What is tinnitus?
Tinnitus is when you hear a ringing in one or both of your ears. What makes tinnitus unique is that people who experience it are hearing a sound that is not produced by something external, like a firework, but from within, which means only you can hear it. Tinnitus is common and affects between 15% to 20% of adults. More often than not, tinnitus is caused by another condition, which means it is a symptom, not a disease.
It can sometimes be difficult to even notice you are experiencing tinnitus because for many people it happens very gradually. However, if you notice any hearing loss or frequent ringing in your ears, chances are you’re suffering from tinnitus. The best thing to do when you notice this is to make an appointment with an audiologist, a hearing care specialist.
The better you can describe the sounds you hear when experiencing tinnitus, the easier it’ll be for your doctor to diagnose the root cause. There are four main sounds people usually hear:
- Clicking suggests that muscle contractions in and around your ear might be causing your tinnitus
- Pulsing, rushing, or humming are usually due to blood vessel (vascular) causes, such as high blood pressure, and you may notice them when you exercise or change positions, such as when you lie down or stand up.
- Low-pitched ringing usually means ear canal blockages, Meniere’s disease, or stiff inner ear bones also known as otosclerosis.
- High-pitched ringing is the most commonly heard tinnitus sound, and it is usually caused by exposure to loud sounds, hearing loss, or certain medications.
Subjective VS Objective Tinnitus
There are two types of tinnitus: subjective and objective. The most common of the two is subjective tinnitus, which is when the ringing in your ear can only be hard by you. Subjective tinnitus can come and go, last a few seconds or days, and can be intermittent or persistent – it’s different for everyone. The main causes of subjective tinnitus are exposure to loud sound, aging, or earwax blocking the ear canal.
Subjective tinnitus has a few different subcategories, like somatic tinnitus, which is usually caused by muscle spasms in the neck or ear. This kind of tinnitus is related to physical movement and touch. Somatic tinnitus is sometimes referred to as conductive tinnitus, meaning it is caused by functions not related to neurological issues. Sensory tinnitus is another kind, usually a side effect of an impaired auditory system. People with sensory tinnitus may feel off-balance at times. In most cases, subjective tinnitus is a permanent condition.
Objective tinnitus is much rarer, usually caused by a vascular disorder or muscle contractions. It is the only kind of tinnitus that can be heard by an outside observer using a stethoscope. It usually occurs in time with the heartbeat, and can often be treated by correcting the issue leading to the sound in the first place.
Constant ringing in both ears
Tinnitus can sometimes affect both ears, called bilateral tinnitus. Sounds can be loud or soft and they can also vary in pitch and loudness. Like with traditional tinnitus, bilateral tinnitus can be continuous, or it can come and go. Again, it is different for each person. The sounds more commonly associated with bilateral tinnitus are roaring, ringing, hissing, whistling, buzzing, clicking, whooshing, and chirping crickets.
Tinnitus can already be very challenging to live with, so bilateral tinnitus can sometimes be even more of a burden. This is why additional symptoms of bilateral tinnitus include anxiety, insomnia, and depression.
Hear a loud thumping in both ears or ringing in one ear
There is another rare form of tinnitus called Pulsatile Tinnitus. Pulsatile tinnitus can be loud or soft, but it tends to happen in time with the heartbeat and often sounds more like whooshing than a ringing in the ears. Like traditional tinnitus, pulsatile tinnitus isn’t a condition, but a symptom of something else, usually vascular disease, meaning conditions that affect your veins or arteries, sometimes even tumors.
Pulsatile tinnitus may impact your ability to sleep, concentrate, or do work. For some people with severe pulsatile tinnitus, it may lead to depression or anxiety. In many cases, pulsatile tinnitus is a warning that something else is going on, likely a serious medical condition, which is why it should never be ignored. If you’re experiencing tinnitus, whether severe or not, pulsatile or not, make an appointment to see a doctor to get to the bottom of it. The sooner you address the issue, the better your chances of finding a solution that works for you.
Tinnitus and “musical hallucinations”
Tinnitus is when you hear sounds that nobody else hears, and it’s pretty common. Musical hallucination or musical tinnitus is when someone can hear music in their ears that is not being played externally. Unlike getting a song stuck in your head, musical tinnitus doesn’t happen after you’ve recently heard a song, and it tends to last much longer.
There is no underlying cause for musical hallucinations, and so far there doesn’t seem to be any connection with other mental health conditions either. Musical hallucinations tend to feel very real to the person hearing it, especially when it’s the first time. People experiencing musical tinnitus tend to hear familiar songs from their childhood, like national anthems or church songs. What’s most interesting is how musical hallucinations affect people with hearing loss. For them, the music they hear sounds exactly right, with no missing frequencies or as it is with their current level of hearing loss.
Tinnitus and Hearing Loss
One of the reasons recognizing the first signs of tinnitus is challenging is because it often comes hand in hand with hearing loss. In fact, about 90% of people with tinnitus have hearing loss. Tinnitus often imitates the same pattern of your hearing loss, for example, if you have hearing loss in your right ear, you will likely experience tinnitus in the same ear. Or if you have trouble hearing lower frequencies, your tinnitus will likely sound like a rumbling, instead of a high-pitched ringing which is usually associated with trouble hearing high frequencies.
