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Tinnitus

JD reported that he started having tinnitus about 10 years ago.  It has become worse for him in the past year. 

He experiences his tinnitus constantly.  He describes tinnitus as a high-pitched whine that sometimes changes pitch and volume throughout the day.  He says that he cannot sleep, he is worried there is something terribly wrong with him.  

He has searched the internet for answers.  He had ordered supplements from an ad he saw on Facebook that cost him $150 and did not help him.  He says that his tinnitus keeps him from hearing well, keeps him from concentrating and he is afraid to go out because he thinks his tinnitus will worsen.  

JD lost his job at a factory last year due to Covid shutdowns and his company downsized.  His mother passed away about 6 months ago after a prolonged illness.  JD has been helping his children with online schooling.  

He went to his doctor to see what he could do about his tinnitus.  His doctor told him that there is no cure for tinnitus, no treatment and that he should learn to live with it.  

JD went home from that appointment in tears.  

He felt hopeless and helpless.  He went into a deeper depression.  

JD saw an article on Facebook about tinnitus posted by the American Tinnitus Association (ATA) and he went on the ATA site and saw that there was a provider in his town who specializes in tinnitus issues. 

JD called the office and set up an appointment. He was asked to fill out history forms and questionnaires prior to coming to his appointment.  He was surprised to see that the history forms asked about medications he has taken and is taking currently, what health conditions he has, his noise exposure history, family history, and smoking history.  

The questionnaires asked him about his tinnitus, how he felt about the tinnitus, issues with concentration and sleep, etc.  When he started his appointment, the audiologist asked more detailed questions regarding his tinnitus.  He was told he was in the right place and that they would fully evaluate his hearing and auditory pathways and develop a plan for treatment. 

He underwent a complete battery of testing that did not indicate any serious disease processes relative to his tinnitus.  It was found that JD had high frequency hearing loss due to damage from loud noises while working at the factory.  

The audiologist thoroughly explained the results of the testing, explained how the auditory system works, and how tinnitus arises because of cochlear changes.  The audiologist also discussed the limbic system and how that affects problematic tinnitus.  It is recommended that JD treat his hearing loss and his tinnitus with a combination device (hearing device and sound therapy) and start Tinnitus Retraining Therapy.  He is also counseled that he could benefit from seeing a mental health specialist to address his depression and sleep disorder. 

JD was fit with combination devices using sound therapy all day long and used tabletop sound generators at night.  He attended TRT sessions as prescribed.   

On follow-up, nine months later, JD is not bothered by his tinnitus.  He perceives it occasionally when it is quiet, but he is no longer worried by it. He admits he is not depressed; he is sleeping much better, he hears and understands speech better using his devices, and finds joy in his daily life again.  

Understanding Tinnitus: Why do I have this noise in my ears? 

So, what is tinnitus?  Noises in the ears, or tinnitus, can be experienced throughout our lifetime, either transiently or constantly.  It is important to understand the underlying conditions that will not only cause tinnitus, but affect our ability to manage our tinnitus.

Common Symptoms of Tinnitus 

Tinnitus symptoms can be described as ringing, buzzing, clicking, seashell type noise, humming, and can sometimes be a combination of sounds.  

Tinnitus can be classified as primary tinnitus, secondary tinnitus, non-bothersome tinnitus, bothersome tinnitus, recent onset tinnitus, persistent tinnitus, spontaneous tinnitus, temporary tinnitus, occasional tinnitus, intermittent tinnitus, pulsatile tinnitus, and constant tinnitus. 

Most of the time tinnitus is subjective, meaning the tinnitus is only heard by the patient.  There can also be cases of objective tinnitus, meaning the tinnitus can be heard by an observer.   

It is normal to have short periods of subjective ear noises that come and go; however, there are about 48 million Americans that will experience tinnitus constantly throughout their day.  

Common Causes of Tinnitus 

Tinnitus can be related to medical conditions such as Meniere’s disease, diabetes, hypertension, hyperthyroidism, TMJ, ear diseases, tumors/neuromas, vascular conditions, cardiovascular conditions, allergies, anemia and side effects from medications/drugs.  

It can also be related to noise exposure, head trauma, barotrauma, hydro trauma, whiplash, and cochlear decline (changes in hearing mechanisms).  

Most of the time, these conditions have made structural changes in the delicate structures of the inner ear, and this is the source of the problem. 

What should I do if I have tinnitus?

If you have tinnitus concerns, you should see an audiologist who will conduct a thorough audiological case history.  

You will be asked to complete tinnitus questionnaires, allowing distinction between bothersome and non-bothersome tinnitus, and you will receive a complete audiological examination.  This examination will include pure tone audiometry, middle ear analysis (Impedance testing), reflex testing and otoacoustic emission testing. 

Pure tone audiometry is a hearing test used to determine the presence or absence of hearing loss. Impedance testing determines the status of the tympanic membrane (ear drum) and the middle ear status. 

Reflex testing is performed to evaluate the acoustic reflex pathways, inclusive of the VII and VIII cranial nerves and the auditory brainstem. 

