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Do you hear ringing or noise that nobody else hears?

You hear whistling, ringing, humming, hissing or pounding in your ears – for no apparent reason. Many people suffer from tinnitus at least once in their lives. For one out of five people, tinnitus is permanent, but treatment options exist.

If you are affected by tinnitus, silence may be especially annoying. This is because tinnitus can become more intense when there is no background noise. Tinnitus causes phantom noise with no external sound source. Why the inner ear and brain generate these sounds remains a mystery to scientists. Tinnitus can be a very bothersome condition which affects each person differently.

The constant noise may be a never-ending ordeal for some. It can affect your concentration and interfere with sleep. Tinnitus may differ from patient to patient in terms of sound, pitch, volume and level of perception. It can be perceived in just one ear, or more centrally, such as in the middle of the head. Tinnitus can occur intermittently, in wave-like intervals or be a permanent, ever-present noise. Tinnitus is commonly associated with hearing loss as well.

Did you know?

Around 80 percent of those affected by tinnitus also suffer from hearing loss.

Why tinnitus happens

Even though nobody else can hear the noise, tinnitus isn’t an imaginary illness. Still, how can you hear a sound that doesn’t exist? Scientist aren’t completely sure.

The most widely accepted theory says that it’s a spontaneous reaction of your brain’s central hearing system. It may be due to damaged cells (called hair cells) in the inner ear. Since hearing is affected, the brain tries to amplify or restore the missing sounds which leads to tinnitus.

A question of perception

If you perceive tinnitus as being severe, stress mechanisms may be activated in your brain’s limbic system (responsible for processing emotions). This may lead to a vicious cycle: as you suffer, you get more stressed which triggers the limbic system, which causes even more stress which then leads to more symptoms.

It’s important to decide whether tinnitus is truly severe/debilitating (decompensated tinnitus) or mild/moderate (compensated tinnitus). This can be partly determined by how the condition affects your quality of life. For instance, decompensated tinnitus can cause sleep disruption, stress, anxiety, depression and social isolation. It can also cause headache, earache, dizziness or muscle tension.

What is “objective tinnitus”?

In this very rare condition, tinnitus noise can actually be detected and measured by an Ear-Nose-Throat (ENT) specialist using special instruments. The cause is usually an anatomical abnormality in the blood vessels of the inner ear, a disturbance of the middle ear, or contamination of the ear canal near the eardrum. In most cases of tinnitus, however, no noise can be detected at all.

Subtypes of tinnitus

There are three subtypes of tinnitus:

  • Acute tinnitus: Present for less than three months. Typically disappears spontaneously. Treatment with medication may help.
  • Subacute tinnitus: Occurs repeatedly within a period of three to twelve months. Medication and/or relaxation exercises may bring about recovery.
  • Chronic tinnitus: Symptoms last for more than twelve months. Usually requires therapeutic or medical treatment.

What causes and triggers tinnitus?

Although there are a number of theories, none of them have been proven. Still, some causes of irritating ear noises may be anatomical changes within the ears or injuries such as:

  • Noise damage
  • Acoustic trauma
  • Acute hearing loss
  • Sensorineural hearing loss
  • Hyperacusis (acute sensitivity to noises)
  • Auditory canal blockage
  • Middle ear infection
  • Menière's disease (infection of the inner ear with dizziness, nausea and difficulty hearing)
  • Acoustic neuroma (a benign tumor)

Causes outside of the hearing system may also trigger tinnitus:

  • Stress
  • Cardiovascular diseases
  • Musculoskeletal problems
  • Dental misalignment
  • Traumatic brain injury
  • Muscle tension (especially in the neck region)
  • Intoxication
  • Medication

How is tinnitus diagnosed?

First, your ENT specialist or hearing care professional will ask questions about previous illnesses, possible triggers and the ear noise itself. It’s important to explain how severely you suffer from tinnitus, for example, how it affects your quality of life.
Next, the doctor will perform a hearing exam, including a hearing and balance test. This determines whether you also have hearing loss or a hearing system disorder.
Finally, a tinnitus analysis will be performed, in which the volume, tone, and pitch of the tinnitus is determined. Identifying tinnitus frequencies helps guide further treatment.

What types of tinnitus treatments are available?

Treatment of acute tinnitus (up to three months) may involve cortisone or circulation enhancing drugs. However, in the majority of cases, acute tinnitus disappears spontaneously.

For symptoms that persist for over three months, no definitive treatment exists. However, there are treatment plans that may help improve your quality of life dealing with chronic tinnitus. Depending on your type of tinnitus, your doctor will recommend the appropriate treatment.

The most common and successful method is tinnitus retraining therapy (TRT). The goal is to get you used to the noise so that you no longer notice it. In TRT therapy, your brain gradually adjusts to the tinnitus, and you don’t perceive the sound as intensely. Tinnitus retraining therapy is ideal for people with mild or chronic tinnitus. The most important factor for successful tinnitus retraining therapy is consistent and active cooperation and a positive attitude.

The three pillars of TRT

Pillar 1: Learn. As you understand more about tinnitus, the condition becomes less threatening.

Pillar 2: Sound therapy. By focusing on pleasant sounds (water fountains, sounds from nature, music, etc.), the tinnitus ear noises become less noticeable.

Pillar 3: Mental and physical well-being. There are multiple approaches to this, from behavioral and speech therapy, to yoga and tai chi.

In addition to retraining therapy, an ENT specialist may also recommend a hearing aid outfitted with a tinnitus noise generator. These devices work by improving how you hear natural external sounds. Plus, by frequency matching, the noise generator helps drown out bothersome tinnitus. Around 80 percent of those affected by tinnitus also suffer from hearing loss. Often the tinnitus noises are at the exact frequency that you have the most trouble hearing.

Tips for dealing with tinnitus

  • Avoid stress. Practice relaxation techniques (autogenic training, yoga, tai chi, etc.).
  • Alcohol and caffeine should be consumed in small quantities only.
  • Exercise relieves stress and distracts you from the tinnitus.
  • Get plenty of sleep. Adequate rest reduces the severity of tinnitus symptoms.
  • Choose activities you enjoy! This distracts you from the tinnitus.
  • Always wear ear protection if you will be exposed to noise.

Prevention Tips

How to prevent tinnitus

  • Protect your ears. Stay away from loud noises. Use ear protection if noise cannot be avoided, such as at work. Use earplugs or special headphones.
  • Avoid stress: Stress can magnify tinnitus symptoms. Take it easy and don’t burn out.
  • See your doctor! Visit the doctor at the first signs of tinnitus. The sooner you are treated by an ENT specialist or a hearing care professional, the better your chances of recovery.

What should I do if I am affected by tinnitus?

Rapid onset, annoying ear noises usually disappear by themselves. Most of the time all you need to do is give yourself and your ears a break. What if the ringing, whistling or hissing just won’t stop?

If the noise lasts longer than 24 hours, you should see a doctor or hearing care professional. The sooner you get treatment for tinnitus, the better your chances of avoiding chronic tinnitus.

Whom should I contact?

The best help you can get is from an ENT specialist or a hearing care professional. Depending on the type and severity of your symptoms, the doctor will set up a personalized treatment plan for you.

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