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A man holds his ear in bed trying to stop hearing the ringing caused by tinnitus.

Tinnitus: what is it?

Tinnitus is the perception of sound without an external source, so other people cannot hear it.

The most common description of tinnitus is ringing, but some people hear other sounds as well, including roaring or buzzing. It is estimated that 10 to 25% of adults have tinnitus. Tinnitus can also affect children. Tinnitus can improve or even go away over time for children and adults, but in some cases it can worsen. Chronic tinnitus occurs when it lasts for more than three months.

The causes of tinnitus are unclear, but most people who suffer from it have hearing loss to some degree. Tinnitus is rarely associated with serious medical problems and is usually not severe enough to interfere with daily life. Some people, however, report that it affects mood, sleep, and concentration. When severe, tinnitus can cause anxiety and depression.

There is no cure for tinnitus, but it can be reduced with sound therapy devices (including hearing aids), behavioral therapies, and medications.

Tinnitus symptoms: what are they?

Tinnitus symptoms can be highly individualized and vary considerably among people. You may hear phantom noises in one, both or all parts of your head. The sound may be heard as ringing, buzzing, roaring, whistling, humming, clicking, hissing or squealing; could be soft or loud and low or high pitched. It might be intermittent or permanent. In some cases, moving certain body parts like the neck or eyes or simply touching a certain area might activate the tinnitus symptoms and change the quality of the perceived sound – somatosensory tinnitus.

Tinnitus is usually subjective, meaning that you can only hear the sounds. Sometimes, the sound pulses rhythmically, often in time with your heartbeat. If a doctor can hear the sounds with a stethoscope in these cases, then it is considered objective tinnitus. Objective tinnitus is often treatable and has a known cause.

Tinnitus: what causes it?

Although tinnitus is not fully understood, the following factors have been linked to it:

  • When people are exposed to loud noise at work, during sports events, or at concerts, they experience tinnitus. As a result of loud noises they may have experienced from gunfire, machinery, bomb blasts, or other similar sources, tinnitus is also the most common service-related disability among veterans.
  • In addition to hearing loss, tinnitus is strongly associated with factors such as aging and exposure to loud noise. However, some people who have hearing loss do not develop tinnitus.
  • The side effects of certain medications, especially those taken in high doses, can include tinnitus. There are many medications associated with tinnitus, including non-steroidal anti-inflammatory medications (for example, ibuprofen, naproxen, and aspirin), certain antibiotics, anti-cancer medications, anti-malaria medications, and antidepressants.
  • Tinnitus can be caused by earwax or an ear infection blocking the ear canal.
  • Injuries to the head or neck can damage structures of the ear, the nerves that carry sound signals to the brain, or areas of the brain that process sound, causing tinnitus.

Among the less common risk factors for tinnitus are:

  • Ménière’s disease. Tinnitus is a symptom of Ménière’s disease, an inner ear disorder that can also cause balance issues and hearing loss.
  • The joint that connects the lower jaw to the skull is close to the ear. Jaw clenching or tooth grinding can damage surrounding tissues, causing tinnitus.
  • Acoustic neuromas, as well as other head, neck, and brain tumors, can cause tinnitus. A vestibular schwannoma (acoustic neuroma) is a benign tumor on a nerve that connects the inner ear to the brain.
  • Problems with blood vessels. High blood pressure, atherosclerosis, or malformations in blood vessels can alter blood flow and cause tinnitus.
  • Diabetes, migraines, thyroid disorders, anemia, and autoimmune disorders such as lupus and multiple sclerosis have been linked to tinnitus.

Tinnitus has many possible causes, but some people develop it for no apparent reason.

How does the ear perceive noise?

There is a leading theory that tinnitus can occur when damaged nerves in the inner ear signal the parts of the brain that process sound, causing tinnitus. Despite the fact that tinnitus appears to occur in the ear, the phantom sounds are actually produced by the auditory cortex in your brain.

Several studies have shown that tinnitus may be caused by abnormal interactions between the auditory cortex and other neural circuits. According to studies, some people with tinnitus have changes in these non auditory brain regions, since the auditory cortex communicates with other parts of the brain, including those that control attention and emotions.

The diagnosis.

The first thing you should do if you have tinnitus is see your primary care doctor, who can check your ear canal for earwax or fluid caused by an ear infection. In order to determine if your tinnitus is caused by an underlying condition or a medication, your doctor will also ask about your medical history.

Next, you might be referred to an otolaryngologist (commonly referred to as an ear, nose, and throat doctor, or an ENT). An ENT will examine your head, neck, and ears, and ask you for details about the tinnitus sounds and when they started. In addition, you might be referred to an audiologist, who can assess your hearing and your tinnitus.

Imaging tests such as magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound may be ordered by your ENT, especially if your tinnitus pulses. Imaging tests can help reveal the cause of your tinnitus, such as a structural problem or an underlying medical condition.

How can tinnitus be treated?

Tinnitus symptoms can be eliminated or greatly reduced if the cause is addressed, such as earwax or jaw joint problems. In many cases, tinnitus symptoms can last for months or even years. It is possible to reduce the impact of tinnitus in several ways. Here are some of the treatments your doctor may recommend.

