What’s that Racket Inside My Ears?

September 30th, 2014 by Sharon Macner, Au.D.


headache

You are not alone

If you suffer from the sound of what is commonly called “ringing in the ears,” you most certainly are not alone. In fact, 50 million Americans report tinnitus — that’s the term that describes the noise that people hear in their ears that others cannot hear.

In addition to ringing, tinnitus is also commonly described as sounding like crickets, hissing, frying, static, humming, buzzing, roaring, or can be just plain hard to describe! Tinnitus is prevalent in persons who have made their living or have had their fun around noisy equipment and/or toys. In fact, noise exposure is by far the greatest contributor to tinnitus. Working around farming or heavy equipment, use of small machinery such as chainsaws and power tools, and firearms can all increase the risk of having tinnitus. On the other hand, a smaller percentage of persons with tinnitus report a negative history of noise exposure. For them, the tinnitus may caused by another non-metabolic source, such as head trauma, or is induced by a substance the individual has taken at some point in life.

Medical causes of tinnitus

Tinnitus can also be caused by a variety of medical causes, with diabetes being the most common metabolic cause of tinnitus. Other contributors of tinnitus include hypertensionhyperthyroidism; drug induced, cardiovascular diseasezinc deficiencyotosclerosis; impacted earwax; anemia; and, rarely, auditory tumors.

If you have tinnitus and you are not greatly bothered by it, then, in a way, you can count yourself fortunate. For you, the perception of the tinnitus doesn’t greatly affect you mood or your sleep patterns. When it’s there, you would prefer that it not be there, but you can shift your attention away from it and carry on with life without additional effort.

However, of the 50 million individuals who report tinnitus, about 15 million report it to be bothersome enough that that it affects their lifestyle, including disrupting sleep, concentration, and attempts to relax.  This tinnitus sufferer is bothered enough by the noise that the individual tends to talk, or shall I say, complain, about it to a spouse, family member, or loved one. In fact, the person they are complaining to is nearly as tired of hearing about it as the affected person is of hearing it. Many tinnitus sufferers in this category report that their tinnitus causes them to feel stressed, irritable, unable to focus, may disrupt sleep, or just plain makes it difficult for them to relax in a quiet room.

Unfortunately, some individuals with tinnitus are severely bothered by it — around 2 million Americans. These are individuals who report that their tinnitus is severe enough that it is debilitating to them. The tinnitus tends to have some degree of control over this individual’s behavior or mood, and the affected person has increased difficulty shifting their attention away from the tinnitus. Psychometric tinnitus measures place this patient in the “severely affected by the tinnitus” category. Also seen with some patients in this category is the emergence of intolerance for loud sounds, or even the strong dislike for certain sounds. This is generally known as hyperacusis, which is treated prior to treating the tinnitus.

Regardless of whether the individual affected by tinnitus is coping well with it or finds it debilitating, the questions and concerns regarding the tinnitus are usually the same: What caused my tinnitus? Do I have a life threatening condition? Am I going to lose my hearing? Will it get worse? And, what can I do to get rid of it? Finding answers to these questions is not always easy. Many persons affected by tinnitus have already heard these words: “Nothing can be done about it,” or “You need to learn to live with it.” In fact, many individuals with tinnitus do not contact their physician or seek out the help of an audiologist because of the widespread belief that tinnitus cannot be treated. Fortunately for the tinnitus sufferer, tinnitus can be treated. A review of current tinnitus treatments and reported clinical outcomes reveals that tinnitus treatment is effective — and in the majority of patients, is quite effective and can alleviate the impact that tinnitus has on the patient’s quality of life.

Tinnitus treatment

Treatment is most effective when a multidisciplinary approach is taken, that is, when the treatment focuses on reducing both the patient’s perception of the tinnitus as well as their reaction to the tinnitus, and includes both the audiologist and the physician. Coordination of tinnitus treatment can be housed either in an audiology practice or in an otology practice. The audiologist, or Doctor of Audiology (Au.D.) who has elected to receive advanced training in tinnitus treatment is responsible for targeting the maladaptive changes that have occurred in the patient’s auditory processing center of the brain as well as redirecting or reducing the emotional reaction to the tinnitus. The audiologist will conduct comprehensive hearing and tinnitus evaluations, which include such measures as pitch and loudness measures of the tinnitus and minimum masking levels required to cover the patient’s tinnitus. The audiologist also administers and interprets the psychometric tests used to measure any tinnitus related impact on daily living. Once the tinnitus evaluation is conducted and the psychometric data is interpreted, the audiologist maps out the tinnitus treatment. Sound therapies, which may be recommended, can include ear-level tinnitus or combination tinnitus and hearing aid devices aimed at reducing the contrast between the patient’s hearing level and their tinnitus, which is necessary to reduce the strain that the brain creates trying to hear well. This strain on the brain to receive sound where absence of sound exists is the source of most patients’ tinnitus. The audiologist may also recommend sound therapy systems for sleep, which may include a bedside tinnitus devices or a sleep therapy sound pillow.

Cognitive behavioral counseling is implemented by the audiologist to decrease the awareness of the tinnitus. If the patient’s tinnitus reaction is severe, or if the tinnitus is exacerbating the patient’s major depression or anxiety, a psychologist becomes an important member of the tinnitus team. The brain of the tinnitus sufferer has already labeled the tinnitus as important, further activating the autonomic nervous system and the limbic system whenever the tinnitus is perceived. The instructional counseling provided is based on the individualized correlation of subjective and objective measures taken at the tinnitus evaluation.

The patient’s physician (M.D. or D. O.) or health care practitioner (P.A. or N.P.) is responsible for conducting the review of the patient’s medical, family, and psychosocial history, including current medications, and will recommend medical interventions as necessary. The physician, who may be an otologist (specialist of diseases of the ear), may order imaging scans to further isolate the cause of the tinnitus.

 So, what exactly is that racket?

Generally speaking, it is a neurological response that the higher level auditory centers of the brain issue in response to deprivation of sound. The reaction that the person has to the tinnitus is influenced by the autonomic nervous system and the limbic system. If treated correctly, the loudness of the tinnitus can almost always be reduced along with the impact that the tinnitus has on everyday function.  Using current treatment methods, there is good prognosis for improving the quality of life for the tinnitus patient. Furthermore, the investigation into tinnitus is as strong as ever, with ongoing research into new methods of treatment.  “Nothing can be done” often isn’t the final answer.

Sharon Macner, Au.D.

About Sharon Macner, Au.D.

Dr. Macner of Champlain Valley Audiology, Plattsburgh, NY is licensed as an audiologist by the New York State Department of Education and is also licensed as a Hearing Aid Dispenser by the New York State Department of State. She maintains certification by the American Speech-Language-Hearing Association and maintain fellowship with the American Academy of Audiology.