Tinnitus
Tinnitus and Hyperacusis
Tinnitus is the perception of sound in the absence of a corresponding external sound. Many individuals experience a ringing sensation but tinnitus can also be perceived as a hissing, crackling, crickets, or roaring sound. Tinnitus is very common with an estimated 40-50 million Americans experiencing it on a regular basis. Of these, about 1 in 4 find the tinnitus has a significant or disabling impact on their daily life.
Hyperacusis often occurs along with Tinnitus (although it can exist independently). Hyperacusis is an increased sensitivity to the loudness of everyday sounds. Individuals with hyperacusis often avoid certain environments because of the loudness of sounds and noises encountered. Some individuals wear earplugs throughout the day. The same physiologic mechanisms that can lead to tinnitus can also lead to hyperacusis, one reason these conditions often co-occur.
What Causes Tinnitus?
This is the most common question posed by tinnitus sufferers. In some cases, the tinnitus is associated with a medical issue such as a lesion on the hearing nerve, Meneire's Disease, TMJ, circulatory issue, etc. Tinnitus commonly occurs along with hearing loss. Therefore, a medical evaluation by a physician and a comprehensive audiologic evaluation are recommended when someone is suffering from tinnitus.
In most cases, however, there is no specific anatomical problem or illness causing the tinnitus that is then treated with medication or surgery. Fortunately, our understanding of tinnitus and hyperacusis has increased significantly over the past decade and there is an emerging consensus on the physiologic nature of these conditions.
Your ears are connected to your brain. This may seem like a simple concept, but we often associate any hearing difficulty, including tinnitus, with a problem in the peripheral auditory system (i.e., your ear canal, middle ear, or inner ear). The peripheral auditory system takes an acoustical signal and changes it to an neural signal that can be passed along by the central auditory nervous system to your brain. An important part of the brain associated with hearing is the auditory cortex. Other parts of the brain are involved as well. Suffice to say, the entire auditory system is very complex and things can go awry at different levels of this system.
Most individuals have experienced occasional tinnitus at some point in their lives. Occasional tinnitus is analogous to a nervous "twitch". Something that happens occasionally and is caused by spontaneous activity in the nervous system. In one classic study, individuals with normal hearing were placed in a soundproof booth for an extended period. No sounds were presented while they were in the room. Yet when asked if they had heard anything, most of the participants reported "hearing" a variety of sounds.
There are several theories on why persistent tinnitus develops in certain cases and why the impact varies from person to person. One aspect that most researchers agree on is that tinnitus involves both a neural and a perceptual component. There is often a trigger event that precedes the perception of chronic tinnitus.
This can happen after exposure to a very loud noise or blast when there has been some damage to the auditory system. Onset is not always associated with an acoustic trauma, however. Perhaps you had very soft tinnitus that was not typically noticeable. You then get an ear infection or bad cold and become "stuffed up". This makes the tinnitus louder in the same way that plugging up your ears makes your own voice sound louder. Once you start tuning in to the tinnitus, it may not go away once the infection or cold clears up.
For other individuals, tinnitus comes on gradually and progresses over time. This often occurs in conjunction with progressive hearing loss. Your auditory system is organized in such a way that different pitches are processed in different areas. Let's say you have a significant hearing loss for higher pitched sounds. The part of your brain that processes higher pitched sounds receives less information as the hearing loss progresses, especially if the individual is not wearing hearing aids. The brain starts to look for the "missing sound". This can lead to hyperactivity in the hearing part of the brain and can be a factor in the perception of tinnitus.
How an given individual reacts to the tinnitus is just as important, if not more important, than what caused the tinnitus to begin in the first place. The reaction has implications for what the impact will be on daily life. As you tune in and notice the tinnitus more, a feedback loop can be created. You notice the tinnitus and know it should not be there. Stress level can rise and adrenaline associated with the "fight or flight" response can kick in. All this contributes to the negative emotional response. Individuals who do not experience tinnitus may have difficulty understanding why you can't just ignore it. That like asking someone not to picture the color red. It will probably be the first color their mind conjures up.
