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:
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.
Increased sensitivity to sound (hyperacusis)
The increase in auditory gain which occurs in tinnitus subjects often results in a general increase in the sensitivity to sound. This is known as hyperacusis. In these subjects loud sounds cause severe discomfort, and also tend to aggravate the tinnitus. Not surprisingly, such people tend to avoid noisy places like pubs and restaurants. This can make matters worse. To achieve a reduction of auditory gain and hence hyperacusis subjects need to be gradually exposed to a variety of sounds. This concept should be explained to patients, so that they can begin the process of auditory retraining.
Auditory processing disorder
The ability to hear specific sounds such as speech in the presence of other background sounds is the result of a complex process. This is mainly a function of the auditory filter. In addition, we have the ability to improve this by ‘straining to hear’ – increasing the auditory gain. This ability is well developed in certain people e.g. musicians. A mother will normally hear her baby’s cry, even if there are other sounds in the house. However, in many others the brain simply cannot cope with the competing sounds. This is known as an Auditory Processing Disorder (APD).
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.
The role of professionals
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.
Tinnitus Desensitisation Therapy (TDT)
Tinnitus Desensitisation Therapy (TDT) is a mixture of tinnitus specific counselling together with sound therapy and relaxation techniques. It is a therapeutic approach based on the neurophysiological model that tinnitus is caused by abnormal processing of a signal generated in the auditory system. TDT is aimed at redirecting your brain’s attention away from the tinnitus signal and thereby enabling the natural habituation process to occur.
Tinnitus retraining therapy (TRT)
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