The word ‘tinnitus’ comes from the Latin word for ‘ringing’ and is the perception of sound in the absence of any corresponding external sound. This noise may be heard in one ear, in both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high-pitched. There may be a single noise or two or more components. The noise may be continuous or it may come and go. People with tinnitus can experience different types of sound. Most people describe it as a ringing sound but other sounds may include: buzzing, humming, whistling, even music.
This is by far the most common type of tinnitus. Everyone, if sitting in a soundproof room, hears noises in their head. Usually these noises are masked in everyday life by all the noise going on in the world around us. If you cannot hear sounds in the outside world so well, you tend to notice the natural noises inside your head much more because they are not being masked by the environmental noises. Tinnitus is often, but not always, linked to a hearing loss. If the tiny hair cells of the cochlea are damaged, for example through certain drugs, noise exposure or as part of the ageing process, the cochlea becomes less good at discriminating sounds, and your hearing is affected.
This type of tinnitus is uncommon. Ringing noises in the ears may be caused by spasms of small muscles in the middle ear (often heard as a clicking sound) or by abnormalities of the blood vessels in and around the ear. It is the turbulent bloodflow that is heard directly by the inner ear, and it usually occurs in time with the heart beat (pulsatile tinnitus). Pulsatile tinnitus can occur when there is an increased bloodflow to the ear, such as during an infection and inflammation, but also because of anatomical abnormalities of the blood vessels. Sometimes, the noise associated with tinnitus beats in time with a person’s pulse. This is known as pulsatile tinnitus. The sounds of tinnitus are usually only heard by the person who has tinnitus, although in a few rare cases, they can also be heard by other people.
Tinnitus is a common condition, and affects about 10% of adults in the UK.
In order to understand tinnitus, it is essential to have some idea about the mechanism of hearing. The process of tinnitus generation is complex, and there may be several different underlying causes for this relatively common condition. Furthermore, it is apparent that tinnitus is not always intrusive or distressing. Many people who have tinnitus do not complain about it. In some, the onset of tinnitus can be linked to a stressful event, either emotional or physical.
How we hear
The hearing pathways consist of the ears, the nerves of hearing and the connections within the brain. It is the brain which recognizes and analyses the sound signal. The brain is also able to reject sounds which are meaningless. The organs of hearing are fully developed in the first weeks of pregnancy. Connections are formed between these organs, the hearing nerves and the brain. Links are also formed between the brain’s hearing area and other centres, such as the pathways of emotion (the limbic system), the alarm centre (reticular formation) and the centres of thought and memory (the frontal cortex). It is now known that an unborn baby can hear sounds. After birth, the brain begins to recognize different sounds, especially speech. This recognition process forms the basis of a child’s language development.
What causes tinnitus?
Tinnitus is not a disease or an illness, it is a symptom generated within a person’s own auditory pathways. Although it is often assumed that tinnitus occurs as a result of disease of the ears, this is often not the case. The precise cause of tinnitus is still not fully understood. The continued stimulation of the brain by different sounds leads to a process of learning – the auditory memory. While being able to analyse and store information about useful sounds such as speech, the brain has the remarkable ability to reject ‘useless’ sounds by a process of filtration (rejection). This process continues throughout the individual’s life. Occasionally this process of sound filtration may fail. This would result in the perception of an unwanted sound in the higher centres (the cerebral cortex).
It is well known that various emotional and physical factors, such as bad news, head injuries, illness such as colds and flu, injuries of the head and neck may be closely linked to the onset of tinnitus. In all these cases there is increased arousal mediated via the autonomic nervous system, resulting in tinnitus, as described earlier. In such cases, because the tinnitus is often of sudden onset, it can raise fears about potentially serious conditions such as brain tumours. Unfortunately, this only serves to aggravate the situation by increasing the brain’s awareness of the tinnitus. This information is not a substitute for medical advice. You should always see your GP/medical professional.
Who gets tinnitus?