In this video, Dr. Robert Sweetow explains the relationship between tinnitus perception and emotional response: To People Suffering From Tinnitus
You do not have to just "live with" your tinnitus.
There are a number of options available that significantly reduce the impact of tinnitus in a majority of sufferers. While there is no cure, tinnitus can be managed in the same way that chronic pain can be managed.
We recommend the following steps be followed:
STEP 1: Talk with your physician about your tinnitus. He or she can assess if there are any medical issues that may be causing your tinnitus. Make sure to mention if your tinnitus began or became worse after you started taking a certain medication. Your physician may refer you to an ear specialist (Ear, Nose, and Throat doctor). You should have you hearing tested as well since hearing loss and tinnitus typically co-exist.
STEP 2: Treat any underlying problems known to be associated with tinnitus such as Temporomandibular Joint Dysfunction (TMJ) or hearing loss.
STEP 3: Modify or reduce any activities that make your tinnitus worse. Stress often increases the perception of tinnitus. For some individuals, excessive caffeine or alcohol consumption can increase the tinnitus. While one glass of wine can be relaxing, and actually reduce stress (and the tinnitus), one bottle might have the opposite effect!
If after going through the above steps your tinnitus continues to have a disruptive impact on your daily life, you should consider undergoing treatment specifically designed to address the tinnitus perception. There are a number of approaches that can be taken and, depending on the severity of your tinnitus, you may work with a team of professionals.
At the East Penn Hearing Center, we provide counseling and several sound therapy options to address tinnitus. What approach will work best for you depends on the severity of your tinnitus and whether or not you have hearing loss as well.
Sound Therapy Options for individuals with hearing loss
For individuals with both hearing loss and tinnitus, the first step is to treat the hearing loss. Many individuals mistakenly believe that the tinnitus is what is causing their hearing difficulties. In most cases, however, it is hearing loss that is allowing the tinnitus to be so noticeable. Hearing aids provide two benefits. First, softer sounds in the environment will be heard again and this typically makes the tinnitus less noticeable. Second, by amplifying sound the brain becomes less "starved" for auditory information and there can be a reduction in the level of the tinnitus over time. For many individuals, using hearing aids leads to a signficant reduction in the severity of their tinnitus.
If amplification alone does not provide tinnitus relief, the next step is to combine sound therapy with amplification. Many hearing aids now have the capability to also produce sounds that are meant to alter the perception of the tinnitus. The sound can be a noise like signal or can be more musical in nature, much of this depends on the user's preferences. As with other sound therapy options, benefit is typically obtained over a period of time and the goal is to achieve a reduction in the severity of the tinnitus. In some cases, the tinnitus may go away for extended periods of time even when the instruments are not worn.
How well do these approaches work?
There is a large and growing body of research on the effectiveness of using sound therapy as part of a tinnitus management program. Success rates, defined as a significant reduction in the perception of the tinnitus, typically range from 60-90%. No single approach has been shown to be the best. That is why we offer several options and always provide a trial period in order to determine which approach is best for a given individual. The key is to combine sound therapy with appropriate counseling in order to maximize the potential for success.
I'd like to have a tinnitus evaluation, what's the next step?
Please call the office to request a tinnitus evaluation. You will need to have your hearing tested if you have not had a test within the past six months. If you have had your hearing tested recently, please arrange to have the results forwarded to our office. We may need to get a referral or script from your physician for the tests to be covered by insurance. Hearing tests are generally covered. Medicare generally covers a tinnitus evaluation, coverage varies for other plans. We are happy to check on your coverage prior to your visit.
For the tinnitus evaluation, you will be asked to complete some questionnaires regarding your tinnitus. We will ask about any treatments you may have tried in the past. We will perform some tests in a soundbooth where you will be asked to judge the loudness and pitch of your tinnitus. Depending on the results of the hearing test and tinnitus evaluation, possible options will be reviewed. Depending on the option chosen, we may be able to provide an instrument(s) that day or a second visit may be required. You should expect to complete several follow-up visits during any trial period.