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Tinnitus

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Tinnitus



Introduction 

Tinnitus is a term that describes any sound a person can hear from inside their body rather than from an outside source.

Although tinnitus is often described as 'ringing in the ears', several sounds can be heard including:



buzzing



humming



grinding



hissing



whistling



sizzling



Sometimes, the noise associated with tinnitus beats in time with a person’s pulse. This is known as pulsatile tinnitus.

Most people learn to live with tinnitus, but it can often have a significant impact on day-to-day life. For example, it can affect concentration and cause sleeping problems and depression.

However, tinnitus itself is a condition that isn’t harmful and usually improves over time. Although there’s currently no single treatment that works in the same way for everyone, if an underlying cause can be established it can often be effectively treated (see below).

What causes tinnitus?

A build-up of earwax, a middle ear infection or a problem with your inner ear (such as Ménière's disease) can sometimes be responsible for the sounds of tinnitus.

It's important to establish what triggers your tinnitus, whether there are particular times of the day when it's more noticeable, and whether there's anything that makes it better or worse.

For example, some people find their tinnitus is worse when they're stressed or anxious and improves when they're calm and relaxed.

Occasionally, temporary tinnitus can be the result of a blow to the head or a sudden, loud noise, such as an explosion or gunfire.

 

Diagnosing tinnitus

See your GP if you're continually hearing sounds such as buzzing, ringing or humming, or if you have regular episodes of hearing these sounds.

They will ask about the noises and examine your ears. Your GP may refer you to an ear, nose and throat (ENT) specialist or an audiologist (a specialist in hearing disorders).

The specialist will carry out tests to help rule out possible underlying causes. They'll also look at your medical history and ask about the type and severity of the noises you hear.

 

Treating tinnitus

At the moment there's no single treatment for tinnitus that works in the same way for everyone. However, research to find an effective treatment is continuing.

If an underlying cause of your tinnitus can be found, effectively treating it may help improve your tinnitus. For example, if a build-up of earwax is responsible, eardrops or ear irrigation (using a pressurised flow of water to remove the earwax) may be recommended.

If a specific cause can't be established, the focus will be on helping you manage the condition on a daily basis.

As tinnitus is often most noticeable in quiet environments, background noise such as music or the television can help distract you from the sound of tinnitus.

Listening to natural relaxing sounds, such as the sound of rain or the ocean, can also help. Environmental sound generators are small, electronic devices that produce these types of soothing sounds.

Understanding tinnitus is also very important in helping you cope with it. Tinnitus counselling involves discussing your condition with a specialist counsellor. As well as learning about your condition, your counsellor will be able to suggest ways of dealing with it.

In some cases, cognitive behavioural therapy (CBT) can be helpful for tinnitus. This type of therapy aims to change the way you think about your condition so that you're able to find more effective ways of managing it on a day-to-day basis.

 

The different sounds of tinnitus 

Tinnitus affects people in different ways. Some are only mildly affected, in others it may be severe.

Some people with tinnitus are more sensitive to everyday sounds. For example, a person with tinnitus may find a radio or television painfully loud when it's at a normal volume for most people. This is known as hyperacusis.

Your tinnitus may be more noticeable at certain times or in certain situations. For example, mild tinnitus is usually more noticable when it's quiet because noisy environments can mask the sounds.

Tinnitus is also sometimes related to posture. You may hear sounds when lying or sitting down, or when you turn your head. After these types of movements, pressure changes in your nerves, muscles or blood vessels may trigger the noises associated with tinnitus.

Most tinnitus is perceived as a high-pitched sound, such as hissing, whistling or buzzing.

However, for some people, tinnitus can be a low-frequency noise, such as humming, murmuring, rumbling or deep droning. Others may experience musical hallucinations, where they repeatedly hear tunes or songs in their head.

These less common types of tinnitus are described in more detail below.

Less common types of tinnitus

Low-frequency noise

People who constantly hear low-frequency noise often think it's coming from an external source rather than from inside their head or ears.

Sources of external low-frequency noise include:



road and air traffic noise  



underground gas pipes



home appliances, such as fans and fridges



air-conditioning units



The wind, sea and thunder are natural sources of low-frequency noise.

Ask other people whether they can also hear the sound.

If you can only hear the noise when you're in one place, it may be coming from an external source, whereas if you can hear it all the time, you may have tinnitus. Stress or a recent illness may be related to your symptoms.

Musical hallucinations

Musical hallucinations are more common in people with long-term tinnitus and hearing loss. However, they're also sometimes experienced by people with normal hearing and those with an increased sensitivity to sound (hyperacusis).