If you have tinnitus it’s a good idea to go to an audiologist not only to see how you can address tinnitus but to check and see whether or not something else is going on. You will want to test your hearing to make sure there’s no hearing loss. One thing to note is that not all audiologists treat tinnitus, so you want to make sure the one you choose does before making an appointment. The good news is that treating your hearing loss may help improve your tinnitus as well! In fact, some hearing aids help tinnitus sufferers by masking tinnitus by slightly amplifying other sounds.
How to get help if you think you’re experiencing tinnitus
If you think you have tinnitus, the first thing to remember is that you’re not alone and that you should not try fixing it on your own! Make an appointment with your doctor or audiologist as the first step. At the appointment you will go over your health history, the medications you’re taking, and discuss any symptoms you may have. The doctor will want to know how long you’ve been experiencing tinnitus as well as what kind of sound you’re hearing.
While there is no test to take to confirm you have tinnitus, the more detailed information you provide, the more ammunition the doctor will have to help you. While at the audiologist, an audiogram should be performed too. An audiogram is a test that determines whether or not there’s any hearing loss. If the sounds you hear are more like thumping, it could be a sign of pulsatile tinnitus. If that’s the case, the doctor may perform different imaging tests to check for blood vessel irregularities and scans to check for sinus wall irregularities.
Tests may include:
- Blood tests
- Blood pressure test
- Thyroid function test
- High resolution computed tomography (CT) scan
- Angiography
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA) to check for blood vessel issues
- Ultrasound of blood vessels
Do not ignore tinnitus or hearing loss. The sooner you get help, the better your chances of finding a solution that works well in the long run.
What treatments are available for tinnitus?
Treating tinnitus will be different for everyone and also depends on the underlying cause for it. Some of the most common treatments are:
Earwax removal: If your tinnitus is caused by an impaction or earwax buildup, it may be that all you need is an earwax removal performed by an audiologist. Please do not try at-home remedies like ear candling, they will not work and are more dangerous than they appear.
Treat blood vessel condition: If the tinnitus is caused by a blood vessel condition, it may be that medication addressing the blood vessel condition will help. The same can be said for surgery.
Use Hearing Aids: For those experiencing tinnitus due to hearing loss, hearing aids may be the answer. They will help you with improved hearing, and may even eliminate tinnitus. Or, they can be programmed to reduce the loudness of the tinnitus frequencies helping alleviate some discomfort.
Change Medication: Sometimes a certain medication may be the cause of tinnitus. If that’s the case it may be worthwhile to switch medications to see if that reduces or eliminates tinnitus altogether.
Tinnitus Retraining Therapy (TRT): One of the more successful therapies for subjective tinnitus is TRT. TRT is a long-term treatment that takes between one to two years to complete. It works by retraining the brain and how you perceive tinnitus. It’s a combination of one-on-one counseling and sound therapy, and one study found that 70% of patients treated with TRT reported moderate to significant improvement in tinnitus severity.
Ways to manage or lessen the symptoms of tinnitus
The good news is that while there is no cure for tinnitus, it doesn’t mean you have no options. On the contrary, there are a few different lifestyle choices you can make that can improve the quality of your life when dealing with tinnitus.
- Reduce your exposure to loud noises – tinnitus can sometimes be caused by loud sounds, like being at a concert, so limiting this (or using ear plugs as-needed) will reduce the likelihood of you getting tinnitus.
- Avoid total silence – you would think total silence would help, but it can actually make the tinnitus feel even louder, and thus, more uncomfortable. Having some light background sounds will help with that.
- Decrease your salt intake – excess salt, or sodium, restricts blood vessels and increases blood flow. Since pulsatile tinnitus is related to vascular issues, it’s good to proactively avoid too much salt to protect yourself.
- Monitor your blood pressure – high blood pressure could cause the blood to move through your body with more force, which could lead to tinnitus. So check your blood pressure to ensure it’s at manageable levels.
- Decrease your intake of stimulants like caffeine and nicotine – these stimulants tend to raise blood pressure, which could lead to tinnitus.
- Exercise regularly- regular exercise can improve circulation which helps the auditory system function at its best.
- Decrease stress levels: try meditating, going on walks, or practicing mindfulness.
You may want to consider counseling or joining a support group. Many audiologists report their patients feel and do better when they have a community they can turn to with their tinnitus issues. Doing regular research on the topic is also useful, as breakthroughs in medicine happen all the time, so you want to make sure you’re up to date on the latest!
Having tinnitus is not the end of the world, especially if you pay attention and take steps to do what you can to address it early on. Remember to get help from an audiologist, and to be detailed with all the information you provide so you can make a treatment plan together. Finding a solution may take time, but remember to be curious and to keep trying new things, you alone have the power to take an uncomfortable situation and change it with your actions. You got this!
