Tinnitus: An Unwelcome Guest

What is Tinnitus? & Why?

Definition: Sounds in the ears or head that occur when there is no sound in the room. Tinnitus ("TIN-a-tus" or "Tin-EYE-tus") may begin gradually or suddenly

The sounds may vary in pitch and loudness or stay the same. It may be a tone or a noise, a roar like a seashell roar, a chirp, hiss, or click or a combination of these.

It may "beat" as your heart beats. The sounds may be louder in one ear or occur only in one ear.

It may prevent sleep, or wake you from a sound sleep. It may be louder in the morning and late at night.

There are about 200 causes for tinnitus- some benign, some quite troublesome. The problem may be in the outer ear, the skeleton, the middle ear, the inner ear, or along the auditory pathway to the brain. The loudness of the sounds has nothing to do with the cause. An experienced audiologist will help you identify the cause and find relief. Causes of tinnitus include:

• Loud noise exposure

• Hearing loss

• Excessive ear wax

• Ear infection

• High blood pressure

• Deficiencies in Vitamin D, Vitamin B12, Zinc

• Medications such as certain antibiotics (erythromycin, gentamycin), some cancer treatment medications, unusually high doses of aspirin, and certain diuretics.

Risk Factors for Tinnitus

There are multiple risk factors that can contribute to the onset of tinnitus. These risk factors include:

• Age related hearing loss, Meniere Disease

• Constant exposure to loud noise, history of a noise trauma event, severe MVA, head trauma

• Chronic middle ear or sinus infections

• Constricted or poor blood flow due to atherosclerosis and/or kinking in the carotid artery or jugular vein

• History of migraine headaches

Tinnitus Evaluation

Individuals consult with an audiologist about their tinnitus because they are either:

• Curious

• Concerned, or

• Distressed

A tinnitus evaluation by an audiologist includes:

• Thorough history, use of OTC and prescription medications, noise exposure, diet, including unusual factors in diet, characteristics of the tinnitus sound

• Hearing Evaluation

• Otoacoustic Emission Testing

• Middle Ear Tests

• Tinnitus Pitch Matching

• Tinnitus Frequency Matching

• Comfortable and Uncomfortable Listening levels

The first visit will take about 90 minutes. No test is painful.

Approaches to Tinnitus Management

Tinnitus is always a symptom. It is never a disease. It is treatable 85-90% of the time. Before treatment, you need a diagnosis. What is the cause of the tinnitus? The answer will dictate the plan of treatment. Some questions to answer: is the tinnitus objective (usually)

A person who describes successful treatment of tinnitus will say something like, “I have to stop and really concentrate to see if I still hear the sound.” Or, “It is so little a bother, I don’t even think of it.”

Options for relief vary based on the status of hearing, the presence of hyperacusis or mysophonia, phonophobia or recruitment, evidence of Meniere Disease, suggestion of chronic Eustachian tube dysfunction, injuries to C1 or C2, TMJ problems, history of vascular disease, deficiency in B-12, zinc, and/or magnesium. Additionally, vertigo or dizziness may shape how we manage tinnitus.

These services result in a success rate of 85-90%:

1. Information and counseling. Often, learning that tinnitus is a symptom and not a disease, what makes it so bothersome, and how you can get relief is enough. But not for all.

2. Current approaches to relieving most types of tinnitus focus on sound de-sensitization, cognitive behavioral therapy, and efforts to moderate the brain sound generator.

3. One theory advances a masking strategy. For some, the sound should be steady and very soft, for others, the amplitude should vary. Different devices/signal generators are demonstrated. The idea is that sounds wired together fire together, and certain sounds will break the unity, create "chaos" in the site and cause the tinnitus to subside.

4. Those who have experienced chronic disease, pain or illness will recognize the potential value in Mindful Meditation. This is the treatment primarily recommended by Harvard Medical School and implemented at the Tinnitus Clinic at Mass General Hospital. Some will choose to learn this centuries old method of dealing with a variety of intrusions to the body as an additional asset in reducing tinnitus.

5. No double blind study to date supports any type of oral medication to relieve the tinnitus sound.

Management approaches to tinnitus focus on the sounds, and/or the effects of the sounds, such as interrupted or poor sleep, concentration difficulties, depression and anxiety, and stress

Manufacturers of hearing aids such as Signia, Resound, Phonak and Widex have released products that provide therapy for tinnitus. The circuit in each model of hearing aid includes a variety of white noise, pink noise, or "Zen" noise. Activated by the audiologist, the customized sounds are mixed into the hearing aid at a loudness level that attenuates the tinnitus and amplifies speech. Over time (six to eighteen months) the user reports diminished perception of tinnitus (the perceived volume level of the tinnitus begins to lessen). A control can be provided to change the ratio of the tinnitus noise to the gain of the hearing aid for those who report fluctuating tinnitus.