As with other types of tinnitus, there's sometimes no apparent reason for musical hallucinations. However, stress can sometimes be a trigger.

Pulsatile tinnitus

Pulsatile tinnitus is where you hear rhythmical noises that often beat in time with your pulse. It's usually caused either by:



blood flow changes in the blood vessels near your ear



increased awareness of the blood flow near your ears



The blood flow through an artery can sometimes become restricted by a build-up of fatty deposits (plaques) on the inside wall of the artery. This is known as atherosclerosis and causes the artery to narrow. The narrowed artery prevents blood from flowing smoothly, resulting in it becoming 'noisy'.

If you have impaired hearing or a hearing condition such as a perforated eardrum, your awareness of sounds that come from inside your body, such as your blood flow, may be increased. This is because your hearing becomes more sensitive and internal noises aren't drowned out by external sounds.

Causes of tinnitus 

It may not always be possible to identify what's causing tinnitus.

However, tinnitus is often initiated by hearing loss. Causes of hearing loss can be varied. Some of the main causes are described below.

Inner ear damage

Tinnitus is often related to damage that occurs inside the inner ear.

Sounds pass from the outer ear through the middle ear to the inner ear, which contains the cochlea and auditory nerve. The cochlea is a coiled, spiral tube with a large number of sensitive hair cells. The auditory nerve transmits sounds to the brain.

If part of the cochlea is damaged, it will stop sending information to parts of your brain. These areas of the brain will then actively 'seek out' signals from parts of the cochlea that still work. These signals are over-represented in the brain and cause the sounds of tinnitus.

In older people, tinnitus is often caused by natural hearing loss, which makes the hearing nerves less sensitive. In younger people, tinnitus can sometimes occur as a result of hearing damage caused by excessive noise.

Other causes

As well as natural hearing loss and inner ear damage, there are several other possible causes of tinnitus. These include:



a build-up of earwax that blocks the ear



a middle ear infection (otitis media)



glue ear (otitis media with infusion)



otosclerosis - an inherited condition where an abnormal bone growth in the middle ear causes hearing loss



Ménière's disease - a condition that affects part of the inner ear known as the labyrinth and causes balance problems



otosclerosis - a growth of spongy bone in the inner ear that causes progressive hearing loss



anaemia - a reduced number of red blood cells that can sometimes cause the blood to thin and circulate so rapidly that it produces a sound



a perforated eardrum



Rarer causes

Less commonly, tinnitus may also develop as a result of:



a head injury



exposure to sudden or very loud noise, such as an explosion or gunfire



acoustic neuroma - a rare, non-cancerous growth that affects the hearing nerve in the inner ear



adverse reactions to certain medications, such as antibiotics, diuretics, quinine and aspirin (this is more likely to occur when the recommended dosage is exceeded)



solvent abuse, drug misuse and alcohol misuse



high blood pressure (hypertension) and narrowing of the arteries (atherosclerosis)



an overactive thyroid gland (hyperthyroidism)



Paget's disease - where the normal cycle of bone renewal and repair is disrupted



Stress isn't a direct cause of tinnitus but it can sometimes make it worse.


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Diagnosing tinnitus 

It's very important that you see your GP if you have a problem with your hearing, such as hearing ringing or buzzing sounds.

Tell your GP if your tinnitus is severe and if it's having an impact on your everyday life or making you stressed and anxious.

Your tinnitus may be caused by a temporary condition that's easy to treat, such as earwax build-up or an ear infection. If this is the case, your GP should be able to treat the condition, which should improve your tinnitus.

Specialist referral

If your GP rules out an underlying cause for your tinnitus, they may refer you to the ear, nose and throat (ENT) department of your hospital.

At your appointment, an ENT specialist will examine your ears, ask you about the type and severity of the noises you can hear, and carry out tests to try to establish what's causing them.

You may have a computerised tomography (CT) scan or a magnetic resonance imaging (MRI) scan. These type of scans will allow the specialist to closely examine the inside of your ear, auditory nerve and brain.

If hearing loss is suspected, you may be referred to an audiologist (a specialist in hearing disorders) who will carry out some specific hearing tests to assess your level of hearing.

Treating tinnitus 

In most cases, tinnitus isn’t harmful and will often improve over time.

If your tinnitus is caused by an underlying health condition, treating the condition will help stop or reduce the sounds you hear.

For example, if your tinnitus is caused by a build-up of earwax, eardrops or ear irrigation may be recommended. Ear irrigation involves using a pressurised flow of water to remove the earwax.

However, in most cases a cause for tinnitus can't be found so the aim of treatment will be to help you manage the condition on a daily basis.

