periphery, it persists because of changes throughout the auditory system. Treating tinnitus may require addressing both the initiator (e.g., hearing loss) and the driver (changes in the auditory brain).
Tinnitus affects males and females in equal numbers. It can affect individuals of any age, even children. Tinnitus, collectively, is a very common condition and estimated to affect approximately 10% of the general population. Rhythmic tinnitus occurs far less frequently than non-rhythmic tinnitus, accounting for approximately 1% of all cases of tinnitus and is considered relatively rare in the general population. The exact prevalence or incidence of rhythmic tinnitus is unknown. Rhythmic tinnitus due to pseudotumor and sinus wall anomalies is found most commonly in overweight women in their 3rd to 6th decade of life. The onset of tinnitus can be abrupt or develop slowly over time.
Along the path a hearing signal travels to get from the inner ear to the brain, there are many places where things can go wrong to cause tinnitus. If scientists can understand what goes on in the brain to start tinnitus and cause it to persist, they can look for those places in the system where a therapeutic intervention could stop tinnitus in its tracks.
Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.
While tinnitus is as varied as its causes, it can be grouped into two categories: tonal and non-tonal. Tonal tinnitus is more common and describes the perception of a near-continuous sound or overlapping sounds with a well-defined frequency (e.g., whistling, ringing, buzzing). Non-tonal forms of tinnitus include humming, clicking, crackling, and rumbling.
Hearing loss: Probably the most common cause for tinnitus is hearing loss. As we age, or because of trauma to the ear (through noise, drugs, or chemicals), the portion of the ear that allows us to hear, the cochlea, becomes damaged. Current theories suggest that because the cochlea is no longer sending the normal signals to the brain, the brain becomes confused and essentially develops its own noise to make up for the lack of normal sound signals. This then is interpreted as a sound, tinnitus. This tinnitus can be made worse by anything that makes our hearing worse, such as ear infections or excess wax in the ear.
Patients with head or neck injury may have particularly loud and disturbing tinnitus (Folmer and Griest, 2003). Tinnitus due to neck injury is the most common type of "somatic tinnitus". Somatic tinnitus means that the tinnitus is coming from something other than the inner ear. Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. This is thought to be due to somatic modulation of tinnitus. We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.
Ear protection can mitigate the negative effects of loud noises and prevent the exacerbation of tinnitus. This is especially important if you work in a loud environment or regularly visit loud places, like shooting ranges, concerts, and clubs. Wearing custom earplugs or special earmuffs can go a long way toward preventing your tinnitus from worsening.
Herbal home remedies (ginkgo biloba, melatonin), and the vitamin zinc are not recommended by the American Academy of Otolaryngology. Lipo-flavonoid is a supplement being marketed as a way to relieve tinnitus, but there is no current evidence it is effective for most cases of the condition; however, it may be helpful for symptoms of Meniere's disease. Check with your doctor or other health care professional before taking any herbal or over-the-counter (OTC) natural remedies.
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.
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.
There are two types of tinnitus: subjective tinnitus and objective tinnitus. Tinnitus is usually subjective, meaning that there is no sound detectable by other means. Subjective tinnitus has also been called "tinnitus aurium", "non-auditory" or "non-vibratory" tinnitus. In very rare cases tinnitus can be heard by someone else using a stethoscope, and in less rare – but still uncommon – cases it can be measured as a spontaneous otoacoustic emission (SOAE) in the ear canal. In such cases it is objective tinnitus, also called "pseudo-tinnitus" or "vibratory" tinnitus.
FACT: Many people with tinnitus will also have a hearing loss. In fact, a recent French study showed that of 123 people with tinnitus surveyed only one did not have hearing loss. The British Tinnitus Association estimates that 90 percent of people with tinnitus also have a hearing loss. Moreover, research says that those who don’t may have a “hidden hearing loss.”
Spontaneous otoacoustic emissions (SOAEs), which are faint high-frequency tones that are produced in the inner ear and can be measured in the ear canal with a sensitive microphone, may also cause tinnitus. About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus,[need quotation to verify] while the percentage of all cases of tinnitus caused by SOAEs is estimated at about 4%.
Objective tinnitus is very rare. It can be heard by a doctor either using a stethoscope or by listening very closely to your ear. It occurs rarely and may due to involuntary muscle contractions or vascular deformities. The sound is often described as pulsating and may be heard in time with your heartbeat. Objective tinnitus usually has a determinable cause and disappears when treated by surgery or other medical intervention.
It is important to note that existing hearing loss is sometimes not directly observable by the patient, who may not perceive any lost frequencies. But this this does not mean that hearing damage has not been done. A trained audiologist or other hearing health professional can perform sensitive audiometric tests to precisely measure the true extent of hearing loss.
Why is tinnitus so disruptive to sleep? Often, it’s because tinnitus sounds become more apparent at night, in a quiet bedroom. The noises of daily life can help minimize the aggravation and disruptiveness of tinnitus sounds. But if your bedroom is too quiet, you may perceive those sounds more strongly when you try to fall asleep—and not be able to drift off easily.
In the advance online edition of Nature on January 12, 2011, the researchers reported that the number of neurons tuned to the high frequency had jumped by 79% compared to control rats. The scientist then tested 2 different tones in a second group of rats but stimulated the vagus nerve only for the higher one. The neurons tuned to the higher tone increased by 70%, while those tuned to the lower one decreased in number. This showed that the tone alone wasn’t enough to initiate the change; it had to be accompanied by VNS.
If you have tinnitus, you might be feeling frustrated and helpless, but there is hope! The first step is to consult a hearing care professional at one of our consumer-reviewed clinics. There are also audiologists who specialize in managing tinnitus and many non-medical ways to help you regain your quality of life. Learn more through the links here and, when you’re ready, let us help you connect with a professional in your area.