WHAT IS TINNITUS?
Tinnitus is the clinical name used to describe a sensation of “ringing in the ears”. Other common descriptions of tinnitus include buzzing, chirping, hissing, and roaring. Tinnitus can be an intermittent or constant sound, and it can vary in pitch and loudness. The sound is not heard from an external source, but is generated internally.
Tinnitus appears in a variety of forms and is very prevalent in our modern society. As of 2008 it was estimated that one in five people in the United States suffer from tinnitus and of that number 20%, or over 7 million, have tinnitus in a severe form. Some patients describe debilitating symptoms of anxiety, sleep deprivation, exaggerated startle response, difficulty concentrating, and hyperarousal. In the audiology clinic, these are characteristics that are commonly seen in patients suffering from tinnitus.
CAUSES OF TINNITUS
Tinnitus is often a byproduct of hearing loss, and caused by damage to the inner ear. However, there are many theories regarding the neural mechanisms that cause tinnitus. Some are based strictly on anatomical changes that occur within the organ of hearing, or the cochlea, while others are more comprehensive and include different changes of the somatosensory systems, and the central nervous system. Thus, all tinnitus patients should be examined by an otolaryngologist or otologist.
One of the most common causes of tinnitus is exposure to excessively loud sounds; not only the loud sounds of industry and the work place, but loud recreational sounds as well. Since tinnitus is often exacerbated by loud sounds, all tinnitus patients are cautioned to avoid extremely noisy environments as much as possible.
TREATMENT OF TINNITUS
Although there is no “cure” for tinnitus, many treatments have been developed that have shown great success in tinnitus relief. The most successful tinnitus treatments focus on not only the actual sound that is heard, but the patient’s reaction to that sound such as stress, anger, and annoyance. In many cases these emotional symptoms that occur are the most debilitating part of tinnitus.
There are several treatment options available for tinnitus patients. Research has revealed that all tinnitus patients are different, and therefore not everyone will benefit from the same type of treatment. It is for this reason that we offer a wide range of treatment options, which are described below.
USE OF A HEARING AID
The most common treatment for tinnitus is the use of a hearing aid. Although tinnitus can be present in an individual with normal hearing, tinnitus is often accompanied by hearing loss. When a person is wearing a hearing aid, there is an increase in neural activity on the hearing nerve. This increase leads to more sounds reaching the hearing centers of the brain, which results in better hearing. Research has shown that this increase in activity can also distract the patient from the tinnitus, and while wearing the hearing aid the patient can get some or sometimes even total relief from the sound in their ears. If a patient is suffering from hearing loss and tinnitus, this will often be the first attempt at treatment.
PHONAK TINNITUS BALANCE
If tinnitus relief is not achieved with a hearing aid alone, or if a patient does not suffer from hearing loss, another option for treatment is the Phonak Tinnitus Balance feature in the Audeo hearing aids. It is a combination hearing aid and noise generator that provides a means of sound enrichment. The goal of this tinnitus management technique is to make the symptoms less intrusive and less distressing. The hope is that by providing supplementary noise we can help focus the patient’s attention away from their tinnitus. The Tinnitus Balance noise generator is available in all levels of the Phonak Audeo Q hearing instruments. Within the tinnitus balance program there are options of different sounds, and adjusting the characteristics of that sound to each patient’s needs. It is important to know that masking of tinnitus (arranging an external sound which covers-up the tinnitus) is not the concept behind this device. The research behind this device is the same of that of the use of a hearing aid, creating more activity on the hearing nerve and within the hearing centers of the brain. When the use of a hearing aid by itself is not creating enough relief, using noise in the sound generator can help create the same relief from the tinnitus.
GN RESOUND TS
Another good option for treatment is the Resound TS device. It is also a combination hearing aid and tinnitus sound generator that was developed with the idea to try and break the vicious cycle of tinnitus causing stress, which exacerbates the tinnitus, which then creates more stress on the patient. The sound generator is an ear level device that emits a soft broadband noise, which can be modified for each specific patient based on their tinnitus characteristics. It is important to know that masking of tinnitus (arranging an external sound which covers-up the tinnitus) is not the concept behind this device. The research behind this device is the same of that of the use of a hearing aid, creating more activity on the hearing nerve and within the hearing centers of the brain. When the use of a hearing aid by itself is not creating enough relief, using broadband noise in the sound generator can help create the same relief from the tinnitus.
