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Tinnitus

Tinnitus: symptoms, causes and treatment

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A ringing or buzzing in the ears is a widespread complaint. A whistling, ringing, or buzzing sound that seems to come from nowhere affects one in two people at some point in their lives.

A ringing or buzzing in the ears is a widespread complaint. A whistling, ringing, or buzzing sound that seems to come from nowhere affects one in two people at some point in their lives. One in five people develop chronic tinnitus.

As real as the noise may seem to sufferers, tinnitus is a phantom that is hard to pin down. It typically starts not in the ear, but in the brain. Find out about the triggers and causes of tinnitus, and how best to cope with it.

Overview:

Is tinnitus harmful?
Will I lose my hearing?
What are the main triggers of tinnitus?
How can tinnitus be prevented?
What should I do if I’m affected by tinnitus?
What will happen when I have my first appointment?
Tips for dealing with tinnitus

What is tinnitus and how is it identified?

Tinnitus is a phantom noise without an external sound source. Its development in the inner ear and the brain remains a mystery to the medical community. The only thing we do know is that it’s not an illness, but a symptom.

The sounds in the ear differ from person to person in terms of tone, pitch, volume and level of perception. Sometimes it is perceived in one ear, and sometimes in the very center of the head.

It may appear in passing phases, in wave-like intervals or may be continuous – and you can never forget that it’s there. People with hearing loss often experience tinnitus, but many people with perfect hearing also have the condition.

One of the most uncomfortable times for sufferers is at night when things quiet down and the sound seems louder. This condition will also mean that general hearing quality is reduced and many sounds may seem distorted.

Is tinnitus harmful?

Purely from a medical perspective, no; however, permanent exposure to noise may still affect you. Some people affected feel that their tinnitus is never-ending, it disturbs their concentration during the day and creates difficulty sleeping at night.

woman receives hearing consultation with audiologist for tinnitus treatment

If the noises you are experiencing are significant and incessant, this can set off a cycle of emotional reactions, from frustration and hopelessness, to stress and anger.

Affected persons are therefore almost constantly aware of their tinnitus.

But not all those affected by tinnitus feel severely afflicted by the noises in their ears. There is therefore a difference between mild tinnitus and severe tinnitus.

Couple with audiologist tinnitus consultation

Difference:

Mild tinnitus

Mild tinnitus is described by those affected as not particularly intrusive. Ideally, they can block out the noise and be unaware of it most of the time.

Severe tinnitus

Severe tinnitus is always present and can cause high levels of physiological strain. It has a direct negative impact on quality of life. Severe levels of tinnitus can cause insomnia, stress, anxiety, depression and social isolation. In some cases, the phantom noise also triggers headaches, earaches, dizziness and muscular tension.

Will I lose my hearing?

Tinnitus isn’t a disorder itself, but a result of hearing loss. While the majority of people with tinnitus can hear normally, it can create temporary or permanent hearing loss in some people. Because tinnitus is generally linked with hearing loss, it doesn’t mean that you will automatically lose your hearing. If you’re concerned, you should see a doctor or ear specialist, or book an appointment for a hearing test.

middle aged couple enjoy life with hearing aids

How long does tinnitus last?

Tinnitus may occur briefly, then immediately disappear again. It may remain for several months, or last a lifetime. Generally, medical professionals distinguish between three forms:

Acute tinnitus

Persists for less than three months, and often stops spontaneously. Treatment with medication may sometimes help in this case.

Subacute tinnitus

Always recurs within three to twelve months. Treatment with medication and/or relaxation exercises may improve the condition.

Chronic tinnitus

The symptoms persist for over twelve months, and only rarely subside without medical intervention.

How do I get tinnitus?

Even if no-one other than the person affected can hear the noise, tinnitus is neither a hallucination nor an imaginary disorder. But how the noise develops is still not entirely clear. Although there are various theories, none have been proven.

