Many people experience tinnitus, or ringing in the ears, at some point in their lives. Music concerts, industrial work environments and other situations that are known for loud noises and sounds are the most common settings that cause tinnitus. While most cases of tinnitus resolve without treatment, chronic or acute tinnitus requires treatment. The board-certified Otolaryngologist/Head and Neck Surgeons of Suncoast ENT Surgical Specialists understand the causes of tinnitus and offer effective treatments for those living in Tampa, Spring Hill and surrounding towns in Florida.
What Is Tinnitus?
Also known as ringing in the ear, tinnitus is an affliction where one hears, either intermittently or continuously, a series of sounds including ringing, hissing, and/or buzzing in the ears. The noise can also vary in degrees of loudness. Interestingly, when the background noise is low, you’re most likely to experience the effects of tinnitus, with the largest effects being felt in a quiet room, at night, when one is trying to sleep. Interestingly enough, the tinnitus can be in sync with your heartbeat, a condition known as “pulsatile tinnitus.”
An estimated 50,000,000 adults in the United States suffer from tinnitus, making it one of the most common afflictions in the United States today. In mild cases of tinnitus, it can simply be an annoyance. In the most severe cases, however, it can actually interfere with everyday life. A person who suffers from severe tinnitus will suffer from relationship interference, difficulty concentrating and sleeping, and, as a result of these afflictions, psychological distress.
The vast majority of tinnitus sufferers handle it well, so only about 1% to 2% of the population have tinnitus that interferes with daily living and quality of life.
Contrary to popular belief, hearing loss does not cause tinnitus, nor does tinnitus cause hearing loss. In fact, many people who suffer from tinnitus experience no hearing loss at all. In the most extreme cases, some tinnitus sufferers suffer from hyperacusis — they hear TOO WELL — and have to take steps to muffle all of the sounds that hit their ears and cause sensory overload.
Sometimes, tinnitus is only temporary, developing as a result of an infection or blockage in the ear. In those cases, once the ear infection is treated, the tinnitus disappears.
Types of Tinnitus
Tinnitus is described as two types: subjective tinnitus (where the patient perceives the noise all on his/her own, and this is actually quite common) and objective tinnitus (where both the patient and other listeners perceive the noise — this is an uncommon type of tinnitus, and the cause of the tinnitus can be found either in the ear or in the head).
Tinnitus is a Symptom
Rather than being considered a disease, tinnitus is actually a symptom of a larger neurological problem. While it may occur as a standalone symptom, it may also occur in conjunction with vertigo, hearing loss or pressure in the ear.
When the auditory nerve — whose singular function is to transmit sound — is irritated in whatever way, shape, or form, “head noise” is produced. This is no different than the types of sensations produced elsewhere in the body when other nerves are irritated.
Tinnitus may be produced in one or more locations, called the site of lesion. It can have a singular cause or many causes.
A peripheral site lesion is located either in the auditory nerve or the cochlea, and may include dysfunctions that can stem up to and including the brainstem.
On the other hand, a central site of a lesion is one that begins in the brainstem and involves other portions of the central auditory pathways.
As you can see, tinnitus is caused by lesions that begin at several different sites. Because the auditory system involves highly complicated inner ear structures that include bones, nerves, and nuclei, pinpointing the exact structure that causes the tinnitus becomes a difficult, if not impossible, process.
When a patient has tinnitus after surgery or several ear diseases, the auditory nerve is often cut to relieve the tinnitus. Should the tinnitus persist thereafter, it indicates that the site of the lesion has moved from the auditory nerve to the central nervous system. This is a perfect demonstration of how difficult it is to pinpoint the exact structure that causes tinnitus.
Some of the causes of tinnitus include, but are not limited to, the following:
- Medications (including excessive aspirin intake)
- Excessive build-up of cerumen (ear wax)
- Otosclerosis (a fixation of the stapes bone in the middle ear)
- Chronic cochlear disorders, including afflictions involving the cochlear fluid
- Abnormal neural activity in the auditory nerve fibers
- Meniere’s disease (a disease that involves hearing loss and vertigo, or dizziness)
- Exposure to excessively loud sounds (such as when you go to a concert)
- Tumors of the central nervous system or within the auditory system
- A direct blow to the head or other forms of sudden trauma, and
- Vascular abnormalities that occur at the base of the head or in the skull
When tinnitus is severe and/or chronic, our ENT specialists recommend a complete battery of tests, known as a complete cochleovestibular evaluation. The evaluation offers two benefits: first, to establish the site of lesion that is causing the tinnitus, and second, to rule out any other pathology (including a tumor) that may be causing the tinnitus should a site of lesion not be established.
Frequency testing is a common test to diagnose tinnitus. Patients who suffer from tinnitus cannot perceive high frequencies, meaning that they have difficulty perceiving frequencies at 16,000 MHz and above. Also, patients who suffer from this type of tinnitus may suffer from high-frequency hearing loss, which also impairs frequency discrimination.
When diagnostic tests fail to determine the cause of the tinnitus, the auditory technician will run the battery of tests. However, the tests that compare the tinnitus pitch to the frequency of the auditory tones may not be as good as the other tests. In addition to determining the pitch-matching and loudness-matching of the tinnitus, the technician may run a test to determine the “maskability” of tinnitus, which is not related to the loudness. Finally, a residual inhibition will be determined, which is when tinnitus is reduced after a “masking” sound is turned off.
Treatment of Tinnitus
Most patients will not need medical treatment for their tinnitus, and even the ones who do need medical treatment will find that there is no medication that will completely eliminate tinnitus.
There are, however, treatment options outside of medication for tinnitus, and they include (but are not limited to):
- Medications (which will decrease the intensity of tinnitus in some patients, but not all of them. Bear in mind that each patient has a different response to tinnitus medication — and it should only be taken after a series of tests confirm that doing so will be to the benefit of the patient, and will indeed counteract the effects of tinnitus).
- Listening to a fan or a radio (which produces “white noise,” canceling out the sound of tinnitus and making it easier for the patient to go to sleep).
- Tinnitus masker (a device that cancels out the noise that causes tinnitus, this is put into a hearing aid case and is just as easily masked as today’s hearing aids. It’s been proven that tinnitus sufferers can tolerate outside noise (that is, noise that comes from the outside world) better than inside noise, or the noise that their own head creates.
- Biofeedback training (wherein the patient learns to relax his/her muscles, which will help the effects of tinnitus subside; patients who try this therapy report that they also have the added benefit of better coping skills along with the decrease of tinnitus symptoms).
- Avoidance (that is, avoiding the anxiety triggers that can also trigger tinnitus. Many people who suffer from tinnitus also tend to lose valuable sleep, causing them to become irritable, and this too can be a trigger of the symptom. In addition to avoiding the general stressors of life, and getting a good night’s sleep, patients are advised to avoid excessive stimulants that can also trigger the effects of tinnitus. Amongst the stimulants that patients are advised to avoid include caffeine — which can be found in coffee, tea, chocolate, and some cola drinks — and nicotine, which, of course, is most commonly found in tobacco products, including cigarettes).
While most cases of tinnitus resolve quickly and interfere very little with daily activities, some people in Tampa and Spring Hill areas live with more advanced and severe tinnitus. Our ENT specialists diagnose the type and severity of your tinnitus and recommend safe and effective treatments. Contact our office today to schedule a consultation.