Tinnitus

What Is Tinnitus?

The ringing is a common symptom of the ear affecting over 50 million people in the United States. It is not a disease, but a symptom that something is bothering your ear(s). The sound varies from person to person but it is often described as ringing in ears, buzzing in the ears, ringing and buzzing in ears or even a rhythmic pulse to your heartbeat, which is called pulsatile tinnitus.

Some people hear hissing, roaring, whistling, chirping, or clicking or another sound. Tinnitus ringing can be in one ear or both ears. It can be intermittent or constant, with single or multiple tones. The volume and ringing in ears can range from very soft to extremely loud and it too can change from day to day (examples of some ringing in ear sounds: link-1 and link-2).

Typically individuals report ringing in ears is most noticeable at bedtime. This is because the house is quiet, free from noise to distract the ears, so the sound is much more noticeable at that time of day (for more information about symptoms of tinnitus, visit National Institute of Health).

Most everyone experiences ringing and buzzing in ears for a short time after being exposed to extremely loud noise or under stressful periods in their life. However, when the ringing in ears lasts for several weeks or more and is not getting better, you should seek a hearing test as soon as possible to diagnosis the main causes of tinnitus and the reason for tinnitus. An audiologist will perform a physical exam of your ears to check for excessive earwax or fluid from an ear infection that could be blocking your ear canal. They will also perform a hearing test to determine if hearing is normal or not.

A hearing test can determine if you truly have hearing loss, the pitch or tone of the ringing, the perceived loudness of the ringing and whether the ear noise can be “masked” or relieved by external noise like a fan or static. Equally important, the audiologist will ask about your medical history to find out if an underlying medical condition may be causing the ringing. Questions about what the ringing sounds like, it is in one ear or both ears, do you have a history of noise exposure and when the ringing and buzzing in ears started. The American Tinnitus Association lists other important factors about the ringing in ear causes and what the audiologist will want to know.

The audiologist will review the results of the hearing test and available treatments. In the uncommon event a referral to a medical specialists is needed, the audiologist will also provide information for that. Don’t delay and seek the hearing test as soon as possible to diagnose the reason and main causes of the ringing you are experiencing.

Peninsula Hearing Services is in-network with many insurance plans who offer a hearing test as one of their benefits. Visit this website at hearing test to learn more about the different subtests of a hearing test and insurance plans to determine if the office is in-network with your plan.

Tinnitus and Causes

The most common reason for tinnitus in ears is excessive noise exposure, hearing loss or recent trauma(loud noise or injury to the ear). Uncommonly, there can be a medical cause. The American Tinnitus Association (ATA) notes buzzing in ear causes can range from something as simple as too much ear wax or a general ear infection to something more serious like a benign (not life-threatening) tumor on the hearing nerve” or head or neck injuries. Even stress, jaw disorders or high blood pressure can cause ringing and buzzing.

Recent research suggests that ringing in ears is likely not caused just by damage to the ear or hearing nerve. but by changes that take place in the brain following ear trauma or hearing loss ( Henry et al 2014) . Researches (Haider et al, 2018, Shore et al 2007) found that usually two or more triggers (eg noise exposure or hearing loss AND emotional distress or sensory overload or trauma are necessary to elicit onset of ringing in the ears where it is persistently noticeable.

The actual mechanism responsible is not yet well understood my medical science. However, the prevailing theory is that something has damaged the delicate hearing nerve and its receptors and that either the malfunctioning hearing nerve is now creating the tinnitus or the brain is misinterpreting signals from the hearing nerve. Either way, the individual “hears” ringing, buzzing or some other noise in the ear or head. The following video illustrates how the ear and brain are believed to interact with one another to create the ringing:

The first step to assessing your experience with the ringing in the ears to determine if hearing loss and/or an underlying medical condition is the reason for the ringing. The solution is to schedule a hearing test right away to determine whether hearing loss is a contributing factor. The Mayo Clinic makes several suggestions with how to prepare for your appointment and what to expect from the audiologist. To learn how a hearing test is administered visit this website at hearing test.

Tinnitus Treatment

Generally, most patients will not need any medical intervention for ringing in ears. And, although medical science does not have a tinnitus cure yet, tinnitus and treatment options are available that work well for most people.

Of those who experience ringing in ears, the WHO (World Health Organization) states that as many as 79% of persons who experience ringing in ears have at least a mild hearing impairment (Hackenberg et al, 2023). The good news is that if hearing loss is found to be present in one or both ears, hearing aids show a high level of success to relieve the noise/ringing:

Hearing Loss and Treatment

Many with hearing loss experience ringing in the ears.  Studies have shown that approximately 67% of patients with hearing loss with ringing in the ears experience total or partial relief while wearing hearing aids. Because of this, hearing aids are the most effective first choice of treatment for ringing and buzzing in ears when hearing loss is present.

It is unclear why this treatment works so well. Researchers believe that either the hearing aids enhance sound to normal levels and thus everyday environmental sounds “mask” (cover up) ringing and hearing nerve receptors are stimulated by normal sound levels because of the hearing aid. The following videos explain this in further detail.

If the hearing test does not reveal hearing loss and no medical concern is determined as the cause, there are treatments that can help. No single treatment works for everyone, so the audiologist will discuss with you what tinnitus treatment therapy or treatment would be best for you.

There are several specially developed devices/therapies that are believed to reverse some the neural changes that occurred in the brain as a result of the hearing loss or trauma to the ear that caused the ringing. It is also believed that these sound therapies can relieve by masking the ringing sound, so that you no longer notice them.

Sound therapy is custom tailored, spectrally modified relaxation music prescribed from the patient’s soundprint match of their perception of the ringing/buzzing in the ear. The are often worn when sleeping, using earbuds to gently play the prescribed sound to help the brain suppress the tinnitus and possibly rewire neural network that caused the ringing back to what it once was.

There are several devices and apps that supplement these treatments. After visiting your audiologist and completing the hearing test and examination, they can review with you whether such a treatment would be appropriate for you.

As with sound therapy, there are several forms of behavioral therapy that statistically show great success for those troubled by the feelings of the ringing and find it difficult to stop thinking about it to such a degree it is affecting their life negatively.

Cognitive behavioral therapy(CBT) is a relaxation technique that changes the way patients thing about and respond to the ringing in the ears. This therapy works best when combined with certain sound generators or sound therapies that match the pitch, volume and quality of the patient’s ringing or buzzing in the ears.

Tinnitus Retraining Therapy utilizes several counseling sessions with the audiologist and sound therapy to help the brain habituate, filter out and make the ringing less noticeable. The brain is ultimately “re-trained” emotionally and physiologically to no longer notice the ringing. Some studies have reported relief by as many as 80% of patients,

tinnitus
Man being treated for tinnitus with Neuromonics
woman holding a cell phone that uses the Lenire tinnitus sound therapy device with a special wrist band
artists rendering of the ear and inner ear organs that make hearing possible

What will work for Me?

There are no FDA-approved medications to alleviate the ringing and there is no clinical data to support any over-the-counter products as proven to support marketing claims they can alleviate the ringing. The different sound and cognitive therapies have show good results but are inconsistent from study to study and often lack control groups (patient who did not receive the therapy being studied even they believed they were being treated) to measure their true success.

The ringing in the ears is unique to each person, so visiting with the audiologist to find the right treatment may means trying several treatments and combinations before finding success. The first step to assessing your experience with the ringing in the ears to determine if hearing loss and/or an underlying medical condition is the reason for the ringing. The solution is to schedule a hearing test right away to determine whether hearing loss is a contributing factor.