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A sound in your ears or head is a widespread complaint, with approximately 17 to 20% of Australians suffering from some degree of tinnitus, varying from mild to severe.*

As real as the noise may seem to sufferers, tinnitus is a phantom that is hard to pin down. Read on to find out about the triggers and causes of tinnitus and how best to cope with it.

What is tinnitus and how is it identified?

Tinnitus refers to sounds you hear in your ears or head that are not in your external environment. Primarily noticed in quiet environments or late at night, the tinnitus experience is unique to each individual. For some people, these sounds can be mild and for others more severe, with noise so “loud” it may cause distress.
Tinnitus is a development in the inner ear and the brain that 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(s) or head differ from person to person in terms of tone, pitch, volume and level of perception. 
Tinnitus can be a temporary or permanent condition – it may appear in passing phases, in wave-like intervals or be continuous, to the point where it’s hard to ignore. People with hearing loss often experience tinnitus, though many people with normal hearing can experience it as well. Tinnitus may also result in the reduction of general hearing quality, with sounds seeming distorted.
For people suffering from tinnitus, the most uncomfortable time is generally at night when things quieten down, naturally making the sounds seem louder.

What is the difference between mild and severe tinnitus?

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, tinnitus also triggers headaches, earaches, dizziness and muscular tension.

How do I get tinnitus - ringing in the ears?

Even if no-one other than the person affected can hear the noise, tinnitus is neither a hallucination nor an imaginary disorder. How the noise develops however, is still not entirely clear – and 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.

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. 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.

Objective tinnitus
In rare cases (objective tinnitus), 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 sometimes be treated with medication or with surgical intervention.

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

Usually 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 or disappear.

What are the main triggers of tinnitus?

There are a number of factors that contribute to and may trigger tinnitus. These include:
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 issues, or, is a result of traumatic life events, such as a death in the family.
Tinnitus may be a side effect of certain medication. In particular, specific pain and rheumatism medications, remedies for malaria and certain antidepressants may trigger the symptom of tinnitus. It is suspected that various remedies for high blood pressure, such as ACE inhibitors and betablockers, may also trigger tinnitus.
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.

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 ringing, 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. If the noise in your ear lasts longer than 24 hours, you should seek the advice of an expert.

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, though in most cases, it does happen eventually.

For those with chronic tinnitus (symptoms persist for longer than twelve months), the situation is somewhat different and a full recovery is not often possible, but there are strategies available to reduce the intensity of tinnitus such as hearing device, tinnitus sound therapies and relaxation techniques. Psychologists and Counsellors may also specialise in tinnitus and can assist by changing a sufferers relationship with their tinnitus. The most important thing is to obtain a precise diagnosis of the causes of these sound in your ear.

What will happen when I have my first appointment?

The first 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 hearing and speech assessments. By doing so, your professional can then establish whether you also have hearing loss or a disorder of the auditory system.

Hearing solutions and tinnitus

Hearing aids and hearing solutions are helpful for tinnitus treatment and relief.
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 and assists by causing the constant ringing to be muffled. In fact, patients with chronic tinnitus can experience great relief when fitted with a hearing device.
Phonak Paradise
Sennheiser MOMENTUM True Wireless 2 earbuds.

Wireless earbuds can also provide hands-free access to tinnitus masking apps.

Tinnitus masking apps are available for both Android and Apple phones. These apps allow you to customise sounds, such as ocean or forest noises. These sounds help by concealing your tinnitus and providing relief by making it less audible. To stream the sound from your phone or tablet, we recommend the Sennheiser MOMENTUM True Wireless 2 earbuds. These lightweight earbuds allow clear streamlining and have additional features, such as transparent hearing, which enable you to still hear sounds from the environment around you so you stay connected.

Alternatively, Phonak Lyric is a 100% invisible hearing solution 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).

While traditional hearing aids capture and process sound outside of the ear, Lyric uses the natural anatomy of the ear to amplify and give you a full, natural listening experience. Users experience greater clarity and better high frequency sound perception than some other hearing aids.
Phonak Lyric

Other tips for dealing with tinnitus

You can help mitigate the effects of tinnitus by developing healthy routines:
  • Reduce stress and find a relaxation technique that suits you (autogenic training, yoga, tai chi, etc.);
  • ​Retrain your brain to ignore tinnitus – this requires a combination of sound enrichment and counselling to help alleviate negative reactions to tinnitus;
  • Avoid smoking keep alcohol consumption to a minimum;
  • Maintain a healthy diet;
  • Lead an active lifestyle and exercise regularly outdoors. Physical activity helps to reduce stress and distracts you from the noises in your ear;
  • Get enough sleep - well-rested people will experience chronic tinnitus less intensely;
  • Choose activities that you enjoy - this also 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;
  • Don't hesitate! Book an appointment with a Hearing Care Professional at the first signs of tinnitus –  because the sooner you seek advice from a professional, the sooner you can be treated with a suitable therapy.

Tinnitus sound therapy can also be useful when wanting to distract yourself from hearing tinnitus, or when you’re trying to sleep. Surrounding yourself with pleasant sounds, such as music, nature or ocean can help distract you from the ringing in your ears – websites such as https://mynoise.net/ can help; there are also apps that can help.
It's important to remember that if your tinnitus is really bothering you and having a serious impact on your life, see your doctor or a hearing care professional as soon as possible. They will be able to talk you through the next steps and find a solution that will work best for you. It’s also important to remember that tinnitus is a common problem, so you are not alone. For more information and to book in for a tinnitus diagnosis, make an appointment with a hearing specialist today.
*Department of Health, State Government of Victoria, Australia.
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