Tinnitus, a constant ringing, buzzing, hissing, or humming in the ears, can drive a person up the wall. Few sounds are as maddening as one that only you can hear.
But the good news is, for most people tinnitus does not indicate a serious health problem. And there are steps one can take to eliminate or manage tinnitus so they can focus on more important things in their life.
What is tinnitus?
Ringing in the ears is a normal response to loud noise, such as a rock concert. While it is essentially the same experience as tinnitus, it usually goes away after a few hours. Chronic tinnitus symptoms are experienced:
- for more than five minutes
- at least twice a week
- for 3-6 months.
“Tinnitus is when we’re hearing a sound either in the ears or sometimes in the middle of the head, when there’s not an actual sound outside or within the body. It’s just happening within the nervous system,” explains WWMG Audiologist Sara Sommers.
You may hear the condition pronounced as “tin-ITE-us” or as “TIN-it-us;” both are considered correct.
The connection between tinnitus and hearing loss
There is a connection between tinnitus and hearing loss, but one does not cause the other.
“The primary theory is that changes in the auditory system cause both the hearing loss and the tinnitus. Most things that cause hearing loss can also cause tinnitus. The majority of people who have tinnitus also have some degree of hearing loss. Even if they don’t notice the hearing loss as a primary symptom, it can make tinnitus more noticeable.”
Tinnitus can be incredibly annoying, and that irritation is not something to ignore.
“We cannot just brush off tinnitus and ask people to get used to it. If the tinnitus is really bothersome and [a person is] told to just deal with it, that can trigger a lot of hopelessness,” said Sommers.
An Audiologist can provide a patient with solutions to help them better cope with tinnitus.
Mental health risks for patients with tinnitus
For anyone who has not experienced chronic tinnitus, it may sound melodramatic to describe it as a serious mental health risk. But tinnitus is linked to elevated rates of anxiety, depression, and even suicidal ideation.
“Serious mental health impacts from tinnitus are more common than tinnitus being a sign of a serious medical problem. If tinnitus is causing the patient a severe amount of distress, they need to seek emergency care right away,” urged Sommers.
When tinnitus can reveal other medical problems
That said, in a small minority of cases, tinnitus can indicate an underlying health problem. When tinnitus is experienced alongside symptoms such as weakness or paralysis in facial muscles, it’s an urgent sign to seek medical attention.
Other rare circumstances that call for immediate medical help are when tinnitus is accompanied by:
- vertigo
- sudden hearing loss, or
- when the ringing begins after an injury.
“For the most part we’re going to see things that impact the head or neck and spine. But I would definitely mention it to a doctor if you have anything that syncs up with brand-new symptoms, even if they seem unrelated,” said Sommers.
Less urgent, tinnitus accompanied by ear pain, pressure, or severe warmness could indicate an ear infection. When tinnitus begins suddenly or is experienced in only one ear, it might be a sign of a temporary medical problem that should be addressed.
What causes tinnitus?
In most cases, tinnitus is caused by the same things that lead to hearing loss:
- aging and
- exposure to loud noises
…but occasionally medications can be the culprit.
Ototoxic medications are drugs that damage the inner ear or auditory nerve, sometimes permanently. These include some antibiotics, diuretics, chemotherapy agents, and even high-dose aspirin and pain medications like ibuprofen.
“If you are taking NSAIDs and develop some ringing, finding a different medication or reducing the dose can improve the tinnitus and hearing problems,” said Sommers.
If you’re experiencing tinnitus after starting a new medication or changing your dosage, talk to your healthcare provider or audiologist.
How to prevent tinnitus
When it comes to preventing tinnitus, “The biggest thing to do would be protecting your ears from exposure to loud noise. There’s been good progress on that, but I am still seeing quite a lot of people who have the kind of hearing loss that can be prevented.
“Noise-induced hearing loss does frequently have tinnitus co-occurring with it, and we know that continued exposure to noise can cause tinnitus,” said Sommers.
