The word 'tinnitus' comes from the Latin word
for 'ringing' and is the perception of sound in the absence of
any corresponding external sound.
Cause
Tinnitus is not a disease or an illness but a
symptom generated by the person's own auditory pathway usually
caused by a disease or condition of the ears but this is not
always the case.
Causes can include;
- Noise induced hearing loss by sustained loud noise (factory)
or sudden noise (gunshot)
- Age related hearing loss
- Outer/middle ear issues; excessive ear wax, Eustachian tube
dysfunction, foreign bodies
- Sinus Pressure/Barotrauma; diving, flying, sinus infection,
concussive explosion
- Ménière's Disease
- Ototoxic drug side effects, some antibiotics, diuretics,
quinine based or non-steroidal anti-inflammatory drugs
- Mental health disorders; stress, anxiety or depression
- Metabolic disorders; hypothyroidism, hyperthyroidism,
anaemia or hormonal changes
- Autoimmune disorders; Lyme’s disease, fibromyalgia
- Cardiovascular disorders, high blood pressure,
atherosclerosis
- Head/neck trauma
Investigations
Although NICE guidelines specify their guidance this is most commonly:
- Thorough Clinical History
- Otoscopy - looking in ear canals
- Tympanometry -
check middle ear pressures and movement of the ear drum
- Audiometry - hearing test
- Loudness Discomfort Levels - No real
usefulness as usually makes patients more anxious
- Tinnitus Matching - No real usefulness except
to validate a patient's perception of the tinnitus.
Presentation
This noise may be heard in one ear, in both
ears or in the middle of the head or it may be difficult to
pinpoint its exact location. The noise may be low, medium or
high‑pitched. There may be a single noise or two or more
components. The noise may be continuous or it may come and go.
It may also vary in intensity, see tinnitus spikes below.
Treatment
There is no known cure for tinnitus but the
following have been shown to help:
- A good explanation of the condition - a form
of counselling
- Reassuring the person that it is a symptom of
a condition - patient feels less anxiety when they are believed
and understood
- Various forms of counselling such as medical,
private, lay or group counselling
- Cognitive Behavioural Therapy has been shown
to be most effective
- Tinnitus Retraining Therapy
- Hearing Aids, restore lost hearing enabling
environmental sounds and other surrounding sounds to override
the tinnitus.
Management of Tinnitus Symptoms:
Human beings are fully capable of filtering
out meaningless sounds and other sensory perceptions with a
process called mental habituation. The problem lies in that the
brain highlights important or new sounds that it subconsciously
considers dangerous or problematic. So instead of ignoring the
tinnitus we end up in a fight or flight situation that doesn’t
ever end because the tinnitus doesn’t ever go away. If we allow
negative thoughts, anxiety (about the tinnitus), frustration or
anger to constantly accumulate we end up in a vicious circle
where the tinnitus seems worse because of these negative
connotations which then makes the tinnitus seem worse and so on.
Mindfulness physical relaxation or breathing techniques can
assist with reducing these negative thoughts and reduce stress.
Counselling, Sound therapy and distraction
are the commonest forms of management for tinnitus symptoms.
Counselling, in the form of Cognitive Behavioural Therapy, is
not always readily available but has been shown to be very
effective in managing tinnitus. Sound therapy uses sound to
provide an alternative auditory stimulus to distract a person
from their tinnitus, it is also known as 'sound enrichment' as
it aims to replace the disturbing tinnitus with a more soothing
sound that is less abrasive to a person.
