What is Tinnitus?
There are many forms of tinnitus treatment. The word tinnitus comes from the root word tinnire which means “to ring.” Tinnitus is a noise in the ears or head that is described as ringing, humming, hissing, buzzing, etc. It is not related to an external sound and is not heard by others. It usually originates from damage to the hair cells in the inner part of the ear and is interpreted in the auditory cortex of the brain. Even if the auditory nerve is severed due to surgery, injury, or a medical condition, tinnitus is still perceived.
Prevalence of Tinnitus
Approximately 10-15% of people report having tinnitus and about 10% of them seek medical attention. A large majority of people who report tinnitus also have some degree of hearing impairment. Even a slight hearing loss can cause tinnitus. For 90% of people with tinnitus, habituation (adapting to tinnitus so that it is easily ignored) happens naturally. For those who do not habituate, there are tinnitus treatment options available (see below).
Causes of Tinnitus
There are many potential causes of tinnitus. Some are related to the ear and some are not. They include:
- Noise exposure
- Hearing loss
- Ear infections
- Cardiovascular and cerebrovascular disease
- Acoustic neuroma or other skull based tumors
- TMJ (temporomandibular joint problems)
- Earwax (cerumen)
- Side effects of prescription and non-prescription drugs
- Head injury
- Hyper and hypothyroidism
- Idiopathic (unknown) causes
For some people one or more of the following may exacerbate tinnitus:
- High cholesterol
- Hyper and hypothyroidism
The Limbic System and Tinnitus
The limbic system is a collection of structures in the brain that are responsible for our emotions and our memories. The limbic system contributes to the activation of stress and tinnitus-related anxiety. Simply put, when you hear a sound, the hippocampus in the brain is activated which compares sounds to what it knows and retrieves memories of sounds. This in turn activates the amygdala which then determines the emotional significance of the event and the need, if any, for the release of flight or fight neurotransmitters.
How does this relate to tinnitus? When the hippocampus is stimulated by the tinnitus it starts to compare that sound to other sound memories stored in your brain. In some people that sound triggers a negative emotional reaction in the amygdala. This may be due to fear that the sound represents something to be afraid of such as a serious medical condition. It’s important to note that most tinnitus is NOT related to a serious medical condition. But when the symptoms first appear, this may not be clear to the person experiencing it. Therefore, the “fight or flight” system is activated in the brain that in turn creates stress and an ongoing cycle of negative reactions ensues.
Tinnitus Evaluation Process
The first step in evaluating tinnitus is a diagnostic hearing evaluation to help determine whether hearing loss or some other medical condition related to the auditory system is the root of the tinnitus. We will also take a medical history and use questionnaires targeted at determining the impact of tinnitus on your everyday activities.
Tinnitus Treatment Options
At Pacific Hearing Service we focus on creating a customized tinnitus program for each individual’s needs. There are many tools for us to choose from to create the most pleasing and effective plan to provide relief.
- Educational: Knowledge is power. Simply understanding the mechanism behind tinnitus reduces the stress and anxiety associated with it.
- Sound-Based Therapies: Because tinnitus is often caused by hearing loss, sound therapy is a very effective tool. Treating the tinnitus with sound stimulates the auditory system and helps draw attention away from the tinnitus. Sound therapy can include hearing aids (appropriate amplification from hearing aids often helps even if you have mild hearing loss), hearing aids with sound generators (many hearing aids now have optional sound generators that stimulate the auditory system and reduce the effects of tinnitus), specific sound generators, (Soundcure) and household items (fans/radios/smartphones, etc.).
- Medical: If a specific medical condition (TMJ, ear infection, cervical alignment issues) is the cause of the tinnitus, medical treatment will help. If our diagnostic process indicates medical intervention is necessary, we will refer you to your own physician or assist you with an appropriate medical referral.
- Psychological: As with medical referrals, sometimes we find it is appropriate for you to seek help from a licensed therapist. Options may include counseling, cognitive behavioral therapy or joining a support group. We may refer you to an appropriate professional if you have significant anxiety or depression related to the tinnitus.
- Alternative Medicine: Licensed alternative medical professionals may be able to help manage the impact of tinnitus.
- Spiritual/relaxation: Options include meditation, prayer, exercise, and effective sleep.
The Goals of Tinnitus Treatment:
- Reduced emotional reactions
- Reduced stress
- Reduced attention paid to the tinnitus (habituation)
- Reduced impact of tinnitus on day-to-day activities
- Resolution such that further help is not needed or wanted