Tinnitus: Causes and Treatments
Tinnitus is the term used to describe the perception of sound, which is not present externally. It is commonly heard, as ringing, hissing, buzzing or clicking and can be a single sound or a number of different sounds.
Tinnitus is not a disease and is very common. With almost every adult experiencing a form of tinnitus at one point in time. Although normal hearing individuals can experience tinnitus, it is most common among populations with an underlying hearing loss. With hearing loss there is typically damage to the sensory cells of the ear, called hair cells, causing a loss of input to the auditory regions of the brain. These areas require constant stimulation, so when their input is reduced, the auditory nervous system compensates by turning up its sensitivity to try to pick up what it is missing. This results in amplification of the background electrical activity of our hearing nerves or “brain hum” which is then perceived. Tinnitus is the side effect of these neural changes. When something disrupts the hearing pathway as in a loss of hearing, we can become aware of our background electrical activity, resulting in the perception of tinnitus.
Some common tinnitus triggers are:
- Exposure to loud noise
- Physical injury or head trauma
- Ear or neural disease
- Extreme stress
- Circulatory changes
- Muscle spasms
- Some prescription and non-prescription drugs
Tinnitus is common, affecting 4 to 25% of the population. If the tinnitus is negatively perceived, it can become highly disturbing, causing significant distress for 1-2% of sufferers, affecting the quality of life and sleep.
While research is yet to develop a cure, there are a number of treatments to help sufferers manage the condition, which starts with identifying and treating the underlying cause of the condition. For bothersome tinnitus, a visit to the doctor helps to determine any underlying medical issues. If tinnitus is related to a particular disease, for example, Meniere’s or temporomandibular joint dysfunction (TMJ), referral to the appropriate specialist is made. An audiologist is then consulted for the assessment and evaluation of tinnitus treatment options.
The first step is to understand what tinnitus is; in most cases a side effect of the auditory system compensation for damage typically to the hair cells, causing hearing loss. If we react adversely to tinnitus and perceive the sound like a threat, our brains tend to focus in on it, making it more alarming. However we can train our brain to ignore it, a process called habituation.
Sound therapies are an important step in tinnitus. Silence is not your friend. Many options exist for sound therapy and one is not necessarily more effective than the other, what is critical is consistency. The basic idea behind sound therapy is to listen to soothing sounds (via earphones, speakers, hearing aids), at a level that does not mask the tinnitus but reduces its perception and provides relief. The brain starts to perceive the constant sound as meaningless or even soothing and the stimulation from the real external sound disrupts the brains attention to the tinnitus.
Another step of tinnitus treatment is a distraction. Tinnitus is just a sound, but how our brain interprets this sound, is what causes a problem. In times of stress and lack of stimulation, we can become even more focused on our tinnitus. Distracting oneself and doing something we enjoy is important to breaking of constant focus on our tinnitus.
Lifestyle modification is the fifth step; diet, exercise, and mental health. Let tinnitus be a wake-up call to get healthy. Poor general health, lack of exercise, poor diet and inadequate sleep, can all exacerbate tinnitus. Improving health and fitness may not cure tinnitus, but can reduce stress, improve sleep and reduce dependence on medications that may contribute to tinnitus. Stress reduction using relaxation therapies and meditation may be very helpful. Seek counselling support to address anxiety and depression, whether it’s related to the tinnitus or not. Clinical psychologists can also provide Cognitive Behaviour Therapy or CBT, a therapeutic approach that helps a patient identify maladaptive thoughts and behaviours and learn stress reduction techniques. CBT for tinnitus treatment is threefold: changing the way a person perceives tinnitus; teaching ways to focus attention away from tinnitus and achieving control over stress.
Practical tips for managing tinnitus
Ensure you maintain a sound enriched environment and avoid silence. Environmental sound generators obtained via a mobile phone app from Apple’s Play Store or Google Play Store (ReSound Relief, Simply Noise or Starkey Relax App) or online sound file played through earphones, speakers or hearing aids should be played as much of the day as possible including during sleep. Notched music therapy (Neuromonics Tinnitus Treatment) is a form of sound therapy, using individually customised patterns of sounds, incorporated within music and delivered via a medical device or an app, that has been shown long term benefits in suitable patients.
If hearing aids are prescribed, use these as much as possible. Hearing aids enable stimulation of the areas of the brain that have reacted to the missing sound and retrain the brain to again focus, on real environmental sounds over the tinnitus. Hearing aids reduce listening effort and the stress this can cause. Some hearing aids include notched filter therapy, which may provide additional benefits by more specifically balancing the neural activity in the affected areas of the brain.
Sleep is very important to reduce stress, which can affect tinnitus. Good sleep habits and use of a sound pillow, which plays soft relaxing sound through your pillow, can help with this (www.sleepsolutions.com.au).
Avoid loud noise, which can damage your ear and exacerbate tinnitus. Wear earmuffs or earplugs for activities such as going to concerts, mowing the lawn or using power tools.
Try not to monitor your tinnitus, endlessly research online or let your tinnitus control you. Let the treatment and your brain do its job. The less you monitor it and consciously engage it, the less you will be aware of it and allow it to fall into the background.
Book a consultation with an audiologist at Hearing Professionals to discuss practical steps to manage your tinnitus.