The ZEN program is integrated into an ear level hearing aid device which can be used along with normal amplification, or used with normal hearing individuals with the ZEN only. Inspired by the relaxing effect of certain types of music, Widex developed Zen tones. Zen is a unique music program available in Widex hearing aids. Based on what is known as fractal technology, Zen plays random, chime-like tones that can be used for relaxation and for making tinnitus less noticeable. Your hearing care professional can adjust each Zen program according to your preferences in terms of pitch, tempo, and volume. Your hearing aid can also be provided with different programs to suit varying situations and purposes. For some hearing aid users the effect of using Zen is immediate, but for most it will take some time. Your hearing care professional will help you set realistic goals and can adjust the Zen programs if needed.
One of the more advanced treatments of tinnitus is with the use of a device called Neuromonics. This is an ear level device with earphones (looks similar to an iPod). This device does not have the capability to be a hearing aid, and is only used as a treatment for tinnitus. Neuromonics is a 5 step program that generally is completed within 6 months. The Neuromonics device emits spectrally modified musical tones, and must be worn for a specific number of hours per day for each step in the process. Research has shown that over time with the use of these musical tones, pathways in the brain can be reorganized to ignore the sound of the tinnitus. For a patient to be successful with neuromonics they must commit to wearing the device the prescribed number of hours for each step, and understand that it is not a quick fix, but over time has the potential to retrain the brain to ignore the sound of the tinnitus completely.
BEDSIDE SOUND GENERATORS
Some tinnitus sufferers only notice their tinnitus in quiet environments, especially while trying to go to sleep. These patients or any patient that has trouble sleeping because of their tinnitus would be a good candidate to use a bedside sound generator. These devices are small tabletop speakers that create soothing sounds, such as waterfalls, rain storms, and babbling brooks. These familiar and relaxing sounds help create a comfortable environment so the patient can sleep or relax without having to sit in silence and listen to their tinnitus.
These treatments provide a combination of the most up-to-date research and technology in tinnitus. It is important for anyone with tinnitus to know that there are treatments available. For more information on these devices, or if you are interested in trying one of these options, please consult with your audiologist.
Information provided by Phonak, GN Resound, Widex, and Neuromonics
What Are the Causes of Tinnitus?
Tinnitus is categorized as being either pulsatile or nonpulsatile.
People who suffer from pulsatile tinnitus report hearing the sound of their own pulse. It is caused by abnormal blood flow within the arteries of the neck or inside the ear, and is fairly rare. Possible causes include:
- Fluid in the Middle Ear
- Ear Infections
- High Blood Pressure
- Head and Neck Tumors
- Blocked Arteries
Nonpulsatile tinnitus – ringing in the ears not accompanied by any type of rhythm – is considerably more common. It can be caused by a variety of conditions including:
- Presbycusis (age-related hearing loss)
- Noise Exposure
- Impacted Earwax
- Otosclerosis (stiffening of the bones in the middle ear)
- Meniere’s Disease
- TMJ Disorders
- Ototoxic Medications
- Thyroid Conditions
- Head or Neck Trauma
- Acoustic Neuromas
Tinnitus is also classified as being either subjective (heard only by the patient) or objective (ringing can be heard by an impartial observer, such as a doctor). Most cases of tinnitus are subjective in nature.
How Is Tinnitus Treated?
Tinnitus can’t be cured, but there are treatments that make it less of a distraction. The approach taken depends on the underlying condition responsible for the ringing in your ears. Sometimes, simple steps like removing built-up earwax or switching to a new medication can markedly decrease symptoms.
Others benefit from noise suppression therapy or masking techniques designed to cover up the ringing noise. White noise machines, fans, air conditioners and humidifiers are all popular, easy to use options.
Tinnitus retraining devices, which rely on patterned tones, are a newer technique that has proven beneficial to many patients.
Call ENT Specialists Of Northern Virginia at 703-644-7800 for more information or to schedule an appointment.