What is known is that only in rare cases do these annoying noises in the ear occur for no reason at all. The most common causes of tinnitus are injuries, illnesses and anatomical changes

These are the main causes of tinnitus:

Inner ear

Tinnitus may develop in the inner ear due to an acoustic trauma, acute hearing loss or age-related hearing loss. Scientists suspect that, after damage to the sensory cells in the cochlea, certain sounds are only faintly transmitted to the brain, or not transmitted at all. The auditory response area in the brain then tries to compensate for the missing frequencies by "turning up the volume“ – even if the person is not hearing that sound at all. Therefore, it has been calculated that the sound of the tinnitus ironically often corresponds to those frequencies that the person affected has difficulty hearing, or can no longer hear at all.

Middle ear

In the middle ear, the trigger may be a defective eardrum . Inflammation is another cause. Subjective tinnitus cannot be measured externally. This makes it very hard for a professional to determine the specific trigger, thus rendering treatment even more difficult. The cause may originate in different areas of the ear, as well as in the nerves or the brain. Tinnitus may also occur when the auditory canal is blocked.

Brain

In some cases, tinnitus may be due to a malfunction in the brain. In these cases, the tinnitus does not disappear even if the auditory nerve is severed. There are only rarely concrete causes of this malfunction, but sometimes meningitis or a brain tumor can be behind it.

Objective tinnitus

In rare cases of what is known as objective tinnitus, however, the noises in the ear can be measured by a Hearing Care Professional using special equipment. Changes in the blood vessels in the inner ear or damage to the middle ear are usually responsible for the noise in the ear.

Objective tinnitus is usually a side effect of another disorder, for example Ménière’s disease (disorder of the inner ear, with dizziness, nausea and hearing loss). This kind of tinnitus can be treated with medication or with surgical intervention.

Typical characteristics of objective tinnitus:

A noise in a person’s ear that is in time with their pulse indicates vascular constriction in the inner ear. At best, this is just some earwax in the ear canal in the vicinity of the eardrum.
It can lead to a clicking noise in the ear.
If the sound of the tinnitus is linked to breathing, the cause may be a damaged closure of the auditory tube (Eustachian tube). This tube, which is around 4 cm long, connects the ear to the neck and throat area.
Grinding and crunching noises in the ear may occur in the case of disorders and wear of the mandibular joint.

What are the main triggers of tinnitus?

Stress

What was previously just a suspicion has now been confirmed: Stress leads to the development of tinnitus. Studies have shown that those affected by acute hearing loss and tinnitus have more frequently been under severe stress than those without. Tinnitus is frequently linked to chronic, continuous stress due to family and work-related worries – or is a result of traumatic life events, such as a death in the family.

Medication

Unpleasant noises in the ear may be a side effect of certain medication. In particular, specific pain and rheumatism medications, remedies for malaria, and some antidepressants may trigger the symptom of tinnitus. It is suspected that various remedies for high blood pressure, such as ACE inhibitors and betablockers, also trigger tinnitus.

Noise

Excessive strain on your hearing by loud noises is the most common trigger of tinnitus. In this case, time is an important factor: Those who have regularly been in a noisy environment (workplace noise, traffic noise, loud music) for years without suitable hearing protection are at much higher risk of tinnitus. The same applies to those with acoustic trauma.

Stimulants

Some experts think that alcohol and nicotine can lead to the development of tinnitus. It used to be thought that another possible trigger was caffeine, but since then there have been studies suggesting that high caffeine consumption actually lowers the risk of tinnitus.

How can tinnitus be prevented?

Tips for preventing chronic and acute noises in the ear:

Avoid the causes and protect your ears: Avoid excessive noise. Protect your ears if you can’t avoid certain sources of noise at your workplace or in your free time. Use earplugs or special headphones.
Avoid excessive stress: Stress promotes the development of unpleasant noises in the ear. It’s better to take things down a gear than to completely break down one day.
Don't hesitate! Go straight to your Hearing Care Professional at the first signs of tinnitus or when it’s acute, because the earlier you seek advice from a professional when you first hear noises in your ear and are treated with a suitable therapy, the better your chances of recovery.

