Information About Tinnitus

Tinnitus is an abnormal perception of a sound which is reported by patients that is unrelated to an external source of stimulation. Tinnitus is a very common disorder. It may be intermittent, constant or fluctuant, mild or severe, and may vary from a low roaring sensation to a high pitched type of sound. It may or may not be associated with a hearing loss. It is also classified further into subjective tinnitus (a noise perceived by the patient alone) or objective (a noise perceived by the patient as well as by another listener). Subjective tinnitus is common; however, objective tinnitus is relatively uncommon. The location of tinnitus may be in the ear(s) and/or in the head.

Tinnitus is a symptom much like a headache, pain, temperature, hearing loss or vertigo. With tinnitus, the reported distress is usually subjective and difficult to record and appreciate by others.

The quality of the tinnitus refers to the description by the patient of the tinnitus: It may be a ringing, buzzing, cricket, ocean, etc., type of sound. The quality may be multiple sounds or a singular sound.

Tinnitus must always be thought of as a symptom and not a disease, just as pain in the arm or leg is a symptom and not a disease. Because the function of the auditory (hearing) nerve is to carry sound, when it is irritated from any cause it produces head noise. This phenomenon is similar to the sensation nerves elsewhere. If one pinches the skin, it hurts because the nerves stimulated carry pain sensation.

There are many causes just related to the ear which would result in tinnitus. Such things as simple ear wax in the ear canal to other middle ear abnormalities may result in tinnitus. Otosclerosis (fixation of the stapes bone in the middle ear) can cause tinnitus as well as fluid in the middle ear. There are many other ear abnormalities which may cause tinnitus. A more common example would be Meniere’s disease. Sudden trauma to the inner ear such as exposure to excessively loud sounds may result in tinnitus. Tumors on the hearing nerve or other problems in the brainstem or central nervous system may also cause tinnitus. In addition, other vascular abnormalities in the skull or base of the skull may result in tinnitus.

A Summary of the Causes of Tinnitus

Tinnitus may originate from various lesions and from different sites. The auditory system involves highly complicated inner ear structures, many afferent and efferent nerve pathways and a great amount of nuclei that form a complex meshwork. To pinpoint tinnitus to a certain structure becomes questionable. This is demonstrated by patients who have had intractable tinnitus after having surgery on their ear or incurring severe diseases of the ear. In an attempt to relieve the tinnitus, cutting the auditory nerve has been done and yet the tinnitus was persistent, indicating the site of lesion causing the tinnitus must have shifted into the central nervous system.

Tinnitus could be explained by abnormal neural activity in the auditory nerve fibers, which may occur if there is a partial breakdown of the myelin covering of individual fibers. A defect in the hair cell would trigger the discharge of connected nerve fibers. For chronic cochlear disorders, there may also be increased spontaneous activity in the hair cells and neurons resulting in tinnitus. In the auditory nerve there are two different kinds of afferent fibers: Inner hair cell fibers with large diameters and outer hair cells fibers with small diameters. Thus, loss of signals from the cochlea might trigger tinnitus as a manifestation of a functional imbalance between the two sets of fibers. In addition, other abnormal changes of the cochlear fluids may result in tinnitus.

There is not one type, one site or one origin of tinnitus, but a multitude of types, sites, and origins. It is also unlikely that one hypothesis on the cause of tinnitus could explain all the features.

Treatment of Tinnitus

Tinnitus Retraining Therapy (TRT) trains the brain to habituate (ignore) the tinnitus sound. Patients wear ear level sound generators (SG) on a daily basis for 6-12 months (sometimes longer). The SG emits a low level white noise that mixes with your perception of tinnitus. This in combination with ongoing audiological support to understand the impact of the negative emotional connection will give most patients ( in my experience 80% +) permanent relief. Other alternative treatments are often used with TRT. These are chosen by the patient and are done independently, yet along side TRT. An example would be biofeedback training. This is effective in reducing the tinnitus in some patients. It consists of exercises in which the patient learns to control the various parts of the body and relax the muscles. When a patient is able to accomplish this type of relaxation, tinnitus generally subsides. Most patients have expressed that the biofeedback offers them better coping skills.

Other measures to manage tinnitus include making every attempt to avoid anxiety, as this will increase your tinnitus. You should make every attempt to obtain adequate rest and avoid over fatigue because generally patients who are tired seem to notice their tinnitus more. Managing stress is especially important. Some popular stress reducers are exercise and meditation. Whatever you choose, do it on a daily basis. As you begin to manage stress you will understand how anxiety and negative emotions fuel your tinnitus perception.

There are medications which have been utilized to suppress tinnitus. Some patients benefit with these drugs and others do not. Each patient has an individual response to medication, and what may work for one patient may not work for another. Some of these medications have been proven, however, to decrease the intensity of the tinnitus and make it much less noticeable to the patient. There is, however, no drug anywhere which will remove tinnitus completely and forever. There are some drugs which will also cause tinnitus. If you have tinnitus and are on medication, you should discuss the symptom of tinnitus with your physician.