  • As a result of hearing loss, hearing induced changes in neural circuits in the brain are believed to cause tinnitus. It appears that some of these neural changes can be reversed and tinnitus can be silenced by exposure to sound. In addition to masking the tinnitus sounds, sound therapy can also help you become accustomed to them or distract you.

There are several types of devices used in sound therapy, including:

  • As a sleep aid or relaxation aid, sound generators are usually found near your bed. A generator or smartphone app can be programmed to play soothing sounds such as waves, waterfalls, rain, or the sounds of a summer night, which can be placed near your bed. Other sound generators, such as a radio or a household fan, might also work if your tinnitus is mild.
  • When you have tinnitus and have hearing loss, you may benefit from hearing aids, which amplify external noises, allowing you to better engage with the world and lessen the impact of your tinnitus.
  • A wearable sound generator is a small electronic device that fits in the ear just like a hearing aid and emits soft, pleasant sounds. With their portability, these devices can provide continuous relief from tinnitus throughout the day. These sounds may also be generated using smartphone apps.
  • A combination device, which fits into the ear like a hearing aid, provides both sound amplification and sound generation. These devices are another way to treat tinnitus.
  • Behavioral Therapy. By reducing the impact of tinnitus on your life, counseling can improve your well-being.
  • Tinnitus education can reduce anxiety by helping you realize that it is unlikely to be connected to a serious health problem in most cases. By limiting your exposure to loud noise, for example, you can learn coping strategies and strategies to prevent symptoms from getting worse through counseling.
  • The goal of cognitive behavioral therapy is to help you identify negative thoughts that make you feel distressed. In order to reduce the impact of tinnitus on your life, your counselor will teach you to change how you respond to negative thoughts and to focus on positive changes you can make. The well-being of people with this condition can be improved by this type of therapy, according to studies.
  • With Tinnitus Retraining Therapy, your brain is “retrained” both emotionally and physiologically so you no longer hear your tinnitus. You get used to the presence of tinnitus through continuous low-level sound from a device worn in your ear, while the counseling aspect of therapy helps you to reclassify tinnitus sounds as neutral.

There are no medications specifically available to treat tinnitus, but your doctor may prescribe antidepressants or antianxiety medications to help you sleep or improve your mood. Vitamins, herbal extracts, and dietary supplements are commonly advertised as cures for the condition, but none have been proven to be effective in treating it.

How are scientists researching tinnitus?

In order to better understand tinnitus and develop new treatment strategies, researchers at the National Institutes of Health (NIH) and at other research centers, many of which are supported by NIDCD, are working. Researchers are testing whether magnetic or electrical stimulation of the brain can help treat tinnitus since it seems to be caused by changes in neural networks in the brain.

Current research topics include:

  • In addition to suppressing tinnitus, cochlear implants restore functional hearing in those with severe-to-profound hearing loss. However, they are not suitable for tinnitus sufferers with significant acoustic hearing. In order to suppress tinnitus without damaging acoustic hearing, researchers are using non-invasive electric stimulation on the inner ear.
  • For long-term relief from tinnitus, acoustic stimulation can be combined with other types of electric stimulation on the tongue, head, or neck.
  • Through a device known as an electromagnetic coil, short magnetic pulses are delivered to the brain in a noninvasive, painless procedure called repetitive transcranial magnetic stimulation (rTMS). As preliminary trials of rTMS have yielded mixed results, researchers are now determining the ideal coil placement and frequency of patient visits.
  • Deep brain stimulation (DBS) is typically utilized to treat people with certain types of movement disorders or neuropsychiatric conditions. Interestingly, some individuals going through DBS found that their tinnitus symptoms were unexpectedly lessened. In contrast to rTMS, DBS necessitates surgery for the implantation of electrodes inside the brain, as it is an invasive technique. Early findings concerning the application of DBS to combat tinnitus have been hopeful; however, further research needs to be conducted in order to decide if this procedure deserves being employed solely for tinnitus treatment.
  • Researchers are testing a number of medications to treat tinnitus, but no medications have been approved by the U.S. Food and Drug Administration.
  • Efforts are being made to develop second-generation versions of a drug that reduces tinnitus in mice.
  • The cochlea is the structure in the inner ear that senses sound. Researchers are studying how tinnitus is associated with hyperactivity in central auditory neurons. To control and relieve tinnitus symptoms, scientists are studying the cellular mechanisms that cause increased activity.
  • In order to identify genetic risk factors for both tinnitus and hearing impairment, scientists are reviewing a large genetic database of people with tinnitus and hearing loss. It may be possible to predict, prevent, screen, and treat age-related hearing impairment and tinnitus based on genetic associations.
  • Tinnitus symptoms range significantly from person to person, as do brain imaging results. To better understand the various forms of tinnitus, scientists are studying data taken from participants monitoring their condition with a smartphone app and utilizing brain imaging technology. Their goal is to identify distinct tinnitus profiles and discover what treatments will be most effective for them.

Many modern hearing aids have built-in sound therapy and tinnitus masking functions. Talk to us at your initial consultation if you feel tinnitus relief needs to be part of your hearing care solution.