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What is Tinnitus?

Tinnitus, the perception of sound without an external source, affects approximately sixty million Americans. These individuals report various sounds including ringing, buzzing, whistling, chirping, hissing, humming, roaring, or even shrieking. Tinnitus can be perceived to be steady or pulsatile, in one ear or both, constant or intermittent, and from within the head or from a distance. The effect of tinnitus differs based on the individual with subjective reports including terms such as non-bothersome, manageable, annoying, distressing, and even debilitating. While the symptoms and impact of tinnitus can widely vary, remediation for all sufferers should begin with education about the condition.

What Causes Tinnitus?

While not everyone with tinnitus has hearing loss, it is common for those with a hearing loss to report tinnitus. Those with presbycusis, also known as age-related hearing loss, and noise-induced hearing loss most often report tinnitus.

A blockage in the ear canal can irritate the tympanic membrane (eardrum) and induce tinnitus. Common obstructions include impacted cerumen (earwax) or a foreign object. Fortunately, following removal of the blockage, symptoms typically subside, though it is not uncommon for an obstruction to cause a chronic case of tinnitus.

Somatic tinnitus is related to head, neck, and dental problems. This type of tinnitus is common for those who have experienced a head or neck trauma which disturbs nerves, blood flow, and muscular tissue. Also, individuals with temporomandibular joint (TMJ) disorder report tinnitus, likely because of the shared ligaments and nerves between the jaw and the auditory system. Seeking treatment for TMJ from a dentist or craniofacial surgeon will likely alleviate tinnitus symptoms in these cases.

Fluctuations in pressure caused by sinus congestion or barometric trauma such as flying or snorkeling can cause either a temporary ringing or chronic tinnitus depending on if lasting damage occurs.

Traumatic brain injuries (TBI), particularly in the military and veteran populations, are a major contributor to the onset of tinnitus.

Ototoxic drugs, those harmful to hearing, can cause short-term or permanent tinnitus. In particular, non-steroidal anti-inflammatory drugs (NSAIDs), certain antibiotics, certain medications for cancer, diuretics, and quinine-based medications can be dangerous.

For more information on ototoxicity of drugs check out this resource from the American Tinnitus Association.

When Tinnitus is a Cause for Concern?

For some people, tinnitus extends beyond an irritating ringing sound and becomes debilitating. If you are experiencing tinnitus that impedes sleep, interrupts concentration, or impacts your mood, it is advised that you seek treatment from an audiologist, your doctor, or someone who specializes in tinnitus management.

Treatment

Similar to the reported symptoms and impact of tinnitus, methodologies for treating tinnitus are also numerous and widely vary.

Counseling with a trained professional can be used as a primary means of treatment or to supplement other forms of remediation. During sessions, the emotional impact of tinnitus is discussed in detail and personalized coping strategies are designed. More specifically, success has been found in the use of Cognitive Behavioral Therapy which teaches the patient to react differently to the tinnitus to mollify adverse responses.

Tinnitus Retraining Therapy is used to help the patient get used to his/her tinnitus through sound enrichment therapy which reduces the contrast between silence and the presence of tinnitus. An analogy used to explain this approach is that of a candle in a dark room in comparison to a candle in a fully lit room. A candle in darkness is the focal point of the brain’s attention, while a candle in a bright room is not nearly as noticeable. Similarly, tinnitus in silence can consume one’s attention while tinnitus in the presence of other sounds is not as apparent. Counseling is done in conjunction with this method.

For those with tinnitus and a hearing loss, hearing aids can be helpful as they apply the same habituation principle as Tinnitus Retraining Therapy. By supplying amplification of all sounds, including environmental sounds, tinnitus is less noticeable.

Ear-level sound generators provide a competing signal, such as white noise or nature sounds, that partially cover the sound of tinnitus to provide relief and promote desensitization. Additionally, some patients find the sound to be relaxing.

Support groups facilitated or attended by an audiologist or psychologist can be helpful in providing education and support because they allow those with tinnitus to share their experiences and discuss treatment options that they found helpful.

Stress management techniques such as Biofeedback assisted relaxation to control breathing, muscle tension and heart rate, as well as yoga, meditation, self-hypnosis, and exercise can alleviate tinnitus symptoms, particularly for those whose tinnitus is brought on by stressful events.

Some patients opt for alternative forms of treatment including acupuncture, homeopathy, and herbal remedies such as ginkgo biloba, though there is no research to support these methodologies.


University of Maryland Hearing and Speech Clinic

Individuals suffering from intrusive tinnitus should seek guidance from a trained specialist such as those at the University of Maryland Hearing and Speech Clinic.

Phone: (301) 405-4218

Email: hespclinic@umd.edu


Resources
For more information about tinnitus, check out
American Tinnitus Association

American Academy of Audiology


LinkedIn_RachelRobinsonRachel Robinson is a doctoral student in the Clinical Audiology program in the Hearing and Speech Sciences department at the University of Maryland, College Park. She received her Bachelor of Science degree in Speech-Language Pathology and Audiology from Towson University in 2017. Rachel is interested in working with a variety of populations including older adults, pediatrics, those with cochlear implants, and the Deaf community.


sohns_s_profile

Sarah Sohns is an Assistant Clinical Professor in the Hearing and Speech Clinic at the University of Maryland. Sarah received her Au.D. from the University of Pittsburgh, and was a LEND pediatric fellow; most recently she has been an Instructor at Temple University Lewis Katz School of Medicine.