07 Apr Tinnitus
Tinnitus is the name given to a condition where you can hear a sound in your ear, ears or head where no external sound is present and there seems to be no apparent cause.
The Tinnitus Improvement Program is designed to help you reduce, relieve or even ‘cure’ your tinnitus, depending on your individual type of Tinnitus and circumstances. For more details please click here.
There are two pronunciations of the word Tinnitus – “TIN – it – tus” and “Tin – NIGHT – us”. Both are acceptable and come from the Latin word for ringing – very appropriate as many describe it as ‘ear ringing’ though the sound can vary considerably.
In some people it can be barely audible, more like a quiet, background noise, whilst in others it can seem to be almost deafeningly loud, even drowning out external sounds.
Types of Tinnitus Sounds
The sound of Tinnitus is often described as ringing but takes different forms in different people. Here are the most common descriptions of the tinnitus sound.
Ringing, Whistling, Whining, Buzzing, Hissing, Whooshing, Jet Noise, Screaming, Roaring, Crickets, Tree Frogs, white noise such as wind or ocean waves, pulsing, high pitched and so on…
It is often referred to as a ‘phantom sound’ because no-one else can hear it – known as ‘Subjective Tinnitus” and there is no apparent cause – but there are cases where others can hear the sound too – this is called Objective Tinnitus. Sometimes the sound comes and goes intermittently, other times it is continuous, but the amount of suffering seems to depend on the individual person, not necessarily the nature of the sound.
Types of Tinnitus
It is important to understand that Tinnitus is an umbrella name to cover a wide range of similar symptoms, so is not an illness or disease in itself, but the result of a whole variety of different underlying causes. Two main medical differentiations are Objective Tinnitus (where others can hear the sound too) and Subjective Tinnitus (only the sufferer can perceive it). It can also be differentiated by Unilateral (one ear) or Bilateral (both ears), or other more experiential differences such as Pulsatile – which pulses, for example.
Although quite rare compared to subjective Tinnitus, in some cases clinicians can perceive a real, actual sound emanating from a persons ear. When the sound can be heard by someone else, this is called Objective Tinnitus.
It is believed this might be caused by muscle spasms that cause clicks or crackling in the middle ear, or by increased blood flow in the arteries, which then becomes audible, in the case of pulsatile Tinnitus. It is called Pulsatile tinnitus because it pulses in time with the beats of the heart and blood flow. Sometimes there may be no cause for the audibility of this, other than the patients suddenly develops an increased awareness of it.
Occasionally, pulsatile tinnitus may be the result of something more dangerous such as problems associated with the carotid artery (aneurysm or dissection).
In a way this is much more frustrating for the patient as no-one else can hear something that may seem unbearably loud to the sufferer. It is also undetectable which means we currently have no direct means for measuring it, hence word ‘subjective’.
Two people may both say they have tinnitus but the sound, intensity, and how it affects them, for example, could be worlds apart, but only definable by the subject themselves.
Standard objective measuring tests do not really provide an accurate guide as to what is really going and tend to only give indirect. Audio metric tests can give an indication as to the frequency of the sound but the most common measurement is the Tinnitus Handicap Inventory Questionnaire (THI). This is a series of questions that really help understand how the tinnitus is affecting the life of thew subject, rather than about the tinnitus condition itself.
For example, it will help a clinician diagnose how the tinnitus is affecting sleep, work, , daily life and so on. The diagnose then become slightly less scientific,m using phrases ranging from ‘Slight’ to ‘Catastrophic’.
The Tinnitus handicap Inventory is also used in research as a means to test whethera treatment or intervention is successful. Although still primitive really, it is the best means availableat the moment.
Causes of Tinnitus
Although it is possible to list many phenomenon that seem to cause the onset of Tinnitus, it is not always known exactly why they do, and the actual mechanism of Tinnitus is still a bit of an open mystery. Couple this with the fact that the same ‘trigger’ does not always seem to create the same effect in everybody and you can see why clinicians have struggled to find a unifying cure. For example, some people say that alcohol helps reduce Tinnitus – whilst others say it makes it worse.
Tinnitus causes are often subdivided into two categories.
Otic– meaning affecting the inner ear and auditory nerve.
Somatic – meaning outside the inner ear and auditory nerve but still within the head and neck.