Examples of these could be something as
environmental sounds such as the sound of rain or rushing water
or it could be relaxing meditation type music. Examples of both
can be found by searching the internet for things like:
Tinnitus – Rain
Tinnitus – Waterfall
Tinnitus – Relaxation
Tinnitus – Sleep Music
Distraction, not just with alternate sounds,
but involving as many other senses as possible will increase the
chance of success in mitigating tinnitus symptoms. Examples of
multi-sensory distractions are:
- Listening to environmental sounds in a hot
bath with a scented candle
- Listening to a podcast whilst
exercising/walking in the countryside
- Listen to music whilst playing a game on a
phone/tablet
Products
There are certain commercially available
Sound and Noise generators (also called Tinnitus relaxers). They
can be sourced on general shopping websites (such as
Amazon.co.uk, etc), Tinnitus dedicated websites
(Tinnitus.org.uk, etc) or Hearing Aid shops (like
deafequipment.co.uk). These can take the form of:
- Wearable items like hearing aids but produce
white/pink/environmental noise instead.
- Bedside or desktop generators that play a
soothing sound
- Sound Pillows, these have speakers inside
that either play white noise or are connected to bedside
generators.
Rehabilitation / Habituation of Tinnitus
Symptoms
There are applications for smart phones that
have been made specifically to alleviate and help rehabilitate
the tinnitus symptoms and these are generally available for free
from the leading hearing aid manufacturers or from other
companies that may include inApp purchases.
Some examples of iOS/Android applications:
Manufacturer
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Oticon Tinnitus Sound
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Phonak Tinnitus Balance
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Resound Tinnitus Relief
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Beltone Tinnitus Calmer
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Widex Zen - Tinnitus Management
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Starkey Relax
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There are many other applications for Tinnitus rehabilitation but many require InApp purchase or subsciption plans, such as Endel and Headspace. The British Tinnitus Association produced an article on their thoughts, this can be found at BTA Mobile Apps
The principle of using sound-therapy products
is not to block out the tinnitus completely but use
the different sounds to distract your brain from focusing
in on it. This will help your brain's filtering
system learn to 'ignore' the tinnitus sounds, so you are no
longer overly aware of them and eventually habituate or
acclimatise to the tinnitus.
Tinnitus Spikes
Although tinnitus symptoms should remain consistent, unless the
hearing degrades, the perception of the tinnitus sound can vary
and should over time become less noticeable due to habituation.
Sometimes it changes for the better but often it will appear to
intensify and become worse, usually temporarily. This is known
as a tinnitus spike.
Tinnitus spikes are unavoidable and not an
indication of a worsening of the condition. Once the underlying
psychology and causation of the tinnitus spikes are understood
you will become more resilient and confident during these
difficult times. Tinnitus spikes are usually related to a
combination of internal and external factors, it is key to try
and figure the cause of the spike.
The commonest cause is stress, anxiety and
sleep deprivation. These three causes will exacerbate any health
problem. There is much research on triggers for tinnitus spikes,
some of the research is strong and evidence based, others are
from small studies and each listed trigger may or may not be
relevant to you. Listed below from strongest evidence to weakest
are common triggers:
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Stress / Anxiety
Sleep deprivation
Certain noises
Loud noise
Dehydration
Certain medications
Supplements and vitamins
High Sodium diet / High sugar diet
Caffeine / Nicotine
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Alcohol
Recreational drugs
Food sensitivities
Allergies
Pollution
Temporomandibular joint disorder
Weather / barometric changes
Extensive air travel.
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A tinnitus trigger will vary in how long
it will last, if you can source and eliminate the trigger
then the intrusive symptoms will reduce sooner. Identifying
the tinnitus trigger is not necessary for coping or
habituation.
There is no perfect fix and you may have
to endure some degree of discomfort. It can be useful to
grade tinnitus on a 1-10 scale with 10 being the worst. If,
during a severe tinnitus spike, you grade it at 10, there is
little chance of reducing the discomfort to 1. Putting on
background sound may reduce the discomfort by a few points,
so you are still at 7 or 8. Introducing other tools, like
mental relaxation or breathing exercises may reduce it by
another point or two. Speaking with friends, playing a game
or exercising may reduce it by a few more points. Even with
all these strategies you may just reduce it to 5 on the
scale but 5 is much better than 10.
Further Information
The following websites may provide more
information:
https://takeontinnitus.co.uk/
https://www.tinnitus.org.uk/
