Tinnitus is a term searched often. People want to know about it. What it is, what causes it and what can be done to “get rid of it.” You might be surprised to find that tinnitus is very common and affects about 30% of the population and is more common in older adults. Tinnitus occurs when you experience a ringing or other noise in one or both ears. Most people are not bothered by their tinnitus; however about 3% of those affected can be severely impacted. It is important to understand Tinnitus is not a disease, but a symptom of an underlying condition.
What Are The Two Common Types of Tinnitus?
Tinnitus occurs when you hear a sound(s) in the ears or head without an external source. The most common form of tinnitus is Subjective Tinnitus, meaning you are the only person who can hear it (it cannot be heard by others). Objective Tinnitus, which is rare, is when the sound can be heard by the examiner and is typically generated by structures in or near the ear.
Tinnitus can be non-bothersome; meaning a person hears it but it doesn’t bother them or affect their life in any way. For others, tinnitus can affect their ability to fall asleep or stay asleep. It can also affect their ability to concentrate, enjoy their social life, and can increase their risk of depression or anxiety.
One of the most common questions I hear is “What causes tinnitus?” There are many causes of tinnitus and certain risk factors that can increase your risk.
The most common causes of tinnitus include hearing loss, ear infections, wax impaction, head and neck injuries, and certain medications.
Other causes of tinnitus can include blood vessel disorders, acoustic neuromas, temporomandibular joint (TMJ) issues, Meniere’s disease, and other chronic health conditions (diabetes, autoimmune issues, migraines, thyroid problems and lupus).
Tinnitus is usually caused by an underlying condition and for many people, tinnitus improves with treatment of the underlying cause. Alternatively, other treatments that reduce or mask the noise can make tinnitus less noticeable.
Could You Have Tinnitus?
Millions of people have tinnitus every year. It can sound like a ringing, buzzing, clicking or whooshing sound. Tinnitus can be soft, loud, constant or intermittent. You can hear it in one ear or both ears, or somewhere in your head. It is very common, however, to not ‘self-diagnose’. If you are hearing a sound in your head, you will want to be seen by an Audiologist. Tinnitus is typically associated with an underlying condition.
Causes Of Tinnitus
It is important to understand that Tinnitus is not a disease itself. It is a symptom associated with other health conditions. The most common cause of tinnitus is hearing loss; however there are over 200 different health disorders that can generate tinnitus as a symptom. Here are the most common:
Hearing Loss – Sensorineural hearing loss is often associated with tinnitus; however the cause of hearing loss could be due to age or noise exposure. In addition, the patient themselves may not realize they even have a hearing loss. This does not mean there is no damage to the hearing system. A hearing evaluation is the only way to assess the hearing system to know if damage is present and the extent of it.
Obstructions in the Ear: Tinnitus can be caused by a simple blockage of wax in the ear canal, congestion/cold like symptoms and middle ear fluid.
Ototoxic Drugs: Many prescription drugs will list tinnitus as a potential side effect. The good news is, for most of these drugs, tinnitus is a short lived side effect once you stop taking the medication. A consult with your pharmacist will help determine if there is a better substitute for you.
TMJ (Temporomandibular Joint Disorder): Somatic tinnitus can be caused by TMJ. This occurs when there is damage to the muscles or ligaments where the lower jaw connects to the skull, in front of the ear. Typically, if you suffer from TMJ you will have symptoms of pain in the jaw or face and hear a popping sound when you talk or chew. A specialized Dentist can diagnose and often fix TMJ issues, which will get rid of the tinnitus.
Head and Neck Trauma: Another way to hear somatic tinnitus is with head and neck injuries. This can cause issues with blood flow and nerves that will, in turn, cause tinnitus. Typically this will produce variability in the sound, pitch and location of the tinnitus.
How Is Tinnitus Diagnosed?
Approximately 25 million Americans experience tinnitus. If you are among them, you might be wondering what you should do. The first step is to see an Audiologist. About 80% of people with tinnitus have some degree of hearing loss, so you will want to see an Audiologist who specializes in Tinnitus. Even if you choose not to get hearing aids, it is important to have a good understanding of your hearing loss, how it is impacting your tinnitus and a review of the different tinnitus therapies available to you. The Audiologist may also refer you to an otolaryngologist or cardiologist to rule out possible underlying medical issues, especially if you have pulsatile tinnitus.
