Tinnitus, commonly described as “ringing in the ears,” affects nearly 15% of the world’s population. For many, tinnitus is merely an annoyance. But for others, it can significantly impact their quality of life and ability to hear. If you have tinnitus, the most important thing is to have your hearing evaluated by an audiologist.
What is tinnitus?
Tinnitus is the experience of hearing a sound in the absence of any external sound source. It often presents as a ringing, buzzing, hissing, humming, or roaring noise in the ears. The sounds associated with tinnitus are usually subjective, meaning they can only be heard by the person experiencing them, but in rare cases they may be audible to others around them.
Tinnitus can originate in the inner, middle, or outer ear, as well as in the auditory cortex of the brain. The condition has a variety of underlying causes, including age-related hearing loss, excessive earwax, traumatic brain injury, inner ear damage, and certain medications or medical conditions. For many cases, however, the exact physiological cause is unknown.
While tinnitus caused by short-term exposure to loud noise often goes away on its own within a few hours to days, chronic tinnitus is often persistent and can only be managed through treatment. There is currently no known cure for the many chronic forms of tinnitus.
What are the different kinds of tinnitus?
There are two main types of tinnitus:
Subjective tinnitus
This is the most common type of tinnitus. It can only be heard by the person experiencing it and is usually described as a ringing, buzzing, hissing, humming, or roaring sound in the ears or head. Subjective tinnitus may be caused by age-related hearing loss and is often accompanied by some degree of permanent hearing impairment.
Objective tinnitus
This much rarer form of tinnitus can be heard by the affected person as well as the doctor during a medical examination. Pulsatile tinnitus is a common form of objective tinnitus that may be caused by blood flow disturbances or muscle contractions in and around the ear. Treatment depends on identifying and addressing the underlying cause.
What are common causes of tinnitus?
There are many possible underlying causes of both subjective and objective forms of tinnitus, including:
- Age-related hearing loss (presbycusis)
- Exposure to excessively loud noise
- Earwax blockage
- Ear bone changes
- Meniere’s disease
- Malformation of capillaries
- Acoustic neuroma (benign tumor on cranial nerve)
- Muscle spasms around the ear
- TMJ disorders
- Head or neck injuries
- Certain medications, such as aspirin, antibiotics, diuretics
- High blood pressure
- Vascular disorders
- Inner ear damage
- Hearing loss
In many cases, tinnitus is accompanied by hearing loss of some degree, although one can occur without the other. The underlying cause often cannot be identified, which is why an audiologist’s expertise is important for diagnosis and management.
How do audiologists diagnose tinnitus?
To diagnose tinnitus and identify potential underlying causes, an audiologist will conduct a thorough evaluation including:
- Health history – The audiologist will ask you questions about your tinnitus symptoms, onset timing, severity, location, and potential triggers. They will also ask about your overall health, medical conditions, and medication use.
- Hearing exam – You will undergo a series of hearing tests to determine the degree, type, and configuration of any hearing loss you may have. Tests may include:
- Pure tone audiometry
- Speech audiometry
- Tympanometry
- Tinnitus assessment – You will be asked to match the volume and pitch of your tinnitus to reference sounds. This provides important baseline measurements.
- Diagnostic imaging – If certain serious causes are suspected, the audiologist may order imaging scans such as CT or MRI scans.
Based on these tests, the audiologist can determine whether your tinnitus is caused by an identifiable, treatable condition or whether it is subjective and likely has no cure except for symptomatic management.
How do audiologists treat tinnitus?
While there is no known cure for chronic subjective tinnitus, audiologists can provide a variety of therapeutic management options to help you find relief and improve your quality of life. These may include:
Hearing aids
If hearing loss is also present, hearing aids can help amplify external sounds and conversations, reducing the prominence of tinnitus noises. Certain hearing aids have built-in sound generators that play soothing background sounds to help mask tinnitus.
Sound therapy
Soothing sounds can help divert your focus from tinnitus or mask the tinnitus noises. Sound therapy devices, apps, podcasts, and bedside sound generators can provide effective relief. Customized sound therapy programs may also be recommended.
Tinnitus retraining therapy (TRT)
TRT uses a combination of sound therapy and cognitive behavioral therapy to help your brain learn to filter out and habituate to the tinnitus over time, reducing its impact.
Counseling
Education, stress management, cognitive behavioral therapy, mindfulness, relaxation techniques, and coping strategies can be very helpful for improving quality of life with tinnitus.
Tinnitus masking devices
These small electronic devices fit in or behind the ear and provide low-level white noise to help cover up tinnitus and provide immediate relief in quiet environments.
Medications
There are no FDA-approved drugs specifically designed to treat tinnitus, but some medications may help reduce associated anxiety, depression, and insomnia. However, all medications carry a risk of side effects, so discuss options carefully with your audiologist.
