What is tinnitus?
It is the name given to the sounds in the head that can be experienced (‘heard’) at times when no physical external sound is present. Although it is usually associated with hearing loss, this is not always the case and conversely, it is also experienced by people with normal hearing. It is common and has been experienced temperarily by most people at some time in their life (eg after a loud concert).
The actual mechanism of tinnitus is poorly understood but it is not imaginary and is a phenomenon caused by some abnormality along the complex pathway of hearing between the ear and the brain.
Classification of tinnitus
Tinnitus is classified into objective and subjective tinnitus.
Objective tinnitus is heard not only by the person experiencing it but also by any interested listener, such as a doctor. It may be pulsatile which may correspond to the pulsing of blood in a vessel (normal or abnormal) near the ear. It may be caused by another physiological sound in the head or neck.
Subjective tinnitus can only be heard by the person who experiences it. It may be heard in one or both ears or somewhere inside the head. It may be constant, fluctuating or intermittent and it may be varying noises at different times.
What causes tinnitus?
A specific cause is not always found, but there are many recognised causes of tinnitus too. Your doctor will assess and examine you and arrange investigations such as a hearing test, MRI scans and blood tests.
Some of the causes are: wax pressing on the eardrum or blocking the ear canal, inherited ear abnormalities, diseases of the inner and middle ear, and drugs for eg from the aspirin family in high doses, quinine and chemotherapy agents. It is recognised to occur in diseases such as Meniere’s disease, otosclerosis, acoustic neuroma, high blood pressure, arthritis and diabetes. Injuries such as whiplash, loud noise, scuba diving and barotrauma can cause tinnitus. Individuals can become aware of intrusive tinnitus at times of stress, anxiety, depression and introspection.
Is there a cure for tinnitus?
There is no ‘magic cure’ for tinnitus, but there are number of different treatments available, such as drugs, hearing aids and masking devices, biofeedback and CBT, dietary awareness and stress reduction, and self help groups. Treatment to underlying conditions such as otosclerosis or Meniere’s may help to reduce the tinnitus. Your doctor or specialist will advise you about the best treatment option for your particular case.
What makes tinnitus worse?
Loud sounds. People who experience tinnitus must avoid loud noise. When using DIY tools, guns, noisy vacuum cleaners etc. It is advisable to wear ear protection.
Excessive use of alcohol and other ‘recreational drugs’. Almost all patients find that following states of intoxication their tinnitus is aggravated.
Caffeine. Caffeine is found in coffee, tea, cola drinks and chocolate. It is advisable for any tinnitus patient to give up any caffeinated foods and drinks for one month to determine if it has an adverse effect on their tinnitus.
Nicotine. It is advisable not to smoke if you have tinnitus because of the vascular effect is has on the body.
Aspirin and anti-inflammatory drugs. Many tinnitus patients have other physical problems that require them to take these medicines. It is advisable to ask the doctor for a suitable substitute or to regualte the dose to cause the least amount of tinnitus.
Stress. It is common that stress aggravates tinnitus. Stress management courses will help to reduce stress and so reduce the tinnitus.
Stress and Tinnitus
For the vast majority of people, the hearing pathway and brain adapt over time to make the tinnitus less intrusive such that individuals are not distressed.
In a minority of people tinnitus can significantly affect their quality of life. People differ greatly in their response to stress. What is a tolerable stress for one person might be an intolerable distress, discomfort or incapacitating situation for another.
Self Help Tips
Think for a moment about your tinnitus and rate its severity on the following scale:
The tinnitus is there if attention is brought to it – it can usually be ignored.
The tinnitus is irritating and can sometimes be ignored – it does not interfere seriously with work or social activities.
The tinnitus is difficult to ignore, but with effort you can maintain work or other activities.
The tinnitus is always present and distressing – it makes it difficult to concentrate and you can only do simple tasks.
The tinnitus is an overwhelming problem much or all of the time – you are unable to perform any work or social activites.
If you rated your tinnitus as 3 or greater, then you probably need to improve your coping skills and reduce the amount of stress in your life. Here are some ways that you can reduce stress. Try them and see if they help you handle the tinnitus.
Learn to relax. Deep breathing is a natural relaxant. Stop every 10 minutes or so and take 3 or 4 deep breaths.
After you have practised deep breathing exercises for a while, start to pay attention to yourself. Shallow breathing and frequent fast pulse are indicators of anxiety and stress. When you notice yourself breathing fast, slow down.
