Gaining understanding of the nature of tinnitus

July 2013

It is estimated that 5 million people suffer from tinnitus in the UK. Mr John Phillips, Consultant ENT Surgeon at Spire Norwich Hospital in Norfolk offers information on the invisible condition of tinnitus.

Tinnitus is a fascinating phenomenon, which is currently the subject of a huge amount of research.  For many people, an annoying ring in their ears can be a constant source of frustration and distress.  Patients often remark that 'nothing can be done' and 'it is something that I am going to have to live with', but these statements couldn’t be further from the truth.  Although tinnitus is complex, understanding why tinnitus is so annoying is often the key for the tinnitus sufferer in getting on with their life.  The way forward for the tinnitus sufferer is to take control, so they rule the tinnitus rather than the other way around.

Mr John Phillips, Consultant ENT Surgeon at Spire Norwich Hospital, explains: although the exact source of tinnitus is unknown our understanding of why it persists is improving.  Almost everybody has the ability to ‘hear’ tinnitus.  A few years ago a scientific experiment was performed on healthy students attending the University of Milan.  Students were asked to sit in a soundproof room and after only 4 minutes 8 out of the 10 students were suffering with tinnitus.

Tinnitus seems to occur in people who are deprived of sound. The Italian experiment above is a perfect example of this. However, tinnitus occurs in a similar fashion in people who notice hearing loss for a variety of reasons including the natural decline in hearing people notice as they get older.  Anyone who has spent the evening (or early hours of the morning) in a noisy nightclub would agree that for a short period of time afterwards they feel deaf and notice a temporary ringing in their ears. This is due to temporary damage to the cells within the inner ear.

As tinnitus is often the result of hearing loss, when I see patients in my ENT clinic at Spire Norwich Hospital, I compare the brain to a modern digital camera.  I explain that when a photograph is taken in low levels of light without a flash the resulting picture can be grainy with random inaccuracies, this is because the camera sets itself up to be extra sensitive and to react to the smallest suggestion of light.  The brain most probably does a similar thing when it struggles to 'hear' at certain sound frequencies, it picks up signals that aren't present in the outside world and these signals are ‘heard’ as tinnitus.

Hearing loss is certainly a factor in experiencing tinnitus in the first place, but the reason why tinnitus is more bothersome in some people than others is even more interesting.  Some people ignore their tinnitus and it never becomes a real issue, whereas other people have a really hard time with it.  This is well illustrated by a conversation I had with an audiologist friend.  She was in bed with her husband and about to fall asleep when he remarked that he always found the sound of the rain on the roof of their house comforting at night as it often relaxed him and helped him get off to sleep.  Upon hearing this she remarked that it wasn't raining and what he was hearing was the broken tap in the en suite bathroom.  From then on the same sound of water, that her husband had considered comforting, had become an annoying, loud and bothersome ‘noise’.  That night my friend’s husband had a terrible nights sleep, however on the flip side the tap was fixed first thing the next morning!

Mr Phillips continues; context is very important, returning to Italy and the study performed on volunteers at the University of Milan, a second experiment was performed whereby the students were placed in a similar soundproof room, but this time there was a huge loudspeaker sitting in the corner.  The loudspeaker was fake, in as much as it was not connected to anything, but due to its very presence the number of students that suffered from tinnitus rose from 8 out of 10 to 9 out of 10.  Neuropsychologists have looked into this in more detail and have proposed a number of theories to explain how different parts of the brain are connected.  For example, tinnitus makes some people anxious which then makes them more aware of their tinnitus which in turn causes more anxiety.  A vicious circle is often created which sometimes blows out of proportion something that starts out as a mild harmless ringing sound.  In contrast, for patients who do not pay much attention to this ringing sound, the problem almost immediately disappears as they subconsciously disregard it and then forget about it completely.

By and large, the majority of tinnitus is not associated with a serious underlying medical problem.  However, if tinnitus is persistent or bothersome it is worthwhile visiting your family doctor as in some cases further tests are required to exclude any rare but more serious causes. As tinnitus is often the result of hearing loss it is useful to have a hearing test performed.

Mr John Phillips advises: “if you remember three things from this article they should be: firstly, tinnitus will usually get better with time and this is the rule not the exception.  Secondly, if you do have hearing loss a hearing aid will help the tinnitus as much as the hearing loss.  By bringing in sound information from the outside world, the brain is kept busy and as a result becomes less sensitive to other misrepresentative signals.  Thirdly, and finally, in severe cases of tinnitus a range of specialist therapies do exist.  These therapies work by trying to 'reprogram the brain'.  This type of therapy is supported in the medical literature but often isn’t required. Having the right attitude about tinnitus will often mean the mild annoying ring many people experience will disappear before it has a chance to become bothersome.

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