There are a number of treatments that can help you achieve a positive state of mind and reach a point where you're no longer really aware of your tinnitus (see below).

Correcting hearing loss

Any degree of hearing loss you have should be addressed because straining to listen makes tinnitus worse.

Correcting even fairly minor hearing loss means that parts of the brain involved in hearing don't have to work as hard, and therefore don't pay as much attention to the tinnitus.

The specialist will test your hearing and recommend appropriate treatment. This could involve having a hearing aid fitted or surgery.

Improving your hearing will also mean sounds you wouldn't otherwise hear will now be audible, which may help override the sounds of your tinnitus.

Sound therapy

Tinnitus is often most noticeable in quiet environments. Therefore, the aim of sound therapy is to fill the silence with neutral, often repetitive sounds to distract you from the sound of tinnitus.

Having the radio or television on can sometimes provide enough background noise to mask the sound of tinnitus. Listening to natural relaxing sounds, such as the sound of rain or the sea, can also help.

Environmental sound generators are electronic devices that look similar to a radio. They produce quiet, natural sounds, such as a babbling brook, leaves rustling in the wind and waves lapping on the shore. White noise generators are similar devices that produce a continuous 'shushing' sound at a level that's comfortable and soothing.

Sound generators can be particularly useful when placed by your bedside because they can distract you from your tinnitus when you're falling asleep. Many sound generators have timers so they can turn themselves off after a set period of time (after you've fallen asleep).

An ear-level sound generator is a small device that resembles a hearing aid. It may be recommended if you have normal hearing or mild hearing loss. For more severe hearing loss, some hearing aids have built-in sound generators. These are known as combination instruments.

Tinnitus counselling

Understanding tinnitus plays an important part in learning how to cope with the condition and manage it more effectively.

Tinnitus counselling is usually carried out by hearing therapists, audiologists (hearing disorder specialists) or doctors. It's a talking therapy that helps you learn more about your tinnitus and find ways of coping with it.

Talking about your tinnitus and how it affects your everyday life will enable you to gain a better understanding of your condition and may possibly help lessen its effects.

Cognitive behavioural therapy (CBT)

Cognitive behavioural therapy (CBT) is often used to treat mental health problems, such as anxiety, depression and post-traumatic stress disorder (PTSD).

CBT is based on the idea that your thoughts affect the way you behave. Treatment aims to retrain the way you think in order to change your behaviour.

This technique can be effectively applied to tinnitus. For example, if your knowledge about tinnitus is limited, you may have certain ideas about it that make you feel anxious and depressed. This can make your tinnitus worse.

Changing the way you think about your tinnitus and what you do about it can help reduce your anxiety and enable you to accept the noises, which after a while may become less noticeable.

CBT can also teach you how to cope with negative thoughts and feelings and how to think more positively.

 

Tinnitus retraining therapy (TRT)

One theory about tinnitus, known as the neurophysiological model, suggests that the limbic system prioritises tinnitus sounds. The limbic system is the area of the brain responsible for emotions.

According to the neurophysiological model, tinnitus sounds have great significance to a person with the condition and perceived as loud or persistent.

Tinnitus retraining therapy (TRT) uses your natural ability to get used to a sound so it becomes part of your subconscious, rather than part of your conscious perception.

For example, after a while the sound of air conditioning units, computer fans and refrigerators become background noises we're able to tune out of. We don't tend to hear these sounds unless we deliberately tune back into them.

TRT uses a combination of sound therapy and counselling to help you retrain the way your brain responds to tinnitus sound so you start to tune out and become less aware of it.

TRT is widely available privately, and may be available on the  for people with very severe or persistent tinnitus. It should only be carried out by someone specially trained in the technique.

Self-help

Some people find self-help techniques useful for managing their tinnitus. These techniques include:



relaxation -stress can make your tinnitus worse so regular exercise such as yoga may help you relax



listening to music - calming music and sounds may also help you relax and fall asleep at bedtime



support groups - sharing your experiences with others who have tinnitus may help you cope better (see below)



Action on Hearing Loss (formerly the RNID) has a tinnitus forum and provides further details about online support groups. They can also put you in touch with support groups in your area.

You may also find the British Tinnitus Association a useful source of information.

Medication

There's currently no specific medication to treat tinnitus. However, as tinnitus can sometimes cause anxiety and depression, antidepressants may sometimes be prescribed in combination with other types of treatment such as counselling.


CBT expert


 


Professor David Clark explains how cognitive behavioural therapy (CBT) works and who could benefit from it.


Media last reviewed: 24/04/2013

Next review due: 24/04/2015





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