What Is Tinnitus?
Tinnitus is a common disorder affecting over 50 million people in the United States. It is often referred to as ringing in the ears, or buzzing in the ears, although some people hear hissing, roaring, whistling, chirping, or clicking or another sound. Tinnitus can be intermittent or constant, with single or multiple tones. Its perceived volume can range from very soft to extremely loud. It is not well understood but is reported in approximately 88% of those with hearing loss and in as many as 60% of those exposed to excessive noise. Ringing in the ears generally does not get worse once it surfaces but it is common to find it distressing.
What Causes Tinnitus?
There are many causes: the American Tinnitus Association (ATA) notes, “almost anything that can go wrong with the ear has tinnitus associated with it a symptom”. The 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”. Even stress, jaw disorders or high blood pressure can cause tinnitus. However, the most common causes are excessive noise exposure (eg. occupational hazards in the construction and music industry to recreational hazards from hunting, shooting and motorcycle riding) and age related hearing loss.
Research suggests that tinnitus is likely not caused just by processes occurring in the ear but by changes that take place in the brain following ear trauma or hearing loss ( Henry et al 2014)1 . Recent review of dozens of past clinical studies finds that usually two or more triggers (eg. noise exposure, hearing loss, emotional distress and sensory overload or trauma) are necessary to elicit onset of ringing in the ears where it is persistently noticeable (Haider et al, 2018).
The actual mechanism responsible is not yet well understood. However, the prevailing theory is that something has damaged the delicate hearing nerve and its receptors and that either the nerve is now creating the tinnitus or the brain is misinterpreting signals from the damaged hearing nerve. Either way, the individual “hears” ringing, buzzing or some other noise in the ear or head. The ringing can be made worse by loud noise so wearing hearing protection once it has started is essential. It is common that stress can make the ringing worse. The following video illustrates how the ear and brain are believed to interact with one another to create the perceived noise:
Peninsula Hearing Services provides comprehensive hearing evaluations as the first step to assessing your experience with the ringing to determine if hearing loss and/or an underlying medical condition is causing the tinnitus. The Mayo Clinic makes several suggestions with how to prepare for your appointment and what to expect from the healthcare provider.
Tinnitus Treatments
Generally, most patients will not need any medical intervention for tinnitus. Once this is confirmed, Peninsula Hearing Services has found the following two treatments to be the most successful to relieve the noise/ringing:
Hearing Aids
Approximately 88% of those with hearing loss experience ringing in the ears. Because of this, hearing aids are the most effective first choice of treatment when hearing loss is present.
Hearing aids address both tinnitus AND hearing loss and treating hearing loss alone often results in a reduction or even elimination of the ringing.
Studies have shown that approximately 67% of tinnitus patients with hearing loss experience total or partial relief while wearing hearing aids. It is unclear why this is so. Researchers believe that either the hearing aids enhance sound to normal levels and thus everyday environmental sounds “mask” (cover up) the annoying noise/ringing and/or hearing nerve receptors are stimulated by normal sound levels because of the hearing aid and thus the brain is provided normal hearing sound input and is no longer “starving”. The following videos explain this in further detail”
Neuromonics Tinnitus Treatment
Using a proprietary, patented app on your smartphone or notepad, this FDA-cleared treatment utilizes a customized neural stimulus enriched in clinically modified music that interrupts and desensitizes ringing. Using earbuds or headphones, this sound therapy works by promoting changes in the brain that allow it to filter out the disturbing noise with an 87% success rate.
The Neuromonics tinnitus treatment involves an initial office visit and then use of the app on your Smartphone from 1-2 hours each day for 2-6 months. Many report relief from tinnitus within the first week. Several telephone and office visits are also required as part of the treatment. It is important to note that the Neuromonics system is not simply a “plug-and-play” therapy. The success of the treatment relies equally on the motivation and compliance of the user to follow when and how to use the device as well as significant interaction, counseling and follow-up from the healthcare provider administering the treatment.
Are there Other Treatments for Tinnitus?
There are no FDA-approved medications to alleviate tinnitus and there is no clinical data to support any over-the-counter products as proven to support marketing claims to relieve tinnitus. Speak with a physician first before considering use of mediations/products to relieve tinnitus as they could be hazardous when mixed with other medications or if you have an on-going health problem(s).
There are some experimental therapies at teaching hospitals throughout the country in development but they have not been fully validated for clinical use: