Tinnitus (pronounced tin-night-is or tin-it-is) is the perception of ringing, hissing, buzzing or other sounds in one’s ears or head when no external sound is present. Different folks describe different sounds–ranging from running water, sizzling, buzzing, and humming–to the sound of escaping air or the noise inside a seashell. In my practice, “crickets” seem to have the lead at present. It’s a common condition–ranging from a minor nuisance to a variably disabling problem in different individuals. In the United States alone, it’s estimated that 12 to 15 million people consider tinnitus to be a distressing and life-altering condition. So, lend me your ear, and I’ll tell you more about this common problem. . .
Tinnitus is not a medical diagnosis, but rather a symptom. It’s believed (but not proved) that the underlying phenomenon in tinnitus may be spontaneous activity in the part of the ear called the cochlea. The majority of people with tinnitus are between the ages of 40 and 80–with prevalence increasing with age. Although the precise physiologic explanation of tinnitus is not known, we do know that some factors and other medical conditions can trigger or worsen tinnitus. The list includes: noise-induced hearing loss, ear and sinus infections, certain tumors in the head and neck, thyroid disease (either overactive or underactive thyroid), hypertension and/or other cardiovascular diseases, jaw misalignment, wax build up in the ear canal, certain medications (e.g. aspirin in high doses), and head and neck trauma. Although the list is extensive and somewhat scary in it’s spectrum of possible associations, exposure to loud noises is by far the most likely cause of tinnitus. In fact, up to 90% of all tinnitus patients have some level of noise-induced hearing loss.
What worsens tinnitus? Certainly, exposure to loud noises. . .esp. if such exposures are repeated over time, can have a cumulative effect on tinnitus. Occupational exposures in factories, auto repair shops, and airports for example can negatively impact hearing over time and worsen tinnitus. Remember, that home exposures such as lawn mowing, and even regular use of hair dryers can generate hearing problems. Regular attendance at Rock Concerts, or standing near your teenager’s room for extended periods of time as their radios and CD players blare are other potential hearing hazards. So ear plugs and/or ear muffs really can help to decrease the sound exposure risks. You just have to get over the stigma of looking like a nerd in such settings.
Foods and beverages can also worsen tinnitus. Alcohol, caffeine, and nicotine are all associated with worsened symptoms. Apparently, high-sugar content foods and quinine (e.g. tonic water) can aggravate tinnitus in some folks as well. So, if these factors ring true with you, work on balancing your intake to minimize symptoms. Of course, nicotine comes from tobacco products, and it worsens tinnitus by constricting blood vessels (and thereby blood flow) to the ears and brain. Since it also promotes heart disease, lung disease and a host of cancers as well. . .a little ringing in the ears is only icing on the cake of health consequences. But, because it’s a nuisance to hear constant chirping, hissing or buzzing, sometimes tinnitus is just the impetus smokers need to kick the habit!
Although psychological or emotional problems can be associated with tinnitus, it is a real medical condition. . .not imagined. However, it is true that most people with the condition realize that stress, increased tension, and fatigue all seem to aggravate the intensity of symptoms. There seems to be a weak imbalance in the auditory nerve impulses in tinnitus patients. This imbalance is detected in the cortical and subcortical areas of the brain where signals to the emotion-generating parts of the brain are created. As a result, negative emotions and the annoyance components of tinnitus are stimulated. One’s emotional reaction to the tinnitus can ultimately lead to more debility than the low grade ringing itself. Consequently, habituation-oriented therapy (also known as Tinnitus Retraining Therapy) is one method used to treat patients. Through a combination of directive counseling and the use of low-level sound generators, this type of therapy helps to diminish both the perception of tinnitus by the brain and also the negative emotions associated with the problem. Though the therapy generally takes 18–24 months, the majority of patients experience a decreased awareness of tinnitus and definitely decreased annoyance with the ringing over time. Basically, one trains the brain not to recognize and be annoyed by the noise. TRT can be a helpful treatment for anyone whose quality of life is compromised by tinnitus.
So, if you’re bugged by this fairly common problem, see a doctor. You will be evaluated for the various medical problems that might be associated with this condition, and should have a thorough ear, nose and throat exam as well as a hearing assessment. Once your symptoms have been evaluated, you can be advised on a specific tinnitus treatment regimen. Strategies include use of various medications, lifestyle and complementary interventions, and possibly surgery if warranted by underlying problems. Acupuncture, herbs (including Ginkgo Biloba and garlic), antihistamines and tranquilizers, biofeedback, self-hypnosis, and sound-masking techniques have all been used with varying success. You’ll find the correct mix of therapies for yourself through trial and error. So, I hope I leave you with your brain (not your ears) buzzing with lots of new and helpful information this week!
Stephen L. Hines, M.D.