JOSEPH R. ANTICAGLIA MD
Medical Advisory Board
Tinnitus (TINN-ih-tus) is the sound you hear in your ears that comes from your own body. It is not the telephone ringing — It’s your ears ringing — It’s your own body making noise.
One in five people in the US complain of tinnitus. It can disrupt your work and concentration and cause emotional stress. It can be temporary or permanent and involve one or both ears.
It’s a ‘symptom,’ not a disease and the causes are many. Millions of people are affected by it and it’s often associated with loss of hearing. Difficulties arise when tinnitus persists for three to six months or more, interfering with the quality of your life.
People plagued by tinnitus describe it in different ways. Actor William Shatner describes his tinnitus as being “tormented by a screeching in my head,” which he dates to a special effects explosion during the filming of an episode of ‘Star Trek.’ “There were days when I didn’t know I would survive. It robs silence from your life.” (1)
Barbra Streisand first noticed a high pitched sound when she was in the sixth grade. She tried to get rid of it by putting a scarf around her ears, but it made the sound worse. She lives with it to this day. (2)
Billy, a factory worker, complains of a hissing sound in his ears. He was exposed to the high shrill noise of electric saws used at work to make wooden ladders. When he quit work for the day, he noticed the ringing in his ears went away. However, after years of noise exposure, the ringing became permanent and so did his hearing loss.
There are two types of tinnitus. One is subjective, wherein only the patient can perceive the sound and the other is objective, when another person besides the patient can hear it.
Objective tinnitus is comparativery rare but potentially more serious. Such tinnitus can result from vascular tumors or defects, as well as, muscle contractions in and around the ear.
The vast majority of patients visit their doctor because of bothersome subjective tinnitus. It can cause anxiety, interfere with sleep and cause trouble concentrating and communicating. Common causes of subjective tinnitus include side effects of drugs, the aging process and exposure to loud noise.
These patients can relate to the “buzzing” in the ears experienced by singer Phil Collins; perhaps to Beethoven who wrote to a friend, “my ears whistle and buzz continuously day and night. I can say I’m living a wretched life;” or to the ringing in the ears of your friends and neighbors.
Musicians exposed to intense sounds for many years have put lyrics to songs to describe the quality of the tinnitus. For example, Bob Seger: “Later in the evening as you lie awake in bed, with the echo of the amplifiers ringing in your head.” ”Bob Dylan wrote: “My ears are ringin. Ringin’ like empty shells.” Some musicians have even cancelled live tours because of intolerable tinnitus. (1)
RISK FACTORS
Tinnitus sufferers should be aware of certain risk factors, such as excessive noise exposure, smoking, certain drugs and hypertension. Also, as we get older we hear less (Presbycusis) and this sensorineural hearing (nerve) loss can be associated with tinnitus.
EVALUATION
Your ENT specialist will obtain a medical history, perform a complete head and neck examination, and check your hearing. She/he will differentiate bothersome from non-bothersome tinnitus, perhaps recommend image studies and review the results with you.
The doctor will be interested in the quality of your tinnitus, since it can be a clue as to the underlying cause of the tinnitus. A high pitched sound is associated with excessive noise exposure or head trauma. Rarely is it due to an Acoustic Neuroma. A low pitch ringing sensation associated with ear fullness is often an initial presentation of Meniere’s disease.
Is the tinnitus pulsatile—beating rhythmically or not? Hearing your heartbeat or a whooshing sound is often caused by a vascular problem. Muscular contractions around the ear can cause clicking sounds.
TREATMENT
Treatment depends on the severity of the tinnitus and whether it disrupts one’s quality of life. In many instances the cause of the tinnitus is unknown and it may or may not be associated with a nerve hearing loss. There is no specific treatment for this Primary Tinnitus.
When there is a specific cause for tinnitus, other than sensorineural hearing loss, it is called Secondary Tinnitus. Examples of this have been noted above in objective tinnitus and individualized treatment can be initiated.
Physicians educate and counsel patients with persistent tinnitus. They often recommend hearing aids in patients with loss of hearing and tinnitus and refer such patients to audiologists for further evaluation and treatment.
Sound therapy practitioners use masking devices, background music and other modalities to change your perception of tinnitus so that it’s less aggravating. If a shower “masks” your tinnitus, perhaps masking methods can help you.
Cognitive-behavioral therapy (CBT) treatment aims to change the way you think about tinnitus, so that it becomes less bothersome and you become less anxious about this unwanted noise. Finally, one should not routinely use drugs to lessen tinnitus. (3)
SUMMARY
Tinnitus is a pervasive, worrisome and an expensive condition. More than fifty million Americans have experienced tinnitus and about ten million seek professional help. (3) Although rare, it can be a worrisome warning of a life changing medical condition.
For most patients it is permanent and costly. In war zones, hearing loss and tinnitus go hand in hand with gunfire and explosions. Sixty per cent of veterans returning from Iraq and Afghanistan have tinnitus and hearing loss. (1)
In 2009, more than seven hundred and sixty thousand US veterans received compensation for tinnitus disability. At the end of fiscal year 2012, nearly a million veterans received US service connected tinnitus disability. Today, the ongoing disability compensation for tinnitus will run into billions of dollars. (1; 3)
If you’re worried about tinnitus and experience severe anxiety, contact your physician as soon as possible. Also contact your doctor if it’s your first experience with tinnitus that comes on suddenly or if the tinnitus is associated with vertigo or loss of balance. These complaints need to be evaluated by your doctor.
Tinnitus is more than ringing in the ears!
References:
- American Tinnitus Association
- Barbara Walters Special
- Otolaryngology, Clinical Practical guidance, Tinnitus, David Tunkel, MD et al