Tinnitus: Symptoms, Causes and Treatment
Tinnitus is the awareness of unwanted noises in the head or ears. Anything that causes hearing loss (e.g., an ear infection, ageing or exposure to loud noise) can cause tinnitus. But, it is also possible to get tinnitus even if there is no associated hearing loss. Some people find tinnitus an occasional nuisance and only notice the noise when it is quiet, while others are unable to concentrate on anything else and may become extremely distressed. About one in ten adults have some tinnitus.
What Actually Happens in Tinnitus
Before a person becomes aware of what their ear is hearing, their brain processes the sound unconsciously. The lower levels of the brain naturally filter out uninteresting background noise and amplify anything that the person is paying attention to. Tinnitus occurs when the lower levels of the brain stop filtering out minor background noise, amplifying it instead and thus creating a disturbance in the ears or head.
There are also some background noises created inside the body. For example, blood flowing through the head creates noise. This internal background noise is usually labelled by the lower levels of the brain as being minor and uninteresting so that it is filtered out and not consciously heard. Tinnitus is basically a failure of this happening.
People with tinnitus might be confused by what they are hearing or worried and irritated by the unfamiliar noise and start paying attention to it. So instead of their subconscious brain labelling this noise as background noise and filtering it out, it makes it louder instead. This can create a vicious circle. The noise gets louder and more intrusive, so they pay more attention to it and so on.
Symptoms of Tinnitus
People with tinnitus hear noises inside their head or ears. These noises often sound like bells, pulsations, rumblings or whistles. Some patients can hear the noise in time to their heartbeat and this is usually just the sound of blood flowing through normal blood vessels. Most people find that they only notice their tinnitus when it is quiet and they are not distracted from it by other activities.
Causes of Tinnitus
Tinnitus is often associated with hearing loss, both temporary and long lasting hearing loss. Therefore, anything that causes hearing loss can potentially cause tinnitus. However, it is also possible to get tinnitus without having problems with hearing. Some of the most frequent causes of tinnitus include:
- Ageing. Most people lose some hearing as they get older. They often experience some tinnitus too. On the contrary, it is unusual for children to get tinnitus.
- Ear infection or ear injury. These can cause temporary hearing loss often accompanied by temporary tinnitus. However, tinnitus may sometimes continue after the hearing gets better.
- Earwax blockage. When too much earwax accumulates in the ear canal it can cause irritation of the eardrum or hearing loss and these can lead to tinnitus.
- Head or neck injury. These can affect the inner ear and the nerves leading to the brain and cause tinnitus.
- Inner ear hair. Delicate hairs in the inner ear, if bent or broken, can produce electrical impulses to the brain and cause tinnitus.
- Loud noise. When lasting over a long period of time, loud noise can often alter hearing.
- Medications. Some medications, including certain antibiotics, antidepressants, diuretics, cancer medications and large doses of aspirin can cause tinnitus.
- Surgery to the ear. This often affects hearing and can cause tinnitus even if the hearing improves.
- Tumors. In rare cases, tinnitus can be caused by more serious conditions such as head and neck tumors. However, it is extremely unlikely for tinnitus to be the only symptom of the tumor.
Less common causes of tinnitus include:
- Cardiovascular problems. Conditions affecting the blood flow can increase the risk of pulsatile tinnitus.
- Getting out of bed. Some people may get tinnitus on waking because their blood sugar levels are low.
- Migraine. People suffering from migraines may have some tinnitus too.
- Thyroid gland. An underactive or overactive thyroid gland can also cause tinnitus.
There are also some other more serious but rare causes of tinnitus such as:
- Acoustic neuroma. This is a non-cancerous tumour that grows near the inner ear. It usually causes hearing loss in one ear only and not just tinnitus on its own.
- Anemia. This blood disorder can occasionally cause tinnitus because the blood flow to the brain needs to be increased. As a result, the sound of blood flow through the arteries in the neck may become easy to hear.
- Arteriovenous malformations. If these abnormal collections of blood vessels occur near the ear then the blood flow may be quite loud, causing tinnitus.
- Benign intracranial hypertension. This rare condition, which tends to occur in young overweight women, can sometimes cause pulsatile tinnitus.
- Palatal myoclonus. This is an extremely rare condition in which the muscle of the soft palate in the mouth twitches rhythmically.
In addition, many people find that anxiety, depression and stress as well as alcohol and caffeine make their tinnitus worse.
Treatment of Tinnitus
There are several different treatments that can help patients with tinnitus including:
Treatments for Hearing Disorders or Hearing Loss
These treatments deal with the physical causes of hearing loss. They do not necessarily cure the resulting tinnitus, but they often help to decrease the symptoms, making them easier to cope with. Treatment options include:
- Hearing aid. These devices can often help tinnitus as well as poor hearing, especially in older people.
- Noise masker. It looks similar to a hearing aid and creates its own noise which can distract from tinnitus, making it more manageable. However, some people find the noise from the masker to be no better than their own tinnitus.
- White noise machines. Like noise maskers, these devices make their own environmental sounds that distract from tinnitus but they take a form of a pillow or an alarm clock.
- Surgery. There are no specific operations for tinnitus, but ear surgery to improve hearing often helps improve tinnitus as well. However, few surgeons would recommend surgery if tinnitus were the only problem.
Tinnitus Retraining Therapy (TRT)
Tinnitus retraining therapy is a form of counselling that helps the brain to re-learn how to filter out the noise, eventually making it disappear. Tinnitus occurs when the brain stops automatically filtering out uninteresting background sounds. A person with tinnitus will start hearing these sounds more consciously and more loudly. Tinnitus retraining therapy helps the patient’s brain to ignore the noise inside their head or ears. The therapy aims to retrain their brain and help it to regard the tinnitus as the uninteresting or irrelevant background noise it always was. The patient may need to spend many months with specially trained counsellors for TRT before feeling any improvement in their condition.
Drug Treatments for Tinnitus
Medications have not become widely accepted as a general treatment for tinnitus. Despite that patients may be prescribed drugs for a specific problem that is causing their tinnitus or making it worse. The type of drug will depend on the condition or symptom causing tinnitus. For example, anti-migraine drugs can be helpful for patients whose tinnitus is triggered by migraine attacks. In addition, some people suffer from anxiety and depression resulting from the tinnitus and it is these conditions that are treated in their own right, rather than the tinnitus itself. Therefore, treatment often involves antidepressants.
Complementary Treatments for Tinnitus
Dietary supplements such as zinc, B vitamins, ginkgo biloba or melatonin are sometimes used to treat tinnitus though there is no scientific evidence that they are really effective. Some experts also recommend acupuncture and hypnosis for the treatment of tinnitus but reliable evidence is still lacking to support their use.
It is impossible to prevent many forms of tinnitus and hearing loss. However, people should avoid very loud noise, especially prolonged exposure to loud sounds to reduce the risk of ear damage and resulting hearing problems.
Coping with Tinnitus
A person suffering from tinnitus may need to see a doctor to confirm that nothing serious is wrong. The less they worry about tinnitus and the less attention they pay to the interfering noise, the easier it is for their subconscious brain to filter it out. To lessen the impact of tinnitus patients should keep active during the day to distract themselves from the tinnitus, while at night it can be helpful to leave the radio on quietly. Patients should also exercise regularly to avoid circulatory problems and get enough rest to prevent fatigue.
Most patients find that with time they get used to their tinnitus. With proper treatment it may disappear completely or at least become much less intrusive. It is rare for tinnitus to progress. It is also very unusual for it to develop into any serious disease.
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