Tinnitus

What is tinnitus?

The definition of tinnitus is ‘the perception of a sound in the absence of any external stimuli’. In basic terms, tinnitus is any sound that is heard, where there is nothing in the outside world making this sound. It can be described as many things, including ringing, humming, buzzing, clicking and many more and can occur in either one ear, both ears or centrally. The sound may be constant, fluctuating or intermittent. In other words, everyone’s tinnitus experience is different.

Causes of tinnitusIt can purely be a symptom of the auditory system working

Tinnitus is a symptom. It is a normal symptom following noise exposure or could simply be the auditory system functioning normally. Tinnitus is described as ‘annoying tinnitus’ when it is present for more than five minutes of the day and not after noise exposure. The causes of annoying tinnitus are varied. Common causes of tinnitus are:

  1. Acoustic trauma (ie, from a loud noise)
  2. Physical trauma (eg, from a car accident)
  3. Consistent and prolonged noise exposure
  4. Ageing auditory system
  5. Barometric pressure change
  6. Jaw joint disorders
  7. Neck injury
  8. Some medications
  9. Upper respiratory tract infection.

Psychological and general health are also important factors in tinnitus onset. If you have not discussed it with your GP it is recommended that you do so.

Various contributors can make tinnitus worse, generally for a short period of time. These are called aggravators and are the reasons why your tinnitus may be better or worse than another persons. Below is a general list of aggravators and all or none of them may be applicable to you.

  1. Stress, worry, fatigue
  2. Caffeine
  3. Noise exposure
  4. Certain medications (check side effects on box)
  5. TMJ/neck injury
  6. Silence (or hearing impairment)
  7. Vigorous exercise

Why does tinnitus become annoying?

The brain is designed to pay attention to sounds which it perceives as important. Other sounds are detected in the same way, but kept in the subconscious and we do not notice them. Sounds which we hear everyday, such as a computer humming or the nearby traffic, the brain is able to block out as they are unimportant. The sounds which the brain will pay most attention to, are those which are:

  1. New and unfamiliar (e.g. when you go to someone’s house with a grandfather clock, they often do not notice the ticking, but to you, it’s quite noticeable)
  2. Signal danger (e.g. siren)
  3. Personally relevant (e.g. if someone says your name in a crowd, even if they are not speaking to you, you will turn around)
  4. Need to act or respond to (e.g. a mother with a baby)

If we look at these sounds, we can see that tinnitus, for some people, could fit in to many of these categories. The brain perceives the tinnitus sound to be of importance, and pays attention to it. The tinnitus then attracts negative associations due to it’s prolonged, continuous presence and potentially the feeling that there is nothing that can be done to help. This in turn, increases the brain’s connection with the tinnitus and it persists. The good news is, there are many things that can be done to break this cycle and reduce the tinnitus noise.

Management of tinnitus

As with the causes of tinnitus, the management strategies are varied, however, the main aim of tinnitus management is for the person to habituate to the tinnitus sound. What this means is the brain becomes used to the tinnitus sound and no longer pays attention to it.

Once you have consulted your GP to determine the cause (if known) and are looking to seek further assistance you may wish to see an audiologist. Audiology Australia has member’s who specialise in tinnitus across the country. Some of the common management strategies for tinnitus include:

  1. Sound stimulation - using sound either to directly change your attention (e.g. TV, audiobooks), as a relaxation (classical music) or as a contrast between the silence and the tinnitus noise (environmental sounds). A hearing aid is also a form of sound stimulation. See the section on tinnitus and hearing loss for more information.
  2. Relaxation and stress reduction - stress, worry and other mental health concerns are common tinnitus aggravators. As such, relaxation and stress management strategies may be given to assist this.
  3. Cognitive behavioural therapy or other counselling - mental health problems play a large role in tinnitus annoyance and improving your mental health will greatly assist your ability to manage the tinnitus.
  4. Jaw joint/neck physiotherapy - if your tinnitus is caused by jaw or neck problems then physiotherapy in these areas may assist.
  5. Tinnitus retraining therapy/neuromonics - TRT and Neuromonics are formal, structured therapies aimed at assisting the habituation process. They are conducted by an audiologist and involve the use of a sound generator and counselling sessions.

Tinnitus and hearing loss

Tinnitus is approximately twice as common in the hearing impaired population. This is often due to the tinnitus being a symptom of the damage to the auditory system. As such, the tinnitus does not cause hearing loss and hearing loss does not cause tinnitus, but rather they are both likely a symptom of the same thing.

When a person has a hearing loss, they cannot hear as much from the outside world as a normally hearing person.  As such, the brain hears more of what is happening on the inside, which for many people is tinnitus.

A hearing aid will often be recommended for a person who has tinnitus and hearing loss. This stimulates the parts of the auditory system which are damaged thus providing more access to the outside world and less attention to the internal tinnitus.

 

Where can I find more information?

There are many reputable sites to find information on tinnitus and its management. Some associations also provide information sessions and resource libraries. The Audiology Australia website has a ‘find an audiologist’ section which will provide details of local audiologists. The following websites are well known tinnitus organisations:

Australian Tinnitus Association (NSW) - http://www.tinnitus.asn.au/

Tinnitus Association of Victoria - http://www.tinnitus.org.au/

Tinnitus SA – http://www.tinnitussa.org

American Tinnitus Association – http://www.ata.org

British Tinnitus Association – http://www.tinnitus.org.uk