Experiences of tinnitus are very common in all age groups, especially following exposure to loud noise; however, it is unusual for it to be a major problem. There is a widely held misconception that tinnitus is confined to the elderly, but various studies have shown that it can occur at any age, even in quite young children. Mild tinnitus is common – about 10 per cent of the population have it all the time and, in up to one per cent of adults, this may affect the quality of their life.
What to do?
Tinnitus is rarely an indication of a serious disorder, but it is wise for the sufferer to see their doctor if they think they might have it. Should something treatable be causing it, they may be referred to a specialist. They should: –
… try not to worry
The noises may seem worse if they are anxious or stressed. When tinnitus starts, particularly if it’s sudden, they may naturally be frightened and their concentration or their sleep may be disturbed. They may get angry and frustrated because no-one else understands, or they may live alone and not have anyone to talk to about it. The British Tinnitus Association can offer expert advice and can also put them in touch with a support group or contact if there is one in their area. Groups are run by people who are living with tinnitus – personal contact and shared experiences are very useful for many people with tinnitus.
… find out more
They will probably feel better when they find out more about the condition – that it’s very common and they’re not alone. Many people say they notice tinnitus less when they are doing something. Keeping their mind occupied helps (but they shouldn’t overdo things). If the noises seem louder at quiet times, particularly during the night, it may help to have soothing music or some other environmental or natural sound quietly on in the background. Practising relaxation and taking time out for themselves can also be a great help.
If a person with tinnitus has any deafness, even just a slight hearing loss, a hearing aid may help. The aid boosts normal sounds which you may not otherwise hear. These may override the tinnitus noise.
What can we do?
Patients with tinnitus who seek advice should undergo a complete medical examination by a doctor to exclude any treatable medical condition. After this, they should be referred to a Specialist Centre where they could receive counselling and advice about the management of their tinnitus.
It is quite common for tinnitus patients to be told that ‘nothing can be done’ or ‘there is no cure’. This is both unfortunate and incorrect. Research carried out in the UK and other countries have shown the benefits of various treatment measures in tinnitus. These include detailed counselling about the tinnitus, behavioural techniques such as Relaxation Therapy and Cognitive Behavioural Therapy (CBT), together with various forms of Sound Therapy. This can take many forms, such as white noise generators (tinnitus maskers), hearing aids (where appropriate), or other noise generating devices such as personal CD’s. There are also numerous tinnitus self-help groups throughout the UK. Information about these groups can be obtained from the British Tinnitus Association.
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One of our own patients speaks about tinnitus.
“I woke up in the middle of the night at Centerparcs on 9 April 2009 with ringing in my right ear. Tinnitus is a poorly understood chronic condition which is most probably caused by damage to the inner ear with a consequential affect on the electrical circuitry in the auditory cortex.
The brain’s many responses to the high pitched ringing which its victims must endure would test the resilience of the strongest person. In the worst cases you will get constant monitoring, insomnia, anxiety and depression. You should read William Shatner’s account of his battle with it on the Internet.
In my search for an answer to this chronic problem I have seen many ENT surgeons, audiologists and other doctors, including experts on Harley Street. Eventually, and basing my approach on Professor Pawel Jastreboff’s book “Tinnitus Retraining Therapy”, I worked out that you can break the response to the ringing by retraining your brain not to respond to the noise.
It’s a long job and involves getting hearing aids fitted which play white noise at the pitch of the hearing loss during the day and which (in my case) masks it completely at night.
Of all the hearing experts I have seen, without doubt, Robert has been the most helpful and effective. He has first class phonak equipment and software and has the most up to date understanding of this problem of all the professionals I have dealt with in my 7 year struggle.
He is also, importantly, a thoroughly decent and compassionate man. If you are struggling with this problem get in touch with Robert. If it’s really bad and you need someone talk to, Robert will give you my number. Don’t give up. There is a way forward. Best of luck.”
(Simon is a partner in a global law firm)