How Is Tinnitus Treated?
There are several established therapies to manage tinnitus; however there is no magic wand or quick pill. All current therapies aim to reduce the impact tinnitus is having on a person’s life, they do not ‘remove’ or ‘get rid of’ the tinnitus. The search for a cure is ongoing and progress is being made; but that doesn’t mean people need to suffer. There are therapies today that will help the emotional and cognitive impact of tinnitus. They will help you to live a fulfilling and productive life, even with the perception of tinnitus. Cognitive Behavioral Therapy, Tinnitus Retraining Therapy, Progressive Tinnitus Management and Tinnitus Activities Treatment have all shown to improve people’s quality of life. Also, sometimes wearing a hearing aid is all a person needs to reduce the impact tinnitus is having on their life.
Tinnitus Risk Factors
Tinnitus has many causes as stated above, but what about risk factors? Is there anything you can do to reduce the risk of experiencing tinnitus? Yes and no… The most common risk factor is exposure to loud noise. Think of loud, heavy equipment (lawn mowers, power tools, firearms, factory and farming equipment) or music devices (earbuds, headphones, speakers, etc…). If you work or enjoy loud sounds, you are putting yourself at risk for hearing loss and tinnitus.
Other risk factors include age, sex, tabacco/alcohol use and certain health problems.
Unfortunately as we age, the number of healthy nerve fibers in our ears go down which can lead to hearing problems that are often associated with tinnitus.
Statistics show men are more likely to experience tinnitus than women. In addition, studies show smoking and drinking alcohol increase your risk of tinnitus. Finally, there are certain medical problems, which you can control, that will increase your risk: obesity, cardiovascular issues and high blood pressure will all increase your risk of tinnitus.
What If The Sounds In My Ear Do Not Go Away?
One of the most common concerns tinnitus patients have is ‘what if the sounds never go away?’ It can seem overwhelming and hopeless, but it doesn’t have to be. Know there are millions of people who have tinnitus and are not bothered by it. Imagine you live near the airport. At first the sounds of the airplanes taking off and landing are very disruptive and noticeable; however after living there for months you will no longer even notice the sounds of the airplanes. Why is that? Your brain has become accustomed to the noise. It has determined the sounds of the airplanes are not important or a threat and so your brain puts those sounds in the background. You no longer focus on it. The same is true for the refrigerator in the kitchen. All day long the fan noise of your fridge will kick on and off throughout the day; however you do not react to that sound. You don’t stand there in the morning with your coffee and think ‘how am I going to get any work done today with that fridge noise turning on and off all day long’. You don’t react to the noise because your brain has determined that sound is not important or a threat.
Complications Of Tinnitus
Not everyone is bothered or impacted by their tinnitus. Many patients with tinnitus will report it as being ‘non-bothersome’, meaning it is not impacting their life in any way. However, the majority of patients will report their tinnitus as ‘bothersome’, indicating it is impacting their life to some degree. Even moderate cases can interfere with the ability to work and socialize. Most common areas of impact are: trouble sleeping, irritability, fatigue, difficulty concentrating, anxiety, and depression.
Types Of Tinnitus
There are many ways to describe tinnitus. The first two main categories are: Subjective and Objective? Subjective tinnitus is the most common. This means only the patient can hear the tinnitus, others cannot. Subjective tinnitus is usually caused by auditory and neurological reactions to hearing loss. Objective Tinnitus is very rare, counting for less than 1% of total tinnitus cases. This is when others can hear what the patient can hear. Objective Tinnitus is typically caused by involuntary muscle movements or vascular issues. Tinnitus can also be classified as Primary or Secondary as well. Primary Tinnitus is when tinnitus is being caused by an unknown source, ‘perhaps’ it is caused by hearing loss or noise exposure or stress…. When Tinnitus is associated with an underlying cause (such as a narrowing of blood vessels in the neck), it is called Secondary Tinnitus. Tinnitus that pulses synchronously with the heartbeat is called Pulsatile Tinnitus and is the most common type of Secondary Tinnitus. Patients with Pulsatile Tinnitus need a thorough medical examination to rule out issues like: heart murmur, hypertension, vascular stenosis or coronary artery disease. Secondary Tinnitus that originates in the body may also be referred to as Somatosounds. Somato sounds are produced by an acoustic source located inside the body that activates the cochlear.