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What is tinnitus?
A simple definition is an –
An auditory sensation without an external stimulus.
In other words a noise that only the person complaining of it can hear produced somewhere in the body – usually the hearing pathway.
Sometimes the cause of the tinnitus can be detected and treated but most of the time the exact cause is unknown and there are no treatments to stop the tinnitus but there is often a lot that can be done to help you live with the tinnitus and deal with any distress the tinnitus causes.
Very common. It is estimated that 10% of the population have tinnitus and about 1% have ‘troublesome tinnitus’. Troublesome tinnitus is tinnitus that is interfering with your daily life.
Interestingly if people are placed into a completely silent room (an anechoic chamber) then about 92% of people will hear a noise – so most of us have a very quiet tinnitus which we don’t normally hear.
No. Tinnitus is a symptom.
It maybe the warning sign of a serious underlying problem however the majority of the time there is no serous underlying problem.
Tinnitus presents in a number of different ways. It will be:
Unilateral (one ear) or
Bilateral (both ears) or
In the head( not sure where its coming from)
It will be:
Continuous or
Intermittent
It will be:
Non-pulsatile(common) or
Pulsatile which is like the sound of your heartbeat (uncommon)
It will be:
Subjective – only the person who has it can hear it(very common), or
Objective – other people can hear it (very uncommon)
Determining the type and nature of the tinnitus helps doctors and audiologists decide on how it should be managed and whether or not it needs investigating.
You should discuss any type of tinnitus with your GP or an Audiologist. The decision whether to investigate further and refer to an ENT surgeon will depend on:
- the type of tinnitus as listed above
- other factors such as age, occupation, associated symptoms( hearing loss, dizziness, pain), past medical history and medication.
For example:
Tinnitus in the elderly which is in both ears, non-pulsatile, non-troublesome , continuous or intermittent will, in most cases, just need reassurance and an assessment of hearing.
If this sort of tinnitus is troublesome then an Audiologist may be able to help with coping strategies and possibly hearing aids.
The following types of tinnitus should be referred to an ENT surgeonfor assessment.
- Unilateral(one sided), non-pulsatile, tinnitus of greater than 3 months duration.
- Pulsatile tinnitus
- Objective tinnitus.
- Tinnitus associated with other symptoms like hearing loss, infection or dizziness.
A very nice video from an organisation called Hearing Healthcare clinic gives examples of what tinnitus can sound like:
What are the causes of tinnitus?
This will depend on whether the tinnitus is Non-pulsatile, Pulsatile, or Objective.
Non-pulsatile tinnitus: (Common)
Causes:
- Ear wax blockage
- Noise exposure
- Hearing loss
- Age
- Genetic
- Tumour – Acoustic neuroma / meningioma
- Menieres disease
- Otosclerosis
- Medications.
- Inner ear damage – head injury / labyrinthitis / sudden sensorineural hearing loss.
But the COMMONEST cause is IDIOPATHIC – in other words ‘we don’t know the cause’.
Assessment of non-pulsatile tinnitus.
A full history and review of your medications. Examination of the ENT system. A hearing test. An MRI scan of the hearing nerves called an MRI of the IAMs. The IAM is the ‘internal auditory meatus’ which is a narrow bony cannel that the hearing and balance nerves run through on their way from the ear to the brain. A swelling on the balance nerve (an Acoustic Neuroma) may compress the hearing nerve and cause tinnitus.
Pulsatile (Less Common)
Pulsatile tinnitus needs investigating. Often a cause can be found but not always. The list of possible causes is long but some of the conditions can be quite serious and may need further treatment.
The noise can come from the Arterial system (the blood vessels taking blood away from the heart) or the Venous system (the blood vessels taking blood to the heart.)
Possible causes include:
- Atherosclerosis of the Carotid artery (the main artery in the neck supply blood to the brain). The narrowing in the artery cause turbulent blood flow which the patient can hear.
- Glomus tumour – a vascular tumour in the region of the space behind the ear drum.
- Arterio-venous malformations – abnormal communications between arteries and veins.
- Aneurysms.
- Fibro-muscular dysplasia, Pagets disease.
- High blood pressure.
- Increased blood flow : anaemia, pregnancy, thyrotoxicosis, exercise.
- Benign Intracranial Hypertension.
Assessment of pulsatile tinnitus
After taking a full history the doctor will look do a thorough examination of your ears, nose and throat, listen to your neck and scalp with a stethoscope and he may check your blood pressure and look in your eyes.
Investigations may include a hearing test, an ultrasound scan of the neck a CT scan or MRI scan of the head depending on the clinical findings.
He may refer you to another specialist such as a cardiologist or a neurologist.
Objective tinnitus (Rare)
The commonest cause is something called Myoclonus. This is continuous twitching of the tiny muscles in the ear or of the palate at the back of the mouth.
The patient complains of a repeated clicking sensation which can last for many hours or days.
Assessment of objective tinnitus
The doctor will take a full history and do a thorough examination of your ears and look in the back of the mouth and look for any neurological signs.
A test may be requested to try and demonstrate movement of the ear drum and an MRI scan to look for anything in the head that maybe triggering the muscle twitching.
What can be done to help tinnitus?
Many Things
- Treat any cause that was found.
- Protect your ears.
- Understanding about tinnitus – very important.
- Hearing Aids.
- Sound therapy – sound generators / tinnitus maskers.
- Psychological approaches – Relaxation / Stress management / Mindfulness / Cognitive Behavioural Therapy(CBT) / Lifestyle management / Tinnitus retraining therapy.
- Medication.
- Experimental – Neuromodulation / Biofeedback / Transcranial magnetic stimulation.
- Cochlear implant.
Protect your ears…
…from loud noise. It is well recognised that loud noises can cause tinnitus. We have all come out of a very loud concert or party and experienced riding in the ears. This is called temporary tinnitus and is usually gone by the next day. In the majority of people with tinnitus we do not know the actual cause or exactly where in the hearing pathway the problem is. If you have tinnitus it would seem a sensible precaution to protect your ears from loud noises.
Understanding about tinnitus
Very often the main problem with troublesome tinnitus is not the noise itself but the patient’s reaction to it. This reaction often occurs at a subconscious level in other words you are not fully aware of it.
A very important part of the management of tinnitus, or in fact any condition, is understanding the symptoms. The brain worries. It is meant to worry because any unexplained symptom could represent something harmful. The brain will not let go of a symptom until it understands its significance. It will keep focusing on there noise, bringing it into consciousness and then other parts of the brain will worry about it, which leads to anxiety, which can make the tinnitus, or any other symptom, worse. This worry can be at a conscious(aware) or subconscious(unaware) level. After a full assessment and a full explanation of tinnitus, and with some time, when the brain understands that in your particular case the noise does not mean that there is anything sinister going on; and also that there are things that can be done do to help, then the brain will let go. The tinnitus will stop becoming a major issue. It will either stop or become something you can live with much better without worry or upset. This is called habituation.
It’s easy to forget what you are told at a consultation and for those people who want to understand their tinnitus and their reaction to it in greater depth and I can recommend a very good book called ‘Living with Tinnitus and Hyperacusis.’ There are also a couple of very good books by people who have actually suffered with tinnitus. Living with Tinnitus by L. Cole and Rewiring Tinnitus: How I finally found relief from the ringing in my ears. Glenn Schweitzer
Hearing Aids
If you have a hearing loss it means that all he noises in the world sound quieter. This means that he tinnitus noise which is generated inside you can be heard more easily because there is no competing noise from outside. A hearing aid will amplify day to day noises and may help mask the tinnitus making it less obvious and so less troublesome.