Tinnitus is a perception of sound in the ears or head when there is no external sound present. Commonly referred to as “ringing in the ears”, every individual’s perception of the tinnitus sound will be different. Tinnitus, pronounced as ti-NIGHT-us or Tin-i-tus, can manifest as buzzing, whistling, swooshing, humming, hissing and clicking.
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It is very important to understand that tinnitus is not a disease in of itself but rather a symptom of an underlying cause, usually associated with dysfunction or disturbance in the auditory system. It usually originates from damage to the hair cells in the inner part of the ear (sound organ) or the nerves carrying the sound impulses up to the auditory cortex (hearing center) of the brain. Even if the auditory nerve is severed due to surgery, injury or a medical condition, the tinnitus signal is still perceived. At best, tinnitus is a minor annoyance when tired or stressed, and severely debilitating at its worst.
There Are Two Kinds of Tinnitus
Sounds or noises within the head or ear(s) which are only perceived by the individual. No one else can hear this sound. More than 99% of all reported cases of tinnitus are of the subjective variety.
Sounds or noises within the head or ear(s) which are audible to another individual. These sounds are usually produced internally within the body as a result of circulatory problems (blood flow) or somatic (musculo-skeletal movement) systems. This kind of tinnitus encompasses less than 1% of all tinnitus cases and is quite rare.
Causes of Tinnitus
There can be many potential causes of tinnitus. Each individual experiencing tinnitus should have a full evaluation by an audiologist (to evaluate hearing) and an otolaryngologist (ear, nose & throat) physician to determine the etiology of their tinnitus. Possible causes include1:
Tinnitus Relief Options
“Life isn’t about waiting for the storm to pass, it’s about learning to dance in the rain.” – Vivian Greene
Even though there is no known cure for tinnitus, you can be rest assured that there are various tinnitus relief options.
Listed below are the various tinnitus relief strategies available.
Various sound therapies are available for those with and without hearing impairment. These devices can be wearable on the ears, such as hearing aids/combination devices with customized tinnitus profiles (even those with mild hearing loss can benefit) or devices similar to MP3 players with customized tinnitus profiles. There is also non-wearable therapy such as tabletop sound generators. It is important for all tinnitus and sound sensitivity patients to avoid silence. You must keep your auditory room “brightened” in order to obtain relief from your tinnitus.
The goal of sound therapy is to stimulate the auditory system and draw attention away from the tinnitus. For patients with hearing loss, hearing devices are the treatment of choice. Allowing your brain to adequately hear the sounds you have been missing often helps keep the tinnitus awareness down. There is evidence which suggests hearing-impaired patients report great relief from tinnitus while utilizing their devices. The hearing devices serve to amplify background sounds thereby reducing the loudness and prominence of the tinnitus signal. In addition, hearing devices provide auditory stimulation to the hearing centers of the brain, which can improve one’s ability to hear and follow conversations.
For patients who suffer from reactive tinnitus to loud sounds, hearing protection is a must. Dr. Novick will recommend use of hearing protection in loud environments to prevent hearing damage. You will receive education on the proper and improper use of hearing protection. You can purchase custom-made hearing protection devices from our office. Please mention your interest in obtaining customized hearing protection devices at the time of your initial consultation. Dr. Novick will take impressions of your ears and process an order.
Alleviating stress can do wonders for those who are frustrated and annoyed by their tinnitus. Many people find relief from massage therapy, meditation, prayer and exercise (yoga, cardiovascular, etc.). Stress management is key in facilitating habituation to tinnitus. Dr. Novick will remind you of how poor stress management can lead and create the vicious stress/tinnitus cycle.
We feel that all patients suffering from tinnitus should have a thorough medical evaluation by an otolaryngologist, a physician who specializes in the diseases of the ear, nose & throat. Sometimes, for those patients with TMJ problems, we will refer you to a dental specialist. If our diagnostic evaluation warrants such referral, we will gladly send a report to your current primary care physician and assist in the referral to any of the aforementioned medical specialists. Your physician may discuss alternative treatment options (e.g. acupuncture, homeopathic remedies, vitamins, etc.). However, there is no evidence based research that shows alternative treatment methods have any effect on tinnitus.
Even though we do our very best in helping individuals cope/manage their tinnitus, sometimes we need a little help. In cases where we feel you have significant depression or anxiety, we will assist in a referral to a licensed clinical psychologist who specializes in Cognitive Behavioral Therapy or Mindfulness Based Tinnitus Stress Reduction. Dr. Novick will gladly furnish you with the names of local psychologists who can help and have some experience working with previous tinnitus patients.
Some individuals may receive additional benefit from meeting others with similar experiences with tinnitus. Tinnitus support groups can help you discuss your feelings about tinnitus and learn coping strategies from others. Ask us how to find a local tinnitus support group.
Knowledge is power! Education is a powerful tool in helping you learn about your tinnitus and what you can do to manage it. The American Tinnitus Association is a wonderful organization that keeps up-to-date information about the on-going research and efforts in finding a cure for tinnitus. Visit their website, www.ata.org, for more information. You can join the association and receive literature about tinnitus and the latest research.
Health and Wellness
We believe in a patient’s overall general well-being. It’s imperative to follow and maintain proper nutrition, diet and physical activity. While there is very little evidence of direct impact on tinnitus, good nutrition and exercise can provide long-term effect on a patient’s overall health and well-being. Engaging in regular exercise and recreational activities/hobbies can help reduce stress and distract the brain from focusing on your tinnitus.
While we cannot take away your tinnitus, we can help effectively reduce your awareness to the tinnitus signal. Tinnitus treatment will involve a series of educational counseling sessions in our office. You will have homework assignments to follow as you work towards your goal of reducing the annoyance of your tinnitus. Habituation will help your brain to reclassify the tinnitus sound as an unimportant, non-relevant sound that should be ignored. As discussed earlier, you can fill your “Craftsman” tool chest with the various tinnitus relief options to help you achieve habituation. It is important you understand never to fear your tinnitus. The tinnitus sound itself is not a danger or threat to your overall health. Patients often ask “how long will the habituation process take?”. While every individual is different, habituation often occurs within 6-18 months, with significant improvement achieved in approximately 80% of patients.
Often times tinnitus may have a psychological impact and sound therapy alone will not be enough to facilitate habituation. Dr. Novick will recommend you obtain a consultation with a local psychologist, who can use various behavioral therapy treatments, such as cognitive behavioral therapy (CBT), to help sever the “negative emotional” reactions to your tinnitus sound. We will be happy to provide you with contact information to various psychologists who are specialized in working with tinnitus patients.
Understand that while habituation is not a cure for tinnitus, it can help the brain reclassify the tinnitus signal as neutral and begin to ignore it. Awareness of the tinnitus will be generally low, but if one’s attention is directed towards it, it can be heard faintly and there is no longer a reaction to the tinnitus sound.