Table of Contents
What Is Tinnitus Like?
Have you ever wondered, “What is tinnitus like?” Can you recall ever walking out of a loud music venue or hearing a loud noise go off close by, like a gunshot? You might remember your ears were ringing or buzzing immediately afterwards. You may have sensed the ringing or buzzing for a few hours, especially if it was quiet.
The ringing, humming, buzzing or another sound you perceive is called temporary tinnitus. Temporary tinnitus due to exposure to loud noise is something most people have experienced.
Although you can hear tinnitus, it’s most often perceived in your brain and not generated by an acoustic source unless it’s a rare case of objective tinnitus whereby the sound has a physical explanation. Less than 1% of reported tinnitus cases in the USA are objective tinnitus.
The sound you perceive because of subjective tinnitus is unique to you. Many people describe it as quiet or loud and high-pitched or low-pitched:
- roaring; or
How Common is Tinnitus in NZ?
Tinnitus, the perception of ringing or noise in the ears, affects a significant portion of New Zealand’s population. According to a recent study, approximately 6.0% of individuals aged 14 years and older experience some form of tinnitus. Notably, this condition appears to be more prevalent among males, with a rate of 6.5%, compared to females, who experience it at a rate of 5.5%.
The data also reveals intriguing age-related trends. Among young adults aged 14 to 24 years, males are 55% more likely than females to report tinnitus. In contrast, among adults aged 50 to 64 years, males are still more likely to experience tinnitus, but the difference narrows to 32%. Tinnitus prevalence consistently rises with age, peaking at a significant 13.5% among older adults aged 65 years and above. This demographic, those aged 65 and older, are three times more likely to report tinnitus compared to those under 65.
Furthermore, tinnitus prevalence varies across ethnic groups. Those identifying as European have the highest prevalence, standing at 7.05%, while individuals identifying as Asian experience it at a notably lower rate of 1.00%.
What Exactly Is Tinnitus, Then?
A 2009 review paper provides the following definition:
In other words, tinnitus is hearing a sound without the standard mechanisms of sound travelling through your ear canal and into your inner ear for processing.
A few different theories attempt to explain the mechanisms underlying tinnitus. For example, one theory suggests damage to the ear’s auditory nerve causes tinnitus. Another theory suggests that tinnitus