What is tinnitus?
When people think of disabilities, they often think of ones easily identifiable, like using a wheelchair or other assistive walking devices. Hidden disabilities are just as common, but often overlooked as they are not easily seen to others. Hearing loss and tinnitus are hidden disabilities. Although these are not thought of as physically disabling, hearing loss and tinnitus can be mentally disabling, and in some cases, physically disabling. This means that they can impact one’s life so severely that it can cause them to stop doing things they love, stop interacting with loved ones, and even to not be able to perform their assigned job tasks.
Many of us are familiar with what hearing loss is, as this is a common diagnosis, especially among older populations. We can all think of a family member or an older friend who has a hearing loss. Tinnitus is less understood and not as commonly discussed but yet, it is more prevalent than hearing loss. Tinnitus is often referred to as “ears ringing”, but it can be a variety of noises and does not have to be a ringing sound.
Types of Tinnitus
There are two types of tinnitus: objective tinnitus and subjective tinnitus. Objective tinnitus is when our inner ear of hearing is producing sound response or echoes, which are then audible to the listeners around them. Subjective tinnitus is hearing a noise without the presence of an auditory stimulus and can be ringing, buzzing, hissing, or whooshing. Subjective tinnitus is more common, and typically what we think of when referring to tinnitus. One specific form of medically concerning tinnitus is pulsatile tinnitus. This is when you hear your tinnitus in beat with your own heartbeat within your ear. This can often be associated with a glomus tumor, which is a vascularized growth within your middle ear space, therefore this can be considered an audiology emergency. If you are experiencing this form of tinnitus, be sure to seek medical attention from an Ear Nose and Throat physician immediately.
The severity of tinnitus ranges depending on the person. Some people can go throughout their day and never notice their tinnitus while others are greatly bothered by it. Although we do not know exactly where tinnitus is generated, the theory is that it is associated with the limbic system within our brain. The limbic system is responsible for your “fight-or-flight response” and our emotions. Therefore, this can cause many people with tinnitus to become bothered and on-edge. When their tinnitus is present, their brain and body activate this response and create a negative reflex, telling the listener that their tinnitus is dangerous, bothersome, and damaging to their life. Tinnitus can be primary, meaning that it occurred spontaneously by itself, or secondary, meaning it occurred in response to another medical condition. Secondary tinnitus is common and can occur in response to hearing loss, noise exposure, ototoxic medications, allergies, TMJ, Lyme disease, or an accident involving trauma to the head. If tinnitus is spontaneous in nature, it may resolve itself within the first 90 days. If the tinnitus continues past this period, then it is most likely going to be a permanent condition.
There are many disabling symptoms of tinnitus. It can impact one’s ability to fall and stay asleep. It can interfere with your performance of work duties and has led to premature departure of a job or a complete change of career. It can also cause people to stop doing things that they love, especially if they are quiet activities. People often report they no longer enjoy reading, sewing or crocheting, playing cards or board games. This can affect overall mental health, as people often report they no longer feel enjoyment from those activities. Sometimes people with tinnitus, also, report that their tinnitus becomes so loud that it interferes with conversations and their ability to hear the things around them. Although, physically, tinnitus is not covering surrounding sounds, your attention cannot be drawn from your tinnitus interfering with your ability to concentrate.
Can I Get Long-Term Disability Benefits for Tinnitus?
Tinnitus can often co-occur with other conditions, commonly mental health conditions. As tinnitus becomes more severe and disabling, the likelihood of developing anxiety or depression is higher. This is two-fold as it is in response to the over-activation of the limbic system and because it has resulted in you not being able to function well within your daily life. These conditions can be managed with the support of mental health professionals and often resolve after treating the source, your tinnitus. It is important that if you begin to feel overwhelmed or helpless, to reach out for support from either the suicide hotline or the American Tinnitus Association hotline at 1-800-634-8978.
How does VA evaluate Tinnitus?
Documenting your tinnitus and the effect it has on your life is a very important step for your treatment plan. You should start by scheduling a diagnostic hearing and tinnitus evaluation with an audiologist that specializes in tinnitus. They will perform a full hearing evaluation and complete subjective tinnitus testing to determine the pitch and loudness of your tinnitus. This information can be documented and tracked throughout your treatment. The audiologist will, also, have you fill out questionnaires like the Tinnitus Handicap Inventory (THI) and Tinnitus Hyperacusis Questionnaire (THQ) which helps describe your symptoms, effect it has on your life, and categorize the severity of the tinnitus. These questionnaires are beneficial as they can be repeated throughout your treatment to determine effectiveness. If you are a veteran experiencing tinnitus, you can be seen at the local VA Hospital for tinnitus services. The VA uses Progressive Tinnitus Management (PTM) to manage severe tinnitus and was developed by their national research and development team. It is a five step approach that involves both audiologists and behavioral health professionals. Step one, is the referral, either from your primary care physician or another medical professional. Step two, is the full diagnostic evaluation, which is similar to what is described above. Step three, is skills education and includes a meeting held within the VA hospital/community center with other veterans who are suffering from tinnitus. There they discuss the mechanisms behind tinnitus and different approaches that can be used to manage it. Step four, is the interdisciplinary evaluation to determine what behavioral health services are needed. Finally, step 5, is individualized support. The veteran will pick and choose treatment options from their group session, start to apply them, and discuss the results with the audiologist. There they can receive more tips on how to best integrate the tinnitus management into their life. PTM is available for other tinnitus clinics, not just veterans seen at the VA hospital. If you are interested in this type of therapy, contact your local audiologists to see if they have any experience with PTM.
For whatever treatment plan you choose, it is important to keep an open mind. Managing tinnitus can be very difficult, especially when it is severe. You must be willing to try and continue to work on your therapy in order to retrain your brain, so that tinnitus is not bothersome or harmful. This may take weeks, months, or years. Continuing with your prescribed therapies and appointments can help reduce the severity of your tinnitus and improve your overall quality of life. As you move through the diagnosis and treatment stage, it is important to have your audiologist document symptoms, effects on life, and any measurable changes in tinnitus. This information can be beneficial in terms of disability or insurance, as they always request a reason for service in order to provide compensation or cover any services provided. Severe tinnitus can qualify for long-term disability, but may require a “fight” from you and your healthcare professionals. Your audiologist can support you by writing a letter documenting your symptoms and how it has severely impacted your life and ability to perform your job. Insurance may require additional testing or information, so it is important to stay patient throughout this process as it can be long and frustrating. It is often helpful to hire a long-term disability attorney to help you through this process. If you believe you developed your tinnitus as a result of noise exposure at work, you can also qualify for a workman’s compensation claim. Generally though, every insurance company treats tinnitus testing and treatment differently, but often they do not reimburse for these services.
Tinnitus, if documented and treated correctly, can be considered a disability. This does not mean that tinnitus cannot be managed or resolved but will involve a full team of healthcare professionals. If you are unsure about where to get started, reach out to your audiologist and see if they work with patients who have significant tinnitus or if they have a referral network on who may be best to help.