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Cincinnati Hearing Center

What is Tinnitus?

What is tinnitus?

The word tinnitus generally refers to any sound that is heard in or about the ears or head that is not externally generated. It can be thought of as a phantom perception. While people commonly refer to it as a ringing sound, it may also take the form of buzzing, humming, static, crickets, or music. Tinnitus can be subjective, meaning that it is heard only by the individual reporting it, or objective, meaning that it can be heard by another person. Tinnitus is not a disease, but an underlying symptom of some other condition.

Incidence of tinnitus

Approximately 10 to 15 percent of the world’s population (including the United States) reports the presence of tinnitus. Occasional tinnitus is fairly common and has been reported by 90 to 95 percent of those who have no ear disease or hearing loss. While it has been reported by both children and adults, it is more prevalent in older adults. As many as 30 percent of people over the age of 65 report its presence. Of the more than fifty million people who report tinnitus, about 15–17 million find it to be disturbing enough to seek medical attention.

Tinnitus generation

Within the inner ear are thousands of microscopic sensory receptors known as hair cells. There are three rows of outer hair cells and one row of inner hair cells. Like all the nerves of the body, these tiny hair cells sometimes fire randomly. Since it is not a pattern, the brain does not pay attention to it, and it is not determined to be sound. The function of the outer hair cells is twofold: to enhance soft sounds so that they are audible to us and to reduce loud sounds so that they are not uncomfortable. These cells are susceptible to damage from noise exposure, viral infections, and medications that are toxic to the ear. There can be a great deal of damage to these cells before we are able to detect it on our standard hearing test. When these cells are damaged, the random neural activity can be altered so that what was once interpreted as quiet, the brain now hears as sound—known as tinnitus.

What causes tinnitus?

There are numerous causes of tinnitus, but for most people with the symptom, the underlying root is never precisely determined. In fact, it is estimated that 90 percent of those free from ear disease or active pathology have experienced tinnitus from time to time. We do know that when there is damage to the inner ear, the tiny nerve cells can emit random electrical impulses, which can be heard as phantom sound or tinnitus. Therefore, anything that can cause damage to these nerve cells has the potential of causing tinnitus as well.

Hearing loss: While tinnitus does not necessarily accompany hearing loss, about 50 percent of those with hearing loss also have tinnitus. Since hearing loss progresses with age, we find increasing numbers of those with tinnitus in older populations.

Noise exposure: Noise exposure is one of the more common causes of tinnitus. The exposure can be the result of working in loud environments without the benefit of hearing protection, or it can be from recreational sources such as exposure to loud music, hunting, trap shooting, or the use of chain saws and power tools.

Otosclerosis and other middle ear disorders: Otosclerosis is a disorder of abnormal bone growth in the middle ear that affects hearing and may cause tinnitus. Ear infections, vascular anomalies, and middle-ear tumors have also been known to produce the symptom.

External ear canal problem: Excessive ear wax , infections, eardrum perforation, and foreign objects in the ear canal are all capable of producing tinnitus.

Medications: Besides substances such as aspirin in large doses, mycin antibiotics, and some of the chemotherapy drugs, there are about 200 prescription and nonprescription medications that list tinnitus as a possible side effect.

Acoustic neuromas: Acoustic neuromas are benign tumors of the hearing nerve that usually produce tinnitus in one ear.

Meniere's disease: Meniere's disease is a disorder of the inner ear whose classic symptoms include vertigo, fullness of the ear, and tinnitus.

Whiplash and head and neck injuries: These injuries can have an impact on the inner ear or brain, thus producing tinnitus.

Cardiovascular disease and circulatory problems: Diseases that restrict blood flow and increase blood pressure can cause or increase the perception of tinnitus.

Tinnitus treatment

There are many different approaches to treating tinnitus. At Tinnitus Treatment Centers, located within Cincinnati Hearing Center, we use a combined therapeutic approach that has been shown to be effective in reducing the negative effects of tinnitus. The approach is individualized and includes any of the following methods deemed appropriate:

Case history: A thorough hearing and tinnitus history is obtained on every patient. In addition, patients are asked to fill out a questionnaire to help determine the severity of the tinnitus and the impact it may have on daily activities.

Hearing evaluation: Since hearing loss may be a factor in the presence of tinnitus, each patient receives a complete hearing test.

Tinnitus evaluation: Measurements of the loudness and pitch of the tinnitus are determined. This is done to help the patient and possibly the family of the patient understand the nature of the symptom.

Hearing aids: A high percentage of those with tinnitus have hearing loss as well. Approximately 50 percent of those report a decrease in the tinnitus from hearing aid use alone. This may be because hearing aids make softer environmental sounds more audible, resulting in a smaller contrast between the tinnitus and the quieter environment.

Sound therapy: Sound therapy can be accomplished by the addition of sound to a quiet background. Since tinnitus is more evident when there is no other sound present, sound is used to reduce the contrast between the tinnitus and the auditory environment. The sound can be a white noise, music, or any sound that is found to be pleasant.

Tinnitus retraining therapy: When tinnitus has become problematic for an individual, an emotional connection has been formed. Therapy seeks to break this emotional connection by examining how it was formed and how it is being maintained.

Relaxation techniques: Patients often report that their tinnitus is worse when they feel stressed, yet the presence of tinnitus itself causes them to feel stress. This vicious cycle results in increased stress and increased tinnitus. The use of relaxation techniques can teach these patients to relax and cope when their tinnitus is present and thus can reduce the tinnitus and its effects.

What should you do about your tinnitus?

Since tinnitus is not a disease but a symptom of an underlying medical condition, it is wise to start with a visit to your physician to determine if the underlying condition can be medically determined and treated. In some cases, the root cause for the tinnitus can be treated, and the tinnitus may subsequently disappear. In other cases, the cause of this condition is not specifically identified, and tinnitus therapy by an audiologist may be recommended. In the meantime, it is helpful to avoid exposure to loud noise, reduce stress, get adequate rest, avoid complete silence, and not dwell on your tinnitus. The most important thing to remember is that there is help for those who suffer from tinnitus.