Tinnitus

While tinnitus can be frustrating it is rarely a sign of a more serious condition. For some people, it can come and go and only be a minor irritation. However, some people’s tinnitus can be continuous and have a huge impact on their everyday lives. Severe cases of tinnitus can be very distressing and can cause the following issues:

• Problems falling asleep and insomnia
• Annoyance, irritation and unable to relax
• Difficulty understanding speech
• Despair, frustration or depression
• Poor concentration or confusion

Tinnitus can occur suddenly out of the blue or develop gradually over some time. Tinnitus can be a symptom of an underlying issue, most commonly hearing loss and exposure to excessive noise. Most underlying causes of tinnitus are classed as either otologic (related to the ear), neurologic, medication-related or infections. When there is no known cause or diagnosis for tinnitus, it’s called idiopathic.

Otologic causes

Otologic causes include:

• Noise-induced sensorineural hearing loss as a result of damage to the inner ears and/or auditory pathway
• Age-related hearing loss (presbycusis)
• Abnormal growth of the small bone in the middle ear
• Impacted earwax
• The mucosal lining of the eustachian tube which links the back of our nose to the middle ear becomes swollen or does not open or close correctly – known as eustachian tube dysfunction
• Sudden deafness or sudden sensorineural hearing loss
• Ménière's disease which causes hearing loss and vertigo
• A pressure-related tissue injury called ear barotrauma which is often seen in divers and frequent flyers

Neurological causes

Tinnitus can be caused by neurological changes within the auditory system and the parts of the brain that influence your conscious and emotions. These changes can be as a result of:

• Head injury
• Whiplash or other neck issues
• Multiple sclerosis
• Acoustic neuroma
• Vascular tumours of the middle ear

Infections

There are several types of infections that can cause hearing loss, including:

• Lyme disease
• Syphilis
• Inflammation of the middle ear called otitis media
• Meningitis

Ototoxic medications

More than 200 prescription and over-the-counter medications used to treat pain, cancer, serious infections and kidney and heart disease have been linked to hearing loss and tinnitus. This can be either temporary or permanent. The most common medications linked with ototoxicity include:

• Salicylates such as aspirin
• Nonsteroidal anti-inflammatory drugs
• Aminoglycoside antibiotics such as neomycin and streptomycin
• Loop diuretics
• Chemotherapy drugs containing platinum
• Tricyclic antidepressants

Noise-induced tinnitus

Exposure to loud noise only needs to make small temporary changes to the ear’s outer hair cells to cause tinnitus. This happens by increasing the sound processing in the central auditory system. Even just occasional exposure to loud noise such as attending a loud music concert can cause tinnitus, although this is generally temporary and symptoms should go within 48 hours.

Tinnitus is believed to the most common symptom of noise-induced hearing loss experienced by musicians. A German study found that professional musicians had a 57% greater risk of developing tinnitus than in any other profession.

Some famous musicians, singers and DJs who have experienced tinnitus during their career include:

• Anthony Kiedis
• Moby
• Trent Reznor
• Chris Martin
• Eric Clapton
• Barbara Streisand
• Pete Townshend (who is also deaf in one ear)

You should talk to your GP if you experience any problems with your hearing, such as a buzzing or ringing sound in your ears. They will ask you about your symptoms and health history, for example:

• Is the sound constant or does it come and go?
• Does the sound only occur in one ear or both?
• Is it impacting on your everyday life?
• Are you experiencing any other symptoms such as vertigo or hearing loss?
• Have you been exposed to loud music or a sudden pressure change?
• Any history of infections or trauma to your ear or central nervous system?
• Have you undergone radiation therapy to your head?

They may also ask you if you have been taking any medication that could cause tinnitus such as aspirin or high doses of antibiotics.

Your ears will be examined, both outside and inside, to check for any obvious issues that can easily be treated such as an ear infection or build-up of earwax. They may listen with a stethoscope to see if there is any vascular noise next to to your ear and near the carotid arteries and jugular veins. They may also suggest a simple hearing test and arrange blood tests to check for any conditions that can be linked to tinnitus such as diabetes, anaemia or thyroid gland problem.

In some cases, your doctor may refer you to an audiologist who will be able to carry out some further hearing tests and discuss the treatments most suitable for you. You may alternatively be referred to the ENT department at the hospital. An ENT specialist will examine your ears and carry out further tests to establish what’s causing your tinnitus. On occasions, people experiencing symptoms of tinnitus have a CT or MRI scan to enable the specialist to have a closer examination of the inside of their ear and brain.

There is currently no cure or single treatment for tinnitus that works for everyone. However, research is continuing into finding an effective treatment. If an underlying cause of your tinnitus has been found, then treating the cause effectively could help improve your tinnitus. For instance, removing earwax build-up. However, if the cause of your tinnitus remains unknown, then treatment will be focused on helping you to effectively manage the condition and daily symptoms. This may include:

Sound therapy: This uses external sounds to distract you from the tinnitus sounds. It can be very effective in making the symptoms less noticeable. There are different devices available that use a combination of masking, distraction and familiarisation to ease symptoms. This could be in the form of a tabletop device or small device that fit in the ear and play music, white noise, nature noises or other ambient sounds. This can help to mask your internal tinnitus sounds.

Behavioural therapy: This focuses on your emotional reaction to tinnitus. Several forms of behavioural therapy have been found to reduce tinnitus-related stress, anxiety and depression while improving a person’s overall quality of life. Some of the techniques involved include:

• Cognitive behavioural therapy
• Mindfulness-based stress reduction
• Acceptance and commitment therapy
• Tinnitus activities treatment
• Progressive tinnitus management

Tinnitus retraining therapy (TRT) is a type of behavioural therapy that can help to retrain the way your brain responds to the tinnitus. This can equip you with the ability to tune out the sounds and become less conscious of it. This therapy can involve a combination of counselling, sound therapy and wearing a noise-generating device such as a hearing aid for several hours a day. This therapy is not effective for everyone as it does take a lot of time, dedication and hard work to be effective.

Experimental therapies

Research into tinnitus and its treatments have produced several experimental therapies that have so far been promising in clinical trials. Some of these therapies are already used to treat other conditions. For instance, deep brain stimulation (DBS) is already used for movement disorders such as Parkinson’s disease. Vagus nerve stimulation is currently used for certain cases of hard to treat depression and epilepsy. Other cutting-edge tinnitus therapies that may soon become mainstream include:

• Repetitive transcranial magnetic stimulation which involves using a magnet to target and stimulate specific areas of the brain.
• Transcranial direct current stimulation provides a non-invasive and painless brain stimulation treatment that uses direct electrical currents to stimulate certain parts of the brain.
• Brain surface implants are devices that are placed on the brain to stimulate it.

Studies on animals have found that there are nerve cells in the brain called fusiform cells, which send phantom sounds to the rest of the brain. A device that was used to stimulate the brain using electrodes and earphones was tested on 20 humans for around 30 minutes a day for four weeks. The study found that it was possible to control fusiform cell activity with a combination of sounds and mild electrical stimulation of the skin. The volume of the tinnitus did return after one week. However, the patients reported an improvement in their quality of life for several weeks after.