Hearing Loss and Tinnitus

By: Dr. Lisa D. Cahill, Ph.D., CCC-A

Nearly 24 million Americans experience the condition known as Tinnitus (pronounced tin-NY-tus or TIN-u-tus).  Tinnitus is not a disease, but rather a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Tinnitus generally manifests as ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears (NIDCD, 2013).

It is difficult to diagnose the etiology of tinnitus in many cases, because this symptom can stem from a number of possible sources.  Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:

• Noise-induced hearing loss
• Ear and sinus infections
• Diseases of the heart or blood vessels
• Ménière’s disease
• Brain tumors
• Central nervous system disorders
• Hormonal changes in women
• Thyroid abnormalities
• Stress and tension

Tinnitus is often an early indicator of a developing hearing loss. It also can be a side effect of medications and over 200 drugs are known to be associated with tinnitus.

People who are noise exposed—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss. Tinnitus can be measured subjectively for perceived frequency and amplitude, and generally matches the pitch of the greatest level of hearing loss. 

Tinnitus has no cure, but treatments that help many people cope better with the condition are available. Many health care providers will offer a combination of the treatments below, depending on the severity of your tinnitus and the areas of your life it affects the most.

• Hearing aids often are helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear, as well as provide a masking effect for the internal noise. Hearing aids do not “cure” tinnitus, but may help reduce the effects of it. Hearing aid candidates with mild hearing loss are more likely to benefit from hearing aids if they also suffer from tinnitus (Oz, Arslan et. al., 2013).
• Counseling helps you learn how to cope with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.
• Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.
• Bedside sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant, white noise based sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might help you fall asleep.
• Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers (Engineer, Moller 2013).
• Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits.
• Antidepressants and anti-anxiety drugs might be prescribed by your physician to improve your mood and help you sleep.
• Other medications may be available at drugstores and on the Internet as an alternative remedy for tinnitus, but none of these preparations has been proved effective in clinical trials.
• Relaxation techniques: Destressing by use of meditation, yoga, massage, acupuncture is reputed to be helpful.  Relaxation of the jaw, tongue, neck, and shoulders can sometimes be helpful in alleviating or reducing tinnitus. 

If you suffer from tinnitus, it is imperative that you seek medical and audiologic counsel.  Tinnitus can lead to a number of debilitating effects, such as depression, hopelessness, and general reduced quality of life.  A full diagnostic workup both from a medical and hearing perspective can help identify possible causes and rule out various pathologies.  Particularly, if you feel your symptoms of tinnitus are unbearable, seek assistance from your physician or hearing health provider immediately. 

References:

NIDCD (2013). Retrieved from: https://www.nidcd.nih.gov/health/hearing/pages/tinnitus.aspx

Engineer, RM, Moller, AR, Kilgard, RP (2013). Directing neural plasticity to understand and treat tinnitus.  Hearing Research, 295:58-66. doi: 10.1016/j.heares.2012.10.001.

Oz, I., Arslan F., Hizal E., Erbek S., Eryaman E., Senkal O. (2013). Effectiveness of the combined hearing and masking devices on the severity and perception of tinnitus: a randomized, controlled, double-blind study.  Journal for Otorhinolaryngology, 75(4):211-20. doi: 10.1159/000349979