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Tinnitus

Tinnitus is one of the most common conditions in the world, and can vary quite drastically from person to person in terms of sound, duration and intensity. In this article we explore the facts, possible causes and treatments. 

 

What is tinnitus?

 

Tinnitus is the experience of hearing sound when there is no external sound present in the environment, in other words only you can hear it. Many people experience tinnitus and describe it as a temporary “ringing” in the ear, particularly after exposure to loud noise or listening to loud music. It can take many forms, such as hissing, whooshing, humming and buzzing, all of which can vary largely between individuals in duration, tone and loudness [1].

 

Who experiences it?

 

Tinnitus is very common and nearly everyone will experience it at some point in their lives. Persistent tinnitus however is less common, affecting around 13% of the population which is just over 1 in 8 people [2]. It can affect all age groups although it is more common in the elderly as it is often associated with some degree of hearing loss [3]. For most people tinnitus is not a problem as it usually disappears after a while [4] or they find ways to ignore it. A small percentage of people experience very loud, intrusive tinnitus which can affect their quality of life, causing stress, anxiety, depression, difficulty sleeping and difficulty hearing.

 

What causes tinnitus?

Temporary tinnitus can be caused by ear wax blockage, eustachian tube dysfunction (congestion in the ear), exposure to loud sound or ear infections [11]. Persistent tinnitus is less well understood, however it is clear that in the vast majority of cases it is not caused by a disease or illness. Research is ongoing, and due to the evolution neuroscience there are a couple of theories which may explain why tinnitus occurs and where it originates from:

1. Brain origin. Many scientists have begun to support the theory that tinnitus is the result of small changes in the brain. This is known as “neuroplasticity” and happens frequently throughout our lives as our brains naturally rewire and adapt to change around us [5]. Broadly speaking the theory suggests that the auditory regions of the brain rewire themselves in reaction to a hearing loss (even mild undetectable ones) so they remain stimulated as oppose to lying dormant [6]. This rewiring may also take place in response to loud noise exposure.

2. Inner ear origin. The inner ear (or cochlear) may also be responsible for tinnitus, and may explain why normal hearing individuals at times experience very short bursts of tinnitus randomly (a ringing that emerges and then fades for example).  The theory suggests that vibrations occur inside the cochlea, created by tiny hair cells overreacting to the natural bodily noise inside the ear [7].  

 

What should you do?

If you have tinnitus the first step is to see your GP who can decide if a specialist opinion is required. A referral to an ENT (Ear, Nose and Throat) doctor is usually only required if the tinnitus is persistent in one ear only, or if the tinnitus is pulsatile in nature (sounds like your heartbeat or has a distinct rhythm). If your GP feels no action is necessary but your tinnitus is distressing, there are a number of options that can help:

 

1. Talking it over. Sometimes the simplest solution is the best, and speaking to someone who knows about tinnitus can be extremely helpful and reassuring. You can call the British Tinnitus Association who have a dedicated tinnitus helpline (https://www.tinnitus.org.uk/), or you can speak to a local Audiologist.

2. Using hearing aids. If you have a hearing loss hearing aids can help alleviate tinnitus to a degree and contribute to an improved quality of life [10]. Getting your hearing tested is recommended, even if you’re not sure you have a hearing loss. This can be done privately or via the NHS.

3. Relaxation. It is widely accepted that stress makes tinnitus noticeably worse [8], so any technique you can use to relax and break the cycle of frustration will help. Studies have shown that practicing Mindfulness in particular can help lower stress levels and the severity of tinnitus symptoms [9].  

4. Sound therapy. Many people report their tinnitus becomes louder and sometimes intolerable when they’re in a quite environment or trying to sleep. A common technique is to use background noise to help fill the environment with some sound that distracts from the tinnitus, such as a radio, music or natural sounds such as recordings of water, wind or the sea.

 

References

 

1.       Baguley, D., McFerran, D. and Hall, D., 2013. Tinnitus. The Lancet, 382(9904), pp.1600-1607.

2.       British Tinnitus Association. 2019. All About Tinnitus. [ONLINE] Available at: https://www.tinnitus.org.uk/all-about-tinnitus. [Accessed 5 June 2020].

3.       Lockwood, A.H., Salvi, R.J. and Burkard, R.F., 2002. Tinnitus. New England Journal of Medicine, 347(12), pp.904-910.

4.       NHS. 2018. Tinnitus. [ONLINE] Available at: https://www.nhs.uk/conditions/tinnitus/. [Accessed 5 June 2020].

5.       Münte, T.F., Altenmüller, E. and Jäncke, L., 2002. The musician's brain as a model of neuroplasticity. Nature Reviews Neuroscience, 3(6), pp.473-478.

6.       Eggermont, J.J. and Roberts, L.E., 2004. The neuroscience of tinnitus. Trends in neurosciences, 27(11), pp.676-682.

7.       Kemp, D.T., 1981. Physiologically active cochlear micromechanics-one source of tinnitus. Tinnitus, pp.54-81.

8.       Mazurek, B., Szczepek, A.J. and Hebert, S., 2015. Stress and tinnitus. HNO, 63(4), pp.258-265.

9.       Roland, L.T., Lenze, E.J., Hardin, F.M., Kallogjeri, D., Nicklaus, J., Wineland, A.M., Fendell, G., Peelle, J.E. and Piccirillo, J.F., 2015. Effects of mindfulness based stress reduction therapy on subjective bother and neural connectivity in chronic tinnitus. Otolaryngology--Head and Neck Surgery, 152(5), pp.919-926.

10.   Del Bo, L. and Ambrosetti, U., 2007. Hearing aids for the treatment of tinnitus. Progress in brain research, 166, pp.341-345.

11. Mayo Clinic. 2020. Tinnitus - Symptoms And Causes. [ONLINE] Available at: <https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156> [Accessed 17 June 2020].

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Durham Hearing Specialists is a trading name of Tonotopic Record Company Limited. Registered in England, company number 09870228. 4 Capricorn Centre, Cranes Farm Road, Basildon, Essex, United Kingdom, SS14 3JJ.