About Tinnitus

Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is a condition characterized by hearing ringing, humming, or buzzing that does not have an external source. The sounds may be a combination of sounds or a single changing sound, constant or intermittent, and may be and heard in just one ear, both ears or inside the head. Patients with tinnitus can sometimes hear singing or music. Tinnitus is not a hallucination or ‘phantom sound’ caused by mental illness. Tinnitus produces real neural activity within your brain which is interpreted as sound.

Over 30 million adults suffer from tinnitus, and for nearly 12 million, it is severe enough to impact everyday life. Close to four in ten people experience tinnitus for 80% of a typical day. More than one in four people experience tinnitus they describe as loud; and nearly one in five experience tinnitus as they describe as disabling or nearly disabling. Tinnitus may be accompanied by hyperacusis, a condition that causes when moderately loud sounds to be perceived as very loud.

Causes of Tinnitus

Tinnitus originates behind the eardrum in the middle ear or in the sensorineural auditory system. The most common causes of tinnitus include head injury, noise exposure, as a side effect of certain medications, and as a natural part of aging.

Tinnitus is very often accompanied by hearing loss. For this reason, it is recommended that if you experience tinnitus, you have a hearing evaluation completed by an audiologist.

Possible causes of tinnitus include:

Damage to hearing system (often accompanied by hearing loss) from the aging process and/or loud noise exposure (Tinnitus is often the first sign of hearing loss in adults!)
Ear and sinus infections
Injury to the ear or head
Disease of the ear
Diseases of the heart or blood vessels
Side effect of medication (More than 200 drugs are known to cause tinnitus when you start or stop taking them)
Emotional stress
Hormonal changes in women
Thyroid abnormalities
Ear wax deep in ear canal
Brain tumors (rare)—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.

Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.

Classifications of Tinnitus

Tinnitus can sometimes be classified as either sensorineural tinnitus or middle ear tinnitus, which corresponds to the underlying pathology, and also corresponds to the classification of hearing loss when hearing is present.

Middle ear tinnitus results from either muscles twitching or abnormal blood flow. In some cases, middle ear tinnitus may be treatable with surgery.

Sensorineural tinnitus can result from head injury, infections, normal aging, side effects from medication or noise exposure. Abnormal spontaneous nerve activity is occurring – an increase in activity, over-representation of a frequency, a synchronous activity across nerve fibers, or a combination of all three.

Why do I have this noise in my ears?

Although we hear tinnitus in our ears, its source is really in the networks of brain cells (what scientists call neural circuits) that make sense of the sounds our ears hear. A way to think about tinnitus is that it often originates in the ear, but it continues and is perceived in the brain.

Scientists still haven’t agreed upon what happens in the brain to create the illusion of sound when there is none. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after an injury has healed.

Tinnitus could be the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by increasing sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise (a phenomenon known as hyperacusis).

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, where the brain processes sound. Another theory is it could be the result of abnormal interactions between neural circuits communicating with the limbic region, which regulates mood and emotion.

Source: American Tinnitus Association

Tinnitus Treatment Goals & Expectations

There is presently no known cure for chronic tinnitus; however, there are very well-established tools and treatments that can significantly reduce the perceived burden of tinnitus. With perseverance and support from trained healthcare professionals, these options can help tinnitus patients—even those with severe cases of the condition.

Source: American Tinnitus Association

Potential Tinnitus Triggers or Exacerbating Factors

In addition to medications, it is important to also understand the factors that may be triggering or worsening your perceived tinnitus. If any of these listed factors are prevalent in your life, you may consider minimizing or eliminating the factor, if possible, and observing if this results in a positive improvement in your tinnitus.

For the majority of individuals with tinnitus, silent or quiet environments cause the tinnitus to be more prevalent and more bothersome. For this reason, it is often helpful to have some sort of background noise (fan, music, sound generator, ear level masker) available to allow your brain to focus less on the bothersome tinnitus.

Triggers: Caffeine • Salt • Alcohol • Stress • Tobacco • Silence/Quiet Environments

Modifiable Environmental Factors to Manage Tinnitus

Avoid silence! Quiet environments often cause tinnitus to be more noticeable, eliciting a stress/ anxious reaction which in turn can further exacerbate the annoyance caused by tinnitus. To break this negative cycle, you can try to:
- Have some type of background noise (fan, music, relaxing sounds) on at all times to help break the negative cycle.
- Use a sound machine or an app to help with sleep. Practice good sleep hygiene: no screen time before bed, follow same routine every night, quiet, cool dark room, etc.
Avoid excessive noise and make sure to always wear hearing protection when around noise.
Consult with your physician regarding medications or supplements you are taking that may be exacerbating your tinnitus.
Identify any potential triggers that may make tinnitus worse for you (salt, alcohol, stress, tobacco, silence) and minimize them in your life as you are able.
If you have a hearing loss—treat it! The majority of individuals with tinnitus and hearing loss report the tinnitus to be less bothersome when wearing hearing devices. Many hearing devices also have special tinnitus programs that can be activated to help relieve tinnitus in addition to treating your hearing loss.