Tinnitus

What is Tinnitus (Ringing in the ears)?

Tinnitus describes the situation when someone hears a noise in their ears or in their heads. It is estimated that about 30% to 40% of the population will suffer from tinnitus at some point in their life. Tinnitus can occur quite frequently as most people will hear a type of rushing or hissing sound if in a very quiet room. Usually this noise is masked by environmental sounds. Remember that if you hear actual words, songs or voices, this is not described as tinnitus.

The noise may become severe enough that it is intrusive into everyday life and quite irritating. The precise noises of tinnitus vary widely in terms of pitch from low to high frequency sounds. They may be intermittent or persistent and usually vary in intensity. Most people are not too concerned about it but some worry that there may be something more sinister such as a brain tumour.

The intensity of the noise often varies according to activities such as exercise, drinking excessive coffee or wine and/or other stimuli.

Although less frequent, children can suffer from tinnitus as well as adults.

Types of tinnitus

Tinnitus is generally divided into two types:

• noises that can be heard by somebody examining the patient (objective tinnitus)
• noises that can only be heard by the patient (subjective tinnitus)

Objective tinnitus

This type of tinnitus is uncommon. Noises may be caused by spasms of the small muscles in the middle ear (giving rise to a click) or by abnormalities of the blood vessels in and around the ear, which often causes a pulsatile tinnitus as it usually occurs in time with the heart beat.

Such objective tinnitus which can be heard by the examining doctor may require further investigation by an ear, nose and throat surgeon or audiological physician, and may in some instances have a surgical cure.

Subjective tinnitus

This is by far the most common type of tinnitus. It is useful to consider the inner ear as an active ‘engine’ which produces a very faint hum in everyone. This quiet noise is masked in normal everyday life by the background noise going on in the world around us. If you cannot hear sounds in the outside world so well, such as if you are in a sound proofed room or if your hearing is deteriorating, you tend to notice the natural noises inside your head much more because they are not being drowned out by the environmental noises.

Tinnitus is often, but not always, linked to a hearing loss. If the tiny hair cells of the cochlea are damaged, for example through certain drugs, noise exposure or as part of the aging process, the cochlea is less able at discriminating sounds, and your hearing is affected. This results in less masking out of surrounding noises and an increase in tinnitus. The damaged hair cells may also cause or create additional random noises. This is the reason that when you consult a specialist about tinnitus, you will have a hearing test.

The loudness of tinnitus is not linked to the degree of hearing loss, nor does the loudness of tinnitus increase with time.

Certain types of specific diseases that affect the inner ear can also be associated with tinnitus (e.g. Meniere’s disease)

Further investigation

If tinnitus is only affecting one ear or if it is disabling, further investigations are likely to be warranted. You are likely to be referred to an ENT (ear nose and throat) surgeon or audiological physician who will undertake an assessment.

Investigations usually include hearing tests, blood tests and/or radiological investigations (x-rays or scans). The most common test used is an MRI scan. Most of the time, the investigations come back as normal. Very rarely a more serious condition will be found, such as a tumour of the auditory nerve. Fortunately, the majority of patients who suffer from tinnitus will either find it gets better by itself, or that they will learn to tolerate the noises after a short period of time of only a few weeks or months.

Treatment

Generally the treatment of tinnitus falls into two main areas: tinnitus counselling or the use of mechanical devices such as hearing aids or white noise generators to control the symptoms.

Simple measures: If the tinnitus is loudest when you are trying to get to sleep, one suggestion is to put a radio next to your bed, turned to a quiet setting that you can just about hear but that is not too loud to prevent you from falling asleep. You can set a snooze function so that it turns off after a set time interval. This will give your ears something else to listen to and many people find it a very useful method of getting to sleep. Other people use relaxation tapes, again with the volume down so that you can only just hear it.

Tinnitus counselling: This is conducted by a tinnitus therapist who spends considerable time explaining the cause of the tinnitus and planning a strategy for understanding and controlling its impact in the patient’s day to day life. This also involves a degree of managing the mental or anxiety-related aspects that such persistent noises can be associated with. It is usually extremely effective.

Mechanical devices

The use of hearing aids or tinnitus maskers amplify surrounding noises so that the tinnitus is no longer heard. Hearing aids are ideal if there is an associated hearing loss with the tinnitus. Tinnitus maskers are not so commonly used any more, but worked on the idea that a continuous noise, generated in the ear canal by the masker, would mask the tinnitus and would also provide an effect for several hours after it had been switched off.

Other types of treatment

Multiple types of treatment have been tried for tinnitus, and although they can be helpful for some patients, none of them will help all patients. Gingko biloba is a herbal remedy which helps in up to 50% of people, but no properly controlled study has shown a definite positive effect. In general, drug treatments are not very helpful. Some types of sedatives have been used, but they are not good for long-term use and do not solve the underlying problem.