On top of this there are many drugs or oral medications that are known to cause a Tinnitus response, such as aspirin, for example. Tinnitus may also result from an abnormally low level of serotonin activity and is a classical side effect of Quinidine an anti-arrhythmic. Drugs that are harmful to the ear or hearing system are called Ototoxic.
In many cases, however, no underlying physical cause can be identified and some people, such as hypnotherapist Andrew Parr, believe that many of these cases of Tinnitus are caused by stress, anxiety or emotional trauma.
As you can see, Tinnitus can have many different causes. The scientific view is that it generally results from otologic disorders, the most common cause being noise-induced hearing loss – caused by exposure to excessive or loud noises – but here is a more comprehensive listing of possible causes of the Tinnitus syndrome.
Causes of tinnitus may include
1. Otologic Problems and Hearing Loss
a. Conductive hearing loss – External ear infection, Acoustic Shock, Cerumen (Earwax Blockage), Effusion of the Middle Ear, Superior Canal Dehiscence
b. Sensorineural Hearing Loss – Exposure to excessive or loud noise, Presbycusis (Hearing loss associated with old-age), Meniere’s Disease, Acoustic Neuroma, Mercury or Lead poisoning, Ototoxic Medications (aspirin, etc.).
2 . Neurologic Disorders
Chiari Malformation, Multiple Sclerosis. Head Injury (skull fracture, whiplash, temporomandibular joint disorder)
3. Metabolic Disorder
Thyroid disorder, Hyperlipidemia, Vitamin B12 Deficiency
4 . Psychological Disorders
Stress, anxiety, emotional shock, depression, anger,fatigue.
5 .Miscellaneous Other Causes sometimes believed to cause Tinnitus
Tension Myositis Syndrome, Fibromyalgia, Hypertonia (muscle tension), thoracic outlet syndrome, lyme disease, hypnogogia, sleep paralysis, Glomus Tympanicum.
What are the mechanisms of Tinnitus? What actually produces the sound?
Whilst there are some good theories, and a lot of evidence to support those theories, the actual mechanism of tinnitus is still a bit of a mystery. Here are some of the most popular theories.
Hair Cell Damage/Interference
The inner ear contains thousands of tiny hair-cells, called stereo-cilia. When sound enters the ear canal and on down through to the inner ear, these hair cells vibrate in response to the sound waves. This vibration is then converted to a neural signal which eventually then passes along the auditory nerve to the brain, where the signal is interpreted as sound. The vibratory cells are set to ‘idle’, (like a car engine ticking over) just below the level of self-oscillation – which makes them very sensitive.
Anything that interferes with this process may cause a false signal/message to be sent ot the brain, which the brain perceives as Tinnitus.
If the Receptor Cells/Hair cells are damaged – temporarily or permanently – by loud noise for example, studies have indicated that the afferent neurons may be activated, again,possibly sending a signal to the brain when there is actually none. Constant exposure to loud noiseor loud music can kill hair cells permanently – resulting in a permanently false signal, which we hear as Tinnitus.
Temporomandibular Joint Disorder
This one causes a puzzle –why should dental issues or Temporomandibular Joint Disorder cause Tinnitus? There is another theory that some ‘somatic tinnitus’ may be caused by a cross talk in the brain, where head and neck nerves enter the brain in close proximity.
Over Stimulation of Auditory Nerve Cells
Some studies have implied that tinnitus is associated with increased neural activity in the auditory brain stem. If some of the nerve cells become over-excited, it may have the same effect as stimulating the hair cells where no signal is present. This over excitement may be caused my changes in the gens that regulate the activity of the nerve cells – or by other more direct means – stress, tension, anxiety and so on.
If this is the case, any treatment that reduces the neural stimulation – either by electrical, chemical or psychological means – should therefore bring about a reduction of the Tinnitus sound.
In 1953 Heller and Bergman conducted a study of 80 tinnitus-free university students. They were placed in an placed in an anechoic chamber (ie zero sound– absolute silence) and it was reported that 93% of them later reported hearing a buzzing, pulsing or whistling sound. The implication is that a form of Tinnitus is present in each one of us – but normally resides below our normal level of consciousness.
Where no physical cause is present, it may be that any form of stress or anxiety may cause an individual to become aware of their internal sound, which then creates more stress. A psychological/physiological loop then develops which maintains both the stress and the Tinnitus awareness.