Distortion Product Otoacoustic Emission testing (DPOAE) records otoacoustic emissions.  

Otoacoustic emissions are sounds that the ear emits and can be detected by microphones placed in the ear that can indicate the health of the auditory receptors.  This test is performed when there is a need to perform baseline cochlear monitoring, cochlear ototoxicity baseline testing, cochlear mapping, and to verify cochlear versus non-cochlear functions. 

You can expect to receive counseling regarding the results and full recommendations to treat your tinnitus based on these findings and discussion of your needs from the tinnitus questionnaires. 

When should you see an audiologist? 

If you experience a sudden hearing loss with tinnitus, you should see an audiologist / otologist as soon as possible.  

It is also recommended that you see an audiologist if you have been experiencing long-standing tinnitus with or without noticeable hearing loss. 

Audiologists work with otologists (ear doctors) to correctly diagnose ear disorders and tinnitus. If you are concerned about tinnitus it is best to schedule for testing and counseling from an audiologist.

Some patients with tinnitus do not find their symptoms problematic and therefore need no tinnitus intervention. Others will blame inability to hear well, to sleep, and to concentrate on their tinnitus and should definitely seek treatment. 

Patients with tinnitus and measurable hearing loss will most likely benefit from treating their hearing loss and tinnitus with amplification.  

Tinnitus FAQs: What if the sounds in my ear do not go away? 

It is estimated that 48 million Americans experience tinnitus. Of those, about 8 million find the tinnitus to be a significant problem, with 2 million finding tinnitus to be debilitating.  

Problematic tinnitus is a combination of otologic origins compounded with the negative reactions from the person’s limbic system in their brain. Regardless of the origin of tinnitus, the treatment objective is to habituate the tinnitus so that the patient “experiences tinnitus but it is not a problem.”  The amount of distress caused by the tinnitus is due to the involvement of the limbic system, with significant negative emotions and reactions associated with the condition.  

Tinnitus FAQs: Are there treatments that can help me? 

Currently, there are no known medications that cure tinnitus. However, many audiologists have completed specialty training in the management of tinnitus.  Chippendale Audiology saw the need for tinnitus services many years ago and Dr. Chippendale has trained under Dr. Pawel Jastreboff to provide Tinnitus Retraining Therapy (TRT). She has helped many patients over the years achieve relief from problematic tinnitus using TRT, along with sound therapy.  

Sound therapy uses devices that administer pleasant steady sounds to reduce the impact of the perceived tinnitus while the patient. TRT counseling and TRT sound therapy work on reducing the impact from the limbic system in the cycle of bothersome tinnitus. Many patients will also benefit from a multi-disciplinary approach, using mental health professionals offering cognitive behavioral therapy (CBT) and mindfulness therapy.  

Tinnitus FAQs: What Risks Increase Chances of Tinnitus?

There are more than 550 prescription and non-prescription medications and chemicals documented that are associated with tinnitus. However, an individual’s side effects will depend on many factors, such as body chemistry, sensitivity to drugs, dosages, pre-existing otologic factors, and length of time the drugs are taken.  Loud noises, stress and fatigue can also increase chances of tinnitus.  

Tinnitus FAQs: What is the most effective treatment for tinnitus?

Although there is ongoing research on tinnitus treatments, at this time TRT and sound therapy are the most widely used treatments, with open studies reporting significant improvement in over 80% of the patients suffering from problematic tinnitus.  It is crucial to obtain proper diagnosis and treatment recommendations from an audiologist. The American Tinnitus Association is an excellent resource to consult regarding current clinical studies and to access articles relative to tinnitus management.  

Complications of Tinnitus

Chippendale Audiology and the Tinnitus and Hyperacusis Clinic receive referrals from medical doctors, as well as patients reaching out directly for help.  There are patients that have non-bothersome tinnitus which can be considered “patients with tinnitus”. These patients can benefit from sound therapy with bedside sound generators for night, use of music or other sounds during the day to avoid silence and treat hearing loss if a loss exists.  It is the patients that have bothersome tinnitus, who are “tinnitus patients” who will need serious attention to diagnose and plan a treatment regime.  At Chippendale Audiology, we know that tinnitus patients often suffer from sleep disorders, attention problems, anxiety, depression, high levels of reactiveness, suppression of positive emotions and decreased “joy of life.” It is important to address tinnitus concerns early and to see audiologists who specialize in tinnitus management to have proper testing completed and to receive appropriate counseling and treatment recommendations.

Tinnitus Prevention 

It is important to understand that most patients describe the emergence of their tinnitus as being during periods of silence, such as lying awake at night.  It is recommended that patients avoid silence by using sound enrichment from the use of sound machines, CD players and water fountains.  It is also important to avoid excessive loud noise. Unfortunately, some patients who seek help from medical professionals are told that there is “nothing that can be done” or there is “no cure”.  This is considered negative counseling.   We caution against negative counseling that can be a strong triggering mechanism that can worsen tinnitus.  Tinnitus treatment is highly effective in helping the patient reduce the impact of their tinnitus.