Tinnitus is sound in the head
with no external source. For many, it's a ringing sound, while for others, it's
whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking. The
sound may seem to come from one ear or both, from inside the head, or from a
distance. It may be constant or intermittent, steady or pulsating.
Almost everyone has
had tinnitus for a short time after being exposed to extremely loud noise. For
example, attending a loud concert can trigger short-lived tinnitus. Some
medications (especially aspirin and other nonsteroidal anti-inflammatory drugs
taken in high doses) can cause tinnitus that goes away when the drug is
discontinued. When it lasts more than six months, it's known as chronic tinnitus.
As many as 50 to 60 million people in the United States suffer from this
condition; it's especially common in people over age 55 and strongly associated
with hearing loss. Many people worry that tinnitus is a sign that they are
going deaf or have another serious medical problem, but it rarely is.
Most tinnitus is
subjective, meaning that only you can hear the noise. But sometimes it's
objective, meaning that someone else can hear it, too. For example, if you have
a heart murmur, you may hear a whooshing sound with every heartbeat; your
clinician can also hear that sound through a stethoscope. Some people hear their
heartbeat inside the ear - a phenomenon called pulsatile tinnitus. It's more
likely to happen in older people, because blood flow tends to be more turbulent
in arteries whose walls have stiffened with age. Pulsatile tinnitus may be more
noticeable at night, when you're lying in bed and there are fewer external
sounds to mask the tinnitus. If you notice any new pulsatile tinnitus, you should
consult a clinician, because in rare cases it is a sign of a tumor or blood
vessel damage.
The course of
chronic tinnitus is unpredictable. Sometimes the symptoms remain the same, and
sometimes they get worse. In about 10% of cases, the condition interferes with
everyday life so much that professional help is needed.
While there's no
cure for chronic tinnitus, it often becomes less noticeable and more
manageable over time. You can help ease the symptoms by educating yourself
about the condition - for example, understanding that it's not dangerous. There
are also several ways to help tune out the noise and minimize its impact.
What's
going on?
Most people who seek medical help for tinnitus
experience it as subjective, constant sound like constant ringing in the ears
or a buzzing sound in the ear, and most have some degree of hearing loss.
Things that cause hearing loss include loud noise, medications that damage the
nerves in the ear, impacted earwax, middle ear
problems (such as infections and vascular tumors), and aging. Tinnitus can also
be a symptom of Meniere's disease, a disorder of the balance
mechanism in the inner ear.
Tinnitus can arise anywhere along the auditory pathway, from the
outer ear through the middle and inner ear to the brain's auditory cortex,
where it's thought to be encoded (in a sense, imprinted). One of the most
common causes of tinnitus is damage to the hair cells in the cochlea. These
cells help transform sound waves into nerve signals. If the auditory pathways
or circuits in the brain don't receive the signals they're expecting from the
cochlea, the brain in effect "turns up the gain" on those pathways in
an effort to detect the signal - in much the same way that you turn up the
volume on a car radio when you're trying to find a station's signal. The
resulting electrical noise takes the form of tinnitus - a sound that is
high-pitched if hearing loss is in the high-frequency range and low-pitched if
it's in the low-frequency range. This kind of tinnitus resembles phantom limb
pain in an amputee - the brain is producing abnormal nerve signals to
compensate for missing input.
Most tinnitus is "sensorineural," meaning that it's
due to hearing loss at the cochlea or cochlear nerve level. But tinnitus may
originate in other places. Our bodies normally produce sounds that we usually
don't notice because we are listening to external sounds. Anything that blocks
normal hearing can bring somatic sounds to our attention. For example, you may
get head noise when earwax blocks the outer ear.
Evaluate and treat underlying problems
If you develop tinnitus, it's
important to see your clinician. She or he will take a medical history, give
you a physical examination, and do a series of tests to try to find the source
of the problem. She or he will also ask you to describe the noise you're
hearing (including its pitch and sound quality, and whether it's constant or
periodic, steady or pulsatile) and the times and places in which you hear it.
Your clinician will review your medical history, your current and past exposure
to noise, and any medications or supplements you're taking. Tinnitus can be a
side effect of many medications, especially when taken at higher doses.
Musculoskeletal
factors - jaw clenching, tooth
grinding, prior injury, or muscle tension in the neck - sometimes
make tinnitus more noticeable, so your clinician may ask you to tighten muscles
or move the jaw or neck in certain ways to see if the sound changes. If tight
muscles are part of the problem, massage therapy may help relieve it.
Tinnitus that's
continuous, steady, and high-pitched, generally indicates a problem in the
auditory system and requires hearing tests conducted by an audiologist.
Pulsatile tinnitus calls for a medical evaluation, especially if the noise is
frequent or constant. MRI or CT imaging may be needed to check for a tumor or
blood vessel abnormality.
Your general health
can affect the severity and impact of tinnitus, so this is also a good time to
take stock of your diet, physical activity, sleep, and stress level - and take
steps to improve them. You may also be able to reduce the impact of tinnitus by
treating depression, anxiety, insomnia, and pain with medications or
psychotherapy.
If you're often
exposed to loud noises at work or at home, it's important to reduce the risk of
hearing loss by using protectors such as earplugs or earmuff-like or
custom-fitted devices.
Managing tinnitus
In addition to treating
associated problems, there are several strategies that can help make tinnitus
less bothersome. No single approach works for everyone, and you may need to try
various combinations of techniques before you find what works for you. If you
have age-related hearing loss, a hearing aid can often make tinnitus less
noticeable by amplifying outside sounds.
There is no
FDA-approved drug treatment for tinnitus, and controlled trials have not found any
drug, supplement, or herb to be any more effective than a placebo. That
includes ginkgo biloba, which is sometimes promoted for this purpose. Some
patients believe that acupuncture helps, but it too has been found to be no
better than a placebo.
The most effective
approaches are behavioral strategies and sound-generating devices, often used
in combination. They include the following:
Cognitive behavioral
therapy (CBT). CBT
uses techniques such as cognitive restructuring and relaxation to change the
way patients think about and respond to tinnitus. Patients usually keep a diary
and perform "homework" to help build their coping skills. Therapy is
generally short-term - for example, weekly sessions for two to six months. CBT
may not make the sound less loud, but it can make it significantly less
bothersome and improve quality of life.
Tinnitus retraining
therapy (TRT). This
technique is based on the assumption that tinnitus results from abnormal
neuronal activity. The aim is to habituate the auditory system to the tinnitus
signals, making them less noticeable or less bothersome. The main components of
TRT are individual counseling (to explain the auditory system, how tinnitus
develops, and how TRT can help) and sound therapy. A device is inserted in the
ear to generate low-level noise and environmental sounds that match the pitch,
volume, and quality of the patient's tinnitus. Depending on the severity of the
symptoms, treatment may last one to two years.
Masking. Masking
devices, worn like hearing aids, generate low-level white noise 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 before they turn to more expensive
options.
Biofeedback and stress management. Tinnitus
is stressful, and stress can worsen tinnitus. Biofeedback is a relaxation
technique that helps control stress by changing bodily responses. Electrodes
attached to the skin feed information about physiological processes such as
pulse, skin temperature, and muscle tension into a computer, which displays the
output on a monitor. Patients learn how to alter these processes and reduce the
body's stress response by changing their thoughts and feelings.
Mindfulness-based stress reduction techniques may also help.
Not all insurance
companies cover tinnitus treatments in the same way, so be sure to check your
coverage. If you're willing to enroll in a research study, you may be able to
receive a cutting-edge treatment free.
Article published in Harvard Health Publishing
Harvard Medical School