Alternative therapies
Stress management through yoga, massage, meditation, tai chi, and other relaxation techniques can help some people manage tinnitus symptoms and improve sleep quality.
How effective is tinnitus treatment?
Outcomes vary widely for people with tinnitus, but with an individualized combination treatment plan, most people achieve some degree of symptom relief and improvement in their quality of life. While tinnitus cannot be cured, audiologists aim to help the majority of patients reach a point where their tinnitus does not negatively impact their daily functioning or cause psychological distress.
However, the most important factor for success is consistency. Tinnitus management requires actively following the full treatment plan over the long term, not giving up when improvements are slow to come.
What can you do at home for tinnitus relief?
In addition to following your audiologist’s recommendations, some self-help tips for minimizing tinnitus effects include:
- Avoiding overexposure to loud noises by using hearing protection
- Reducing intake of stimulants like excessive caffeine, alcohol and nicotine
- Exercising regularly to improve blood flow
- Finding ways to manage stress and fatigue through sufficient sleep, relaxation, and saying organized
- Making dietary changes to improve circulation like reducing sodium, increasing antioxidants, and taking supplements like gingko biloba or melatonin
- Masking sounds at bedtime using apps, fans, sound machines or TV
- Limiting use of Cotton swabs to clean ears
While these tips can provide some relief, be sure to discuss any significant dietary or lifestyle changes with your doctor.
Should you consider alternative medicine for tinnitus?
Some people turn to complementary and alternative medicine (CAM) options for tinnitus relief, including:
- Acupuncture
- Herbal remedies
- Vitamin and mineral supplements
- Hypnosis or biofeedback
- Hyperbaric oxygen therapy
There is limited evidence that any CAM therapies can cure or adequately treat tinnitus on their own. However, some mind-body medicine techniques like hypnosis, meditation, yoga, and acupuncture may help with relaxation and reducing stress, which can complement traditional tinnitus management. Discuss any interest in incorporating CAM with your audiologist to ensure safety and effectiveness.
When should you see an Ear, Nose and Throat doctor?
Your audiologist will refer you to an otolaryngologist (ear, nose and throat specialist) if any of the following are present:
- Pulsatile tinnitus – rhythmic whooshing sounds that may require surgical treatment
- Single-sided or unilateral tinnitus – could signal acoustic neuroma or nerve damage
- Sudden or rapidly worsening tinnitus – should be urgently evaluated
- Dizziness, vertigo, or balance problems along with tinnitus – indicates inner ear condition
- Ear pain, drainage, or lots of ear wax – requires medical clearing of ear canal
- Abnormal hearing test results – may warrant medical intervention
An ENT can rule out serious causes of tinnitus and evaluate if any medical or surgical treatments are appropriate in your case.
When should you consider surgical options?
Surgery should only be considered in cases where tinnitus is caused by a treatable underlying condition that cannot be addressed medically, such as:
- Meniere’s disease unresponsive to other therapies
- Vestibular schwannoma (acoustic neuroma) putting pressure on the auditory nerve
- Malformed blood vessels causing pulsatile tinnitus
- Glomus tumor inside or near auditory nerves
- Otosclerosis affecting bone near middle ear
- Ear bone changes or inner ear damage
- Significant TMJ disorder alignment issues
An experienced ENT specialist and audiologist will advise if surgery is appropriate for treating your type of tinnitus after thoroughly evaluating your condition.
What is the outlook for tinnitus patients?
Unfortunately, there is currently no universal cure for most chronic subjective tinnitus. However, the outlook for management and long-term improvement is generally positive with the right multidisciplinary treatment approach. Each patient’s response is unique based on cause, mindset, consistency implementing treatments, and other factors.
Here are some general outlooks you can expect with professional tinnitus treatment and self-management:
- Most patients experience gradual lessening of symptoms over 6 months to 2 years
- Tinnitus may not go away completely, but most patients reach a point where it no longer bothers them
- Counseling and sound therapy help teach your brain to tune out and be less bothered by tinnitus signals
- Hearing aids and devices can greatly improve quality of life and limit tinnitus perception
- Alternative approaches like mindfulness meditation can reduce annoyance and anxiety
- Adopting healthy lifestyle habits can support progress managing tinnitus symptoms
While tinnitus relief takes patience and perseverance, an audiologist can help you successfully manage symptoms and improve your quality of life.
Conclusion
Living with tinnitus can be challenging, but seeking help from an experienced audiologist provides the best chance of controlling symptoms and limiting the condition’s impact on your life. With a customized combination of sound therapy, medications, counseling, hearing aids, devices, and alternative approaches, most people with tinnitus are able to find meaningful relief.
Working closely with your audiologist and following their comprehensive management plan is key to successfully treating your tinnitus for the long run. Although tinnitus cannot yet be cured, an audiologist’s expert intervention can help you live and sleep better as your brain learns to tune out the sounds over time.