Anything reduce the emotional stress and anxiety of a patient will therefore help break the loop. This is supported by clinical experience of people such as Hypnotherapist Andrew Parr.
How Can You Measure Tinnitus?
This is difficult to measure accurately but there are ways of obtaining a quantitative measurement of Tinnitus. The brain has a tendency to select or focus on the loudest sounds – ie those with the greatest amplitude. By playing sounds of known amplitudes, you can ask the patient which one she/he hears, and as the sounds eventually match, you can obtain an estimate for the apparent amplitude of the Tinnitus.
However, the results can be influenced by the subjects focus of attention. For example, a subject can often detect an external sample noise right down to a level of 5 db. This would imply that their Tinnitus is virtually silent, in order to allow them to detect the sample sound. But when the same subject is told to focus on their tinnitus, they can report hearing it, even when the external sample sound is increased to 70 decibels – making the tinnitus louder than a ringing phone.
So the real/perceived amplitude of Tinnitus may depend upon what the patient is focusing on or attempting to hear. By switching attention, the tinnitus may change for 70 db toi 5 db and back.
Patients who suffer most are often described as having become obsessed with the noise. This is true, to a certain extent, but the real problem is their inability to override or ignore their tinnitus. When the noise is present in both quiet and noisy environments, and it can then become quite intrusive to their daily lives.
Prevention of Tinnitus
Theonly active prevention you can really put in place, without becoming obsessively fearful, it ot restrict your exposure to loud music and loud noise. Both these cause hearing loss – sometimes temporary, sometimes permanent. If you get ringing ears after a rock concert it is an indicator that there has been some damage.
Many musicians and DJ’s experience prolonged exposure to loud music and so special ear plugs have been developed to lower the volume without distorting the sound. The same applies to anyone operating noisy machinery in the workplace, such as drills, hairdryers, lawn mowers and vacuum cleaners.
You may also prevent tinnitus by checking any medication for it’s ototoxicity. Some medications are ototoxic,and may either cause direct hearing loss, of exacerbate existing symptoms or conditions. You should check with your physician about the dosage and possible side effects, whicu could help reduce potential damage.
At the moment there is no single treatment that can reliably cure or reduce all kinds of Tinnitus. Many, many claims are made, but they have varying degrees of statistical reliability. On this website we offer the Tinnitus Improvement Program but here are some of the other main treatments available for Tinnitus…
Objective Tinnitus Treatments:
Gamma Knife Radio Surgery, Teflon implant to shield cochlea, Botulinum Toxin, Proprananol and Clonazepam, clearing ear canal (where build up of earwax present).
Subjective Tinnitus Treatments
Drugs and Nutrients:
Ginkgo Biloba (completely unproven); Lidocaine – suppresses Tinnitus for 5 – 20 minutes but has major side-effects; Benzodiazepines, such as Lorazepam or clonazepam (in small doses); Tricyclics such as amitriptyline and nortriptyline); Zinc supplements (completely unproven, but may be effective where Zinc Deficiency is present; Acamprosate – has been successful for noise induced tinnitus; Etidronateor sodium fluoride has helped otosclerosis; lignocaine or anti-epileptics and anti-convulsants; Carbamazepine; Melatonin has helped with sleep disturbance; sertraline; some vitamin combinations.
Subjective TinnitusTreatment by Electrical Stimulation:
TMS (Trans Cranial Magnetic Stimulation) ; Trans Cranial Direct Current Stimulation: Trans-cutaneous Electrical Nerve Stimulation; implanting electrodes for direct stimulation of auditory cortex;
Subjective Tinnitus Treatment By Surgery:
Implant of above mentioned electrodes for direct stimulation of auditorycortex; Repair of perilymph fistula.
Subjective Tinnitus Treatment By External Sound:
Neuromonics; low-pitched sound treatment; Tinnitus masking; TRT (Tinnitus Retraining Therapy); Music therapy; hearing aids to compensate for lost frequencies; ultrasonic bone conduction by external acoustic stimulation; external noise avoidance for exogenous tinnitus.
Subject Treatment for Tinnitus using Psychological Means:
CBT (Cognitive Behavioral Therapy) ; hypnosis and hypnotherapy;
Light Based Tinnitus Treatment
Low level Laser Therapy