Simple exercises can help you to relax. Tense all your muscles for five seconds, then let go. Do this several times a day and you’ll soon recognise how you should feel with tension loosened. Many books have been written about relaxation for the layman; a good one is “You Must Relax” by Edmund Jacobson.
Use mental imagery to help you relax when busy or at work. With eyes open, you can concentrate on a beautiful flower or other objects for a few minutes. Force yourself just to enjoy it and not think of anything else. With eyes closed you might think of something pleasant and warm like standing on a sandy beach. These short rest periods can be better than a nap.
Exercise every day. Take a walk, jog, swim, play tennis. Do whatever form of exercising you enjoy doing. Exercising will make you feel stronger and better able to cope with tinnitus.
SMILE: happiness is catching. No one wants to hear you complain. Don’t be afraid to speak out about your tinnitus to let family and friends know you have a problem. They might surprise you with their consideration.
Try not to focus on the unpleasant or stressful aspect of your tinnitus. Don’t feel you must fight it all the time. Try to think of it as just something you have, like your hair colour, your height or your disposition.
Learn more about your tinnitus. The more you know about a problem, any problem, the more you are in control and the less helplessness you feel in dealing with it.
Loud noise is the enemy of the tinnitus patient. Even a short exposure to noise can make the tinnitus worse and make you tense and irritable. Get away from the noise if you can or wear ear protectors.
Talking to other people who have tinnitus can also be a big help. You might learn some new tips about how to get along better with your tinnitus.
Go even further. Join a Tinnitus Self Help Group or start one in your area. Your local Hearing Association probably has a Tinnitus Support Group as part of their membership.
If sleep is a problem for you because of the tinnitus there are several things that you might try. First of all you should try to wind down or relax before going to bed. Sometimes reading for a time before retiring is useful. Your sleeping place should be comfortable. Nightclothes should not be too tight. Some people benefit from having a light snack before going to bed. Soft music or pleasant sounds can often be utilised to help one fall asleep. Changing your routine so that you go to bed at a different hour might make a difference.
Where and from whom can I get help?
This cannot provide the answers to everyone but we can offer a few guidelines:
Tinnitus is a medical symptom. Each patient should be seen initially by an ENT surgeon to rule out any serious problems associated with the tinnitus.
Secondly, hearing tests can be performed by an Audiologist. Testing will reveal whether you are discriminating speech and other sounds in a normal way, whether your ears are functioning properly mechanically and whether you perceive loudness levels in the normal way. Other specialised tests may be performed to evaluate the pitch and loudness of your tinnitus.
Next, the hearing aid dispenser will use the recommendations from the ENT surgeon and the audiologist to select the best type of instrument for your particular problem. Sometimes tinnitus is relieved just by wearing hearing aids. In other cases, “masking” sounds be recommended.
Some tinnitus patients who are experiencing an extreme amount of stress may be referred for biofeedback or relaxation therapy. Biofeedback is used to teach the individual how to self-control bodily functions. Many people who have chronic problems have learnt to react to them in a more healthy way through this type of instruction. These techniques may be able to help you teach your body not to fight the tinnitus but to accept it as merely a condition that you have.
Tinnitus retraining therapy, performed by suitable trained therapists, is another established way of helping tinnitus.
Many other treatments have been tried for tinnitus. Because tinnitus is such a widespread symptom and associated with so many pathologies, it may respond to treatment given to alleviate some other condition. Some tinnitus sufferers report relief when jaw pain or other jaw problems are corrected. Others have been helped by medication to increase blood circulation or relieve high blood pressure. Some individuals are sufficiently troubled so that psychiatric or psychological counselling is recommended. A few patients have reportedly been helped with hypnosis or acupuncture. Anecdotal accounts of a number of helpful treatments have been recorded, but in the absence of verification by scientific method, recommendations cannot be made. A few antidepressant drugs have helped tinnitus. However some antidepressant drugs will actually make tinnitus worse so it is important to use a cautious approach with such drugs.
A great many drugs have been tried in the hope that they might relieve tinnitus. Most have not had any noticeable effect on the tinnitus and often cause undesirable side effects such as nausea or heart palpitations. Although drug research on tinnitus is going on constantly so far there has not been the breakthrough we are all waiting.
Further information can be obtained from:
The NZ Tinnitus Association
PO Box 28205
Ph: 09 524 9847 ext 20
University of Auckland
Hearing and Tinnitus Clinic
Tamaki Campus Level 1,
261 Morrin Road, Glen Innes 1027
Ph: 09 373 8791