What should I do if I’m affected by tinnitus?

While there is currently no cure for tinnitus, clinical research is constantly being conducted to try and find one. If you suddenly hear whistling, whooshing, or buzzing in your ear, the first step is to stay calm. While tinnitus is unpleasant, it’s not a symptom of a serious illness.

Studies have indicated that tinnitus disappears completely or at least diminishes over time in the majority of cases. This occurs as the brain loses interest in the sound and stops surveying the signal – a process known as ‘habituation’. The amount of time this process takes varies from person to person, but it does happen eventually in most cases.

For those with chronic tinnitus (symptoms persist for longer than twelve months), the situation is somewhat different and a full recovery is usually not possible, but there are treatment options. The most important thing is to obtain a precise diagnosis of the causes of the sound in the ear.

Important: If the noise in your ear lasts longer than 24 hours, you should seek the advice of an expert, because the earlier you do something about acute tinnitus, the better your chances of recovery, and the more likely you are to prevent chronic tinnitus.

What will happen when I have my first appointment?

The first, detailed conversation (often referred to as taking medical history) between you and your Hearing Care Professional is a decisive factor in the diagnosis and treatment of noise in the ear.

During this conversation, questions are asked about pre-existing conditions, possible triggers, and about the intrusive noise itself. Your professional will also try to assess the level of psychological strain caused by the tinnitus.

You should be prepared to answer the following questions:

Do you have any pre-existing conditions?
Do you take any medication?
When did the noise in your ear first start?
Is there anything that may have caused it?
Did the tinnitus begin suddenly or has it developed gradually?
What does the tinnitus sound like?
Was there a potential trigger, such as acoustic trauma, continuous noise, or an unusually stressful situation?

Your professional will then carry out various auditory tests, including a hearing test and a balance test. Your professional can then ascertain whether you also have hearing loss or a disorder of the auditory system.

Lastly, the actual tinnitus analysis is carried out, in which the volume and pitch of the noise in your ear is determined. By doing this, your professional can find out which frequencies the noise covers, and how it can be treated.

Hearing aids and tinnitus

For people with severe tinnitus, or those who already suffer from hearing loss, a hearing aid can make a big impact in reducing the severity of tinnitus. Hearing aids work by balancing the sounds of everyday life like conversations and music which causes the constant ringing to be muffled. In fact, a suggests that patients with chronic tinnitus can experience great relief when fitted with the hearing device. Lyric is a device that can be worn for months at a time and does not need to be removed when sleeping (when tinnitus is said to be most bothersome).

middle aged man using a hearing aid for his tinnitus

Other tips for dealing with tinnitus

Reduce stress and find a relaxation technique that suits you (autogenic training, yoga, tai chi, etc.).
Stop smoking, as nicotine promotes tinnitus.
Watch what you eat. Alcohol should only be consumed in moderation.
Lead an active lifestyle and maintain regular exercise. Physical activity helps to reduce stress and distracts you from the noises in your ear.
Get enough sleep. Well-rested people experience chronic tinnitus less intensely.
Choose activities that you enjoy. This distracts you from the noises in your ear.
Always wear hearing protection when you are exposed to noise or loud music, but remove them once you’re in a quieter environment.
Tinnitus sound therapy can be useful when you’re trying to sleep. Playing some background noise, such as ocean or rain sounds, can help to create enough environmental noise to help distract you from the ringing in your ears.
You may also need to see a counselor who can help you to manage any stress and anxiety brought on by your tinnitus.

It's important to remember that if your tinnitus is really bothering you and if it’s having a serious impact on your life, see your doctor or an audiologist as soon as possible. They will be able to help you with the next steps and find a solution that will work for you. It’s also important to remember that tinnitus is a common problem and you are not alone. For more information and to book in for a tinnitus diagnosis make an appointment with a hearing specialist today.

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