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What is Tinnitus? - From the American Tinnitus Association (ATA)

Tinnitus is the perception of sound when no actual external noise is present. While it is commonly referred to as “ringing in the ears,” tinnitus can manifest many different perceptions of sound, including buzzing, hissing, whistling, swooshing and clicking. In some rare cases, tinnitus patients report hearing music. Tinnitus can be both an acute (temporary) condition or a chronic (ongoing) health malady.

Millions of Americans experience tinnitus, sometimes to a debilitating degree, making it one of the most common health conditions in the country. The U.S. Centers for Disease Control estimates that nearly 15% of the general public — over 45 million Americans — experience some form of tinnitus. Roughly 20 million people struggle with burdensome chronic tinnitus, while 2 million have extreme and debilitating cases.1

Tinnitus is not a disease in-and-of-itself, but rather a symptom of an underlying health issue. While tinnitus is a symptom of a wide range of conditions, it is most frequently the result of some level of hearing loss.

There is currently no scientifically-validated cure for most types of tinnitus. There are, however, treatment options that can ease the perceived burden of tinnitus, allowing patients to live more comfortable, productive lives. ATA is leading the charge in the ongoing search for a definitive tinnitus cure.

Symptoms

While commonly referred to as “ringing in the ears,” tinnitus can actually manifest in a variety of different perceived sounds, both tonal and pulsing. People describe hearing different sounds: ringing, hissing, static, crickets, screeching, whooshing, roaring, pulsing, ocean waves, buzzing, dial tones, even music.

Treatment

Despite the high prevalence of tinnitus and its obvious impact on the psychological health of the patient, only a small number of people contact physicians or hearing care professionals for help. The reason perhaps lies in the widespread belief that tinnitus is incurable or untreatable. Yet, there are several methods for treating tinnitus by alleviating the impact it has on quality of life.3,5,6

One major inadvertent tragedy associated with the belief that tinnitus cannot be helped is that people, in addition to not seeking help for their tinnitus, also do not seek help for their hearing loss. In a recent large-scale survey of the US hearing-impaired population who had neglected their hearing loss, 39% (more than 9 million adult Americans) indicated they had not sought help for their hearing loss specifically because they concurrently had tinnitus.7

The literature is quite specific that untreated hearing loss negatively affects nearly all dimensions of the human experience. Research demonstrates the considerable negative social, psychological, cognitive and health effects of untreated hearing loss—with far-reaching implications that go well beyond hearing alone. In fact, those who have difficulty hearing can experience such distorted and incomplete communication that it seriously impacts their professional and personal lives, at times leading to isolation and withdrawal. Studies8,9 have linked untreated hearing loss to:

  • Irritability, negativism, and anger;
  • Fatigue, tension, stress, and depression;
  • Avoidance or withdrawal from social situations;
  • Social rejection and loneliness;
  • Reduced alertness and increased risk to personal safety;
  • Impaired memory and ability to learn new tasks;
  • Reduced job performance and earning power; and
  • Diminished psychological and overall health.

A survey of 230 hearing care professionals suggests that six out of 10 patients (60%) experience minor to major relief of tinnitus when wearing hearing aids, and a total of one in five (22%) receive major relief. Less than 2% of patients experience a worsening of their tinnitus when wearing hearing aids, while 39% receive no benefit.

So the individual with both untreated tinnitus and untreated hearing loss would be expected to suffer an even more diminished quality of life than individuals with only tinnitus or only hearing loss.10

The ATA believes that, if hearing care professionals can provide effective treatment for tinnitus, they can also be instrumental in motivating people to concurrently treat their hearing loss. This will have a double impact in improving their patients’ quality of life.

Nearly everyone with tinnitus also has a hearing loss. For those with hearing loss, hearing aids should obviously improve their hearing and communication. But many do not appreciate that hearing aids can also improve tinnitus11-15

Improving communication reduces stress, therefore making it easier to accept or cope with tinnitus.

