Tinnitus is the sensation of hearing sounds that are not present. The phantom noise may sound like a ringing, buzzing, roaring, clicking or hissing, and may range in pitch from low to high. Some patients experience these sounds all the time and others hear them only sporadically.
There are two kinds of tinnitus: subjective and objective. Subjective tinnitus can only be heard by the patient. This type of tinnitus can be caused by a problem with the outer, middle or inner ear, an issue with the auditory nerve or the auditory pathway in the brain that interprets nerve signals as sound.
Objective tinnitus can be heard by the audiologist performing the evaluation. This type of tinnitus is rare and usually caused by a blood vessel problem, a middle ear bone condition or muscle contractions.
The most common cause of tinnitus is damage to the hair cells within the inner ear. The hair cells move in response to the pressure of a sound wave. When the hairs move, an electrical signal is sent through the auditory nerve to the brain, where it is interpreted as sound. If the hairs become damaged they can randomly send electrical signals to the brain. The brain will interpret these signals as sounds, even though there is no sound actually present.
Damage to the hair cells can be caused by age-related hearing loss, exposure to loud noises and earwax blockage. Less common causes of tinnitus include Meniere’s disease, TMJ disorders, an injury to the head or neck or acoustic neuromas. In rare cases, blood vessel disorders have been linked to tinnitus symptoms. More than 200 drugs are known to list tinnitus as a side effect. The most common drugs are antibiotics, cancer medications and diuretics.
In addition to the bothersome tones, complications such as fatigue, stress, sleep problems and depression often accompany tinnitus.
In order to make a diagnosis, the audiologist will require an audiological exam, a movement test and an imaging test. These exams are used to rule out or identify possible causes of tinnitus. If no cause is identified, treatment options are focused on helping the patient reduce the severity of the tinnitus and cope with the noise.
Noise suppression treatments are used to help the tinnitus become less bothersome. A white noise machine provides the patient with environmental sounds, such as a babbling brook. These devices are especially helpful when used while falling asleep. Masking devices are worn in the ear like a hearing aid and produce continuous low-level noise. This helps drown out the tinnitus symptoms.
Over 90 percent of those with tinnitus also experience hearing loss. A hearing aid is typically recommended if the patient shows any sign of a hearing impairment. This device can work to make other sounds louder, potentially drowning out the tinnitus.
Lifestyle changes have also been shown to help reduce tinnitus symptoms and help the patient deal with the noises. Stress management, through relaxation therapy and exercise, can provide relief. Limiting a patient’s alcohol consumption is recommended as alcohol increases the force of blood flow, especially in the inner ear. Counseling, support groups and education are able to help patients cope with tinnitus that does not sufficiently improve with treatment.