Today we live in a noisier world. Noise induced hearing loss can happen at any age and research already shows that one in five teens have some degree of hearing loss due to excessive volume in headphones.
Protecting your ears now is essential to preventing or minimizing hearing loss later.
Different situations may call for different types of hearing protection. Sommers often recommends Loop earplugs to provide a good balance between noise protection and sound quality, such as in a restaurant or coffee shop with a lot of background noise.
But stronger protection may be required when using power tools, riding a motorcycle, going to a concert, or working in consistently loud environments such as a machine shop.
Treatments for tinnitus
Any treatment for tinnitus will begin with a hearing test, because the most common relationship between tinnitus and other conditions is hearing loss.
“We know that tinnitus is perpetuated by the auditory system, the nervous system and the brain. We can sever the auditory nerve, and it does not improve the tinnitus for the vast majority of cases. That’s why brain-based treatments are the most effective,” said Sommers.
“We want to prevent our nervous system from thinking of the tinnitus as a threat. If it continues to check and check and check the threat, we’re noticing it more and it seems louder. It becomes more bothersome. “
Some common brain-based treatments for tinnitus are:
Cognitive Behavioral Therapy
Cognitive Behavioral Therapy (CBT) which is also used to treat anxiety, insomnia, and many mental health issues, is the gold standard for treatment of tinnitus.
CBT “is highly recommended by the American Academy of Otolaryngology. But it is hard to find a provider who knows both cognitive behavioral therapy and tinnitus. Patients may have difficulty accessing it,” said Sommers, noting that insurance doesn’t always cover CBT for tinnitus.
Progressive Tinnitus Management
That’s why Sommers’ recommendation for the first line of treatment is Progressive Tinnitus Management, an approach developed by the Veterans’ Administration.
Based on a combination of CBT and sound therapy, the VA provides a free handbook and online resources that anyone can use.
Tinnitus Retraining Therapy & Sound Therapy
“Tinnitus retraining therapy is another treatment option that combines counseling with sound therapy,” said Sommers. Sound therapy involves purposefully using sound in your environment to reduce the contrast between ambient noise and tinnitus.
“Sound therapy can be done with hearing aids. Just wearing your hearing aids to hear what’s around you can help quite a lot for a whole lot of people. But we also might need solutions for at night, or for folks who don’t have much hearing loss and don’t need hearing aids,” said Sommers.
Lenire
Lenire is device that treats chronic tinnitus by combining sound stimulation through headphones with mild electrical pulses to the tongue.
“We have referred people out for that,” said Sommers, “But even clinics that provide Lenire use it as a last resort because it is expensive and intensive” therapy.
The relationship between tinnitus and other health issues
Some lifestyle and health issues will cause tinnitus or make it worse, and must be treated to manage the tinnitus effectively.
Depression and anxiety
“Tinnitus can cause depression and anxiety. And for people who have both tinnitus and depression or anxiety, even if they’re not causing each other, they make it more difficult to deal with or treat the tinnitus effectively,” said Sommers. “We do also need to treat underlying or co-occurring problems.”
Sleep issues
Another relationship connects tinnitus with sleep problems.
“If we’re not sleeping well, we don’t really have the toolbox for taking good care of ourselves, including managing tinnitus. And if we’re not sleeping well, we’re much more likely to notice our tinnitus at night when it’s quiet.
“Tinnitus can be one of the things that’s causing us not to get a great night’s sleep. It’s a very nasty cycle that we get into,” said Sommers.
Supplements or prescription medication for insomnia can sometimes help break the cycle enough to allow the tinnitus treatment to be effective.
Where to get help for tinnitus
Tinnitus may not be dangerous, but it can seriously affect person’s quality of life.
If it’s keeping you up at night or interfering with your daily activities, contact a WWMG primary care provider or our ENT and Audiology clinic to schedule a hearing evaluation, and discuss which tinnitus treatments are the most appropriate for you.