Tinnitus—the false perception of sound in the absence of an acoustic stimulus, a phantom noise—is one of the most common clinical syndromes in the United States, affecting 12 % men and 14% women who are sixty-five and older; which accounts for 1 in 5 people. It only rarely afflicts the young, with one significant exception: those serving in the armed forces. Tinnitus affects nearly half the soldiers exposed to blasts in Iraq and Afghanistan. Tinnitus is often described as ringing in the ears, but that’s not the only sound that qualifies. It can also present as buzzing, roaring, clicking, hissing, or a noise like crickets, among other things. A type known as pulsatile tinnitus is rhythmic, often keeping time with the person’s heartbeat.
Normally, the outer ear, known as the pinna, collects sound waves and directs them into the ear canal, which carries the sound waves to the eardrum. In turn, the eardrum vibrates, and these tremors are picked up by the three tiny bones in the middle ear: the malleus (resembling a club), the incus (shaped like an anvil), and the stapes (similar to a stirrup). These bones amplify the sound vibrations and transmit them to the inner ear, where the cochlea converts the vibrations into electrical impulses, which travel from the acoustic nerve to the part of the brain that processes sound, the auditory cortex. Tinnitus can be temporary, caused by excess wax, an infection of the inner ear, or the toxic effects of drugs like aspirin (which appears to weaken the neural signals from the ear to the brain) or those used to treat cancer. Some people with normal hearing develop spontaneous tinnitus when placed in total silence; this is believed to be a response of the auditory cortex to the abnormal absence of all ambient sounds. But the majority of people with chronic symptoms develop them in conjunction with hearing loss. With the recent proliferation of MP3 players, rates of hearing loss and tinnitus may rise sharply in the coming years.
The health related causes for tinnitus includes:
Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.
People who work in noisy environments—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss.
Tinnitus involves the annoying sensation of hearing sound when no external sound is present. Tinnitus symptoms include these types of phantom noises in your ears:
The phantom noise may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears. In some cases, the sound can be so loud it can interfere with your ability to concentrate or hear actual sound. Tinnitus may be present all the time, or it may come and go.
There are two kinds of tinnitus.
The first thing is to see your primary care doctor, who will check if anything, such as ear wax, is blocking the ear canal. Your doctor will ask you about your current health, medical conditions, and medications to find out if an underlying condition is causing your tinnitus.
If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.
Questions that a doctor might ask include:
Tests may include:
The first step is to treat any underlying cause of tinnitus.
This may involve:
There is no cure for most cases of tinnitus. Most people become accustomed to it and learn to tune it out. Ignoring it rather than focusing on it can provide relief.
When this does not work, the individual may benefit from treatment for the effects of tinnitus, insomnia, anxiety, hearing difficulties, social isolation, and depression. Dealing with these issues can significantly improve a person’s quality of life.
Here are some other things a person can do to manage tinnitus and its effects.
Sound therapy uses external noise to mask the individual’s perception of tinnitus. Low-level background music, white noise, or specialized ear maskers can help. The choice of sound should be pleasant to the individual. Masking devices offer temporary relief, and the awareness of tinnitus returns when the sound therapy is turned off. Hearing aids are a common type of sound therapy. They amplify environmental sounds and redirect attention to those noises instead of the tinnitus.
Tinnitus retraining therapy (TRT) involves retraining the auditory system to accept the abnormal sounds of tinnitus as natural rather than disruptive. It involves help from a trained professional and wearing a device that emits low-level white noise. Ongoing counseling sessions can help people cope with the tinnitus. This therapy’s success is proportionate to the severity of the tinnitus and the individual’s overall mental health. Follow-up studies suggest that TRT provides relief for around 80 percent of people with tinnitus.
Other techniques to mitigate the impact of tinnitus includes:
n 2009, the National Institute on Deafness and Other Communication Disorders (NIDCD) sponsored a workshop that brought together tinnitus researchers to talk about the condition and develop fresh ideas for potential cures. During the course of the workshop, participants discussed a number of promising research directions, including: