Almost everyone will experience tinnitus at some point in their lives. But for around one in eight adults in the UK, tinnitus will become a persistent problem in their life. And for one in a hundred adults, it will significantly reduce their quality of life. Tinnitus also affects children, with reports that up to almost half of all children with normal hearing will experience tinnitus. So what exactly is it?
Tinnitus is hearing sounds coming from within your own body, not the outside world. The type of sound varies greatly between individuals and includes buzzing, chirping, hissing, ringing, whistling, even sounds of the sea or musical sounds. The sounds can be quiet or loud, constant or come and go.
If you have tinnitus, you’re more likely to be aware of it when the background noise is low, when you’re trying to fall asleep or when you’re stressed. Depending on the severity of your tinnitus, it may be annoying or slightly distracting, or it may cause you sleepless nights and reduce your ability to concentrate. In severe cases, it can cause you to have dark thoughts and become depressed.
Thankfully, tinnitus is no longer a condition you need to simply ‘put up with’. Depending on the underlying cause, there may be a straightforward remedy to reduce or completely resolve your tinnitus. If your tinnitus isn’t caused by a specific medical condition, there are still treatments and therapies available to make it easier to manage.
There are several different causes of tinnitus but perhaps the most well-known is exposure to loud sounds, which can damage your inner ear. The typical example is not wearing ear defenders whenever you’re at a loud music concert or using power tools. For some people, noisy working environments can cause tinnitus eg if you work in construction, factories or on the railways. However, increasingly tinnitus is caused by listening to music via headphones with the volume up too high.
Although tinnitus is usually caused by repeated exposure to loud noises, in rare cases, it can be caused by a one-off exposure to a sudden loud sound eg a gun going off at a shooting range, a car tyre bursting next to your ear or an explosion.
Other conditions that can cause tinnitus include a build-up of ear wax, middle ear infections and Ménière's disease.
Tinnitus is also more common if you have hearing loss; as your ability to hear sounds from the outside decreases, sounds created from within your body and ear become more obvious. Certain neck and jaw issues can worsen your tinnitus too as many of the muscles and nerves in your jaw and neck connect to your inner ears.
A long list of medications, up to 200 in fact, can also cause tinnitus as a side effect. These include high-dose aspirin, certain antidepressants and certain chemotherapy drugs. If you’re concerned that a medication is causing your tinnitus, do not stop taking your medication without first consulting your GP.
Hearing loss and tinnitus
Tinnitus does not cause hearing loss. Although, as we’ve already discussed, if you have hearing loss, you’re more likely to also have tinnitus. The most common type of hearing loss is age-related — over time, the cells in your inner ear that detect sounds wear out, reducing your ability to hear properly, usually from around age 60.
It is important to get hearing loss treated as early as possible. Untreated hearing loss not only decreases your quality of life in the immediate term but also increases your risk of dementia in the long term. What’s more, treating your hearing loss is likely to also improve your tinnitus.
Mythbusting tinnitus causes
Current evidence shows that tinnitus is not caused by how close you live to 5G masts or power lines, or by mobile phone usage.
Do you hear noises that people around you don’t hear? If the answer is yes, then you may have tinnitus and it’s time to see your GP or an Ear, Nose and Throat (ENT) surgeon.
If you take medication that can cause tinnitus as a side effect, think back to when your tinnitus started. Does it roughly coincide with when you started on your medication?
If you work in a loud environment or frequently go to loud music concerts or parties, make sure you protect your ears with earplugs or sound defenders. Continued exposure to loud noises can worsen your tinnitus.
If you’re concerned that you have tinnitus, see your GP or ENT doctor. They will ask you about your medical history, any medications and supplements you’re taking, as well as whether you have a family history of hearing loss or hearing problems. They may carry out a general physical examination, as well as examining your ears, nose and throat.
You should then have a hearing test. You may need to see an ENT doctor if the tinnitus or hearing loss is troublesome or especially if it is one-sided. In rare cases, you may also need to have a CT scan or MRI scan.
Based on your examination and test results, your ENT doctor will be able to make a diagnosis of tinnitus and in many cases, identify the underlying cause.
Your treatment for tinnitus will depend on the underlying cause. It may include microsuction to remove excess ear wax, antibiotic ear drops to treat an ear infection, hearing aids to treat hearing loss or changing a medication that is causing your tinnitus.
If you have a jaw disorder that is making your tinnitus worse, your doctor may refer you to a dentist or an orthodontist who can provide you with a custom-made appliance to help correct your jaw problem.
If there is no underlying cause to treat for your tinnitus, your symptoms can still be reduced with other approaches.
You can try wearing sound maskers that sit in or behind your ears. They create a constant, low-pitched noise (white noise) to mask your tinnitus. Certain sound maskers can be tuned into the frequency of your tinnitus so they can generate white noise that better cancels it out.
Similarly, you can place a white noise device under your pillow at night to mask your tinnitus as you try to go to sleep. A DIY version of this that you can try at home today is to turn the radio on but not set it to a specific channel to create background white noise.
Tinnitus retraining therapy
Tinnitus retraining therapy provided by specially trained audiologists focuses on teaching your brain to tune out your tinnitus. This is called habituation and it’s something your brain already does. For example when you’re in a car with the air-conditioning turned on, at first you notice the sound but after a while, your hearing adjusts and you can’t hear it.
Tinnitus retraining therapy involves sound therapy, where you wear a sound masker that plays a neutral sound into your ears. You also need to take part in one-to-one counselling to learn how to habituate to that sound. Learning how to habituate can take several sessions.
Although many different drugs for treating tinnitus have been studied, there are none that have proven helpful for most people.
However, some people with tinnitus find it useful to take anti-anxiety medication. This reduces their anxiety levels, which helps them focus less on their tinnitus.
Studies have shown that injecting the local anaesthetic lignocaine into the inner ear can also reduce tinnitus symptoms. However, lignocaine also disrupts the rhythm of your heart and it is therefore not suitable for most people.
Relaxation and coping techniques
Taking your mind off your tinnitus can help you cope better with your condition. There are a variety of relaxation techniques you can try, including mindfulness, deep breathing and yoga. You can also try biofeedback, exercise or other activities that help you destress.
You can speak to your GP about relaxation techniques, counselling and local support groups. Whichever approach you choose, it is important to commit to your treatment route and maintain a positive mental attitude.
Although some people take vitamins, minerals and herbal supplements, such as gingko biloba, to treat their tinnitus, there is no evidence to suggest that these work. You should always speak to your GP before you take any supplement to check that it won’t do more harm than good or interact with any other medications or supplements you’re taking.
Tinnitus can’t always be completely eliminated. However, your symptoms can be reduced and better controlled. In some cases, tinnitus will spontaneously go away without any treatment.
It is important to remember that however mild or severe your tinnitus is, there are options you can explore with your doctor to reduce the effects tinnitus has on your quality of life.
Mr Anand Kasbekar is a Consultant Ear, Nose and Throat Surgeon at Spire Nottingham Hospital and at Nottingham University Hospitals NHS Trust. He specialises in children and adult ear and hearing problems, tonsils and adenoids, balance, dizziness and snoring, as well as nasal, sinus and allergy treatments. He is also an Honorary Assistant Professor at the University of Nottingham. In addition to his clinical responsibilities, he runs training courses for ENT doctors, teaches on various national ENT courses and is in charge of ENT training in the East Midlands Region. Visit Mr Kasbekar's website.