What Is Tinnitus?
Tinnitus, also known as a ringing in the ear is a widespread condition that affects an estimated 50 million Americans. Some people describe it as a hissing, roaring, whooshing or buzzing sound instead of ringing. It may be sporadic or constant and is a symptom of an underlying condition rather than a disease itself. There are many factors that can cause tinnitus.
What Are the Causes of Tinnitus?
Tinnitus is categorized as being either pulsatile or nonpulsatile.
People who suffer from pulsatile tinnitus report hearing the sound of their own pulse. It is caused by abnormal blood flow within the arteries of the neck or inside the ear and is fairly rare. Possible causes include:
- Fluid in the middle ear
- Ear infections
- High blood pressure
- Head and neck tumors
- Blocked arteries
A ringing in the ears not accompanied by any type of rhythm is considerably more common. It can be caused by a variety of conditions including:
- Presbycusis (age-related hearing loss)
- Noise exposure
- Impacted earwax
- Otosclerosis (stiffening of the bones in the middle ear)
- Meniere’s disease
- TMJ disorders
- Ototoxic medications
- Thyroid conditions
- Head or neck trauma
- Acoustic neuromas
Tinnitus is also classified as being either subjective (heard only by the patient) or objective (ringing can be heard by an impartial observer, such as a doctor). Most cases of tinnitus are subjective in nature.
In addition to hearing a ringing in the ear, tinnitus can have an impact your quality of life. Many with tinnitus will also experience:
- Trouble sleeping
- Problems concentrating
- Issues with memory
How Tinnitus is Diagnosed
In order to treat your tinnitus, your doctor will try to determine the cause. After reviewing your medical history and completing a physical exam of your ears, head and neck, your doctor may order some tests including hearing exams, movement assessments and imaging tests.
Sometimes the cause is as simple as built-up earwax or a new medication. Unfortunately for most, the condition responsible for their tinnitus is never identified.
There is no universal cure for tinnitus, but there are treatments that make it less of a distraction. Because tinnitus is a side effect of an underlying condition, identifying the problem may lead to a medical or surgical solution. The cure rates for pulsatile tinnitus are quite high once the problem has been identified.
Unfortunately, in many cases the exact cause of tinnitus can’t be identified, or treatment is not possible. However, symptoms can often be managed successfully through a number of different strategies.
Sounds are used to cover up, or mask, the tinnitus. This distracts your brain and helps you tune out the ringing in your ears. Electronic devices that produce white noise, air conditioners, fans, soft music, etc. can all be employed.
There are a range of sound therapy options you can employ including audio files, sleep noise generators, tinnitus specific ear buds and more. These acoustic therapy methods are designed to habituate a tinnitus sufferer to their symptoms by reducing the contrast between the tonal sounds they hear and their environment. This allows the brain to blend and mask tinnitus sounds with natural and therapy added environmental noises.
Tinnitus Retraining Therapy
Similar in concept to acoustic therapy, tinnitus retraining therapy utilizes a portable sound generator that produces soft patterned tones to help desensitize the brain to the sounds of tinnitus.
One of the latest iterations of tinnitus retraining therapy is called acoustic neuromodulation. Using a combination of computer software, self-reporting and ongoing hearing tests, a specialist can create a custom tone profile designed to treat your specific tinnitus tones. The profile can be adjusted as needed over time.
Meniere’s disease has a number of symptoms, including hearing loss, tinnitus and vertigo that fluctuate due to increased fluid pressures in the ear organs. The resulting hearing loss and tinnitus can be treated with a series of injections of a potent steroid, which has an 85 percent chance of reducing symptoms.
As many as 80 percent of those with a benign tumor of the cranial nerve that connects the inner ear and the brain known as an acoustic neuroma also suffer from tinnitus. The tinnitus may be resolved through a surgical removal of the acoustic neuroma.
A common treatment option utilizes hearing aids, as nearly 90 percent of those with tinnitus also experience hearing loss. Hearing aids are used to amplify background sounds, which can mask tinnitus. These devices can also help the you distinguish one sound from another, improving communication and helping with focus and concentration difficulties. Many hearing aids come packaged with noise generators to replace ambient sounds if amplification alone does not reduce tinnitus.
Counseling and cognitive behavioral therapy (CBT) can be practical in helping you manage your tinnitus symptoms by reducing the stress, anxiety and sleeplessness that are often associated with tinnitus. Our providers teach some methods to help you manage your tinnitus symptoms but may refer you for ongoing CBT.
Behavioral therapy can be very effective and provide a range of coping skills that can help you manage tinnitus symptoms and the associated stress and depression that often accompany the condition.
Tinnitus is often described as a ringing in the ears, but can also sound like hissing, buzzing, roaring, sizzling, clicking or other noise. Tinnitus can manifest as an acute symptom lasting just a few days, or a chronic or recurring symptom lasting weeks, months or years.
Tinnitus is a symptom of a wide range of health conditions, and it can occasionally point to a more serious problem that needs professional medical attention. This is why trying to identify a cause is important, even though it may not be possible.
During a tinnitus evaluation, an audiologist will typically administer:
- An in-depth review of your medical history
- A complete physical examination of your auditory system
- A pure tone and ultra-high frequency audiometry test
- Speech reception and word recognition tests
- Additional tests, studies and evaluations
If you’re one of the five percent of Americans suffering from tinnitus that is “moderately to significantly annoying,” it’s a great idea to visit a hearing specialist for an evaluation. Our team of audiologists is equipped with many tools and strategies to help patients with tinnitus, but first we need to assess your condition.
What to Expect During an Evaluation
When evaluating a patient with tinnitus, we have several goals we hope to accomplish:
- Identify the underlying cause of your tinnitus symptoms
- Determine if your tinnitus is subjective or objective
- Evaluate how your tinnitus is affecting your speech reception
- Assess whether you’re experiencing hyperacusis (sound sensitivity)
- Pinpoint the frequency and loudness of the sound you’re hearing.
One of the goals of an evaluation is to rule out what is not causing your tinnitus symptoms. Some common causes include hearing loss, ear bone changes, inner ear disorders, blood pressure changes due to an underlying condition and even certain medications.
Hearing Assessments for Tinnitus
Audiometric evaluations for tinnitus typically focus on high frequency sounds between 2000 and 4000 Hz. An otoacoustic emissions test can provide a strong indicator for tinnitus as studies have found emissions can be diminished in those with tinnitus and hearing loss.
Questionnaires your provider may have you take include:
- Tinnitus Functional Index
- Tinnitus Handicap Inventory
- Tinnitus & Hearing Survey
Because tinnitus can be difficult to pinpoint, questionnaires can help to identify causes that a patient may not have considered. The Tinnitus Functional Index is designed to identify the impact of tinnitus on areas from sleep to the ability to relax. The Tinnitus Handicap Inventory can help determine the perceived impact tinnitus is having on a patient’s daily life.
Types of Tinnitus
Tinnitus only you can hear is called subjective. Subject tinnitus is the most common type and is often caused by ototoxic medications or one of many audiological, neurological, metabolic and psychological conditions.
Objective tinnitus is much rarer and the sound it causes can be heard by the patient and an outside examiner or observer. This type of tinnitus is often tied to underlying vascular or neurological problems.
If we can determine a diagnosis and address the condition causing your tinnitus, we may also be able to treat that condition and relieve your symptoms although tinnitus is not always treatable and may require management instead.
If we can’t identify a specific cause of your tinnitus, we will recommend other treatment options that can help you to manage and reduce your tinnitus symptoms.
Call River ENT at (512) 677-6368 for more information or to schedule an appointment.