Amplifying background sound, or producing background ambient noise, thereby reduces the loudness or prominence of tinnitus.

New open-fit hearing aids might be a particular effective sound therapy for some suffering from tinnitus.13

Tinnitus is likely coded by spontaneous neural activity in the auditory cortex (the hearing center of the brain), perhaps as an increase in activity, an over-representation of some frequency-tuned neurons, or an increase in synchrony across neurons. By viewing hearing aids as physiotherapy or sound therapy for the ears, the very act of listening to sound exercises the auditory portion of the brain.

In the presence of hearing loss, the fitting of hearing aids activates the auditory cortex. Thus, sounds amplified by hearing aids may interfere with the central auditory representation of tinnitus.13 Hearing aids might be viewed as Gestalt therapy for the ears since tinnitus that was previously conspicuous in the foreground is relegated appropriately to the background with all other environmental sounds. The very act of taking the focus off of tinnitus spells relief for many people.

Conclusions

Nearly 9 million people with hearing loss have not sought out the services of a hearing care provider because they have tinnitus and believe that nothing can be done about it. Most people with tinnitus also have hearing loss. In addition to improving communication, hearing aids can also help tinnitus. The results from this survey indicate:

  • 60% of patients report some relief of their tinnitus when using hearing aids;
  • 22% actually report major relief of their tinnitus when using hearing aids;
  • 56% of respondents to the survey reported they had taken at least one course on tinnitus;
  • The median time spent in tinnitus counseling was 10 minutes;
  • 18% of respondents indicated they distributed a self-help book on tinnitus to their patients.

References

  1. Davis A, El Refaie A. Epidemiology of tinnitus. In: Tyler RS, ed. Tinnitus Handbook. San Diego: Singular Publishing Group; 2000:1-24.
  2. Erlandsson S. Psychological profiles of tinnitus in patients. In: Tyler RS, ed. Tinnitus Handbook. San Diego: Singular Publishing Group; 2000:25-58.
  3. Tyler RS. Neurophysiological models, psychological models, and treatments for tinnitus. In: Tyler RS, ed. Tinnitus Treatment: Clinical Protocols. New York: Thieme; 2006:1-22.
  4. Noble W, Tyler R. Physiology and phenomenology of tinnitus: implications for treatment. Int J Audiol. 2007;46(10):569-575.
  5. Tyler R, et al. Tinnitus Activities Treatment. Tinnitus Treatments. New York: Thieme; 2006.
  6. Jastreboff PJ, Hazell JWP. Tinnitus Retraining Therapy: Implementing the Neurophysiological Model. Cambridge, UK: Cambridge University Press; 2004.
  7. Kochkin S. MarkeTrak VII: obstacles to adult non-user adoption of hearing aids. Hear Jour. 2007;60(4):27-43.
  8. Kochkin S. Hearing loss and its impact on household income. Hearing Review. 2005;12(11):16-24.
  9. Kochkin S, Rogin C. Quantifying the obvious: the impact of hearing aids on quality of life. Hearing Review. 2000;7(1):8-34.
  10. Stocking C. Hearing loss and communication. In: Tyler R, ed. The Consumer Handbook on Tinnitus. Sedona, Ariz: Auricle Ink Publishers; 2008.
  11. Bentler RA, Tyler RS. Tinnitus management. ASHA. 1987;29(5):27-32.
  12. Surr RK, Montgomery AA, Mueller HG. Effect of amplification on tinnitus among new hearing aid users. Ear Hear. 1985;6(2):71-75.
  13. Searchfield GD. Sound therapy options. In: Tyler R, ed. The Consumer Handbook on Tinnitus. Sedona, Ariz: Auricle Ink Publishers; 2008.
  14. Vernon J, Schleuning A. Tinnitus: a new management. Laryngoscope. 1978;88(3):413-9.
  15. Johnson RM, Goodwin P. The use of audiometric tests in the management of the tinnitus patient. J Laryngol Otol. 1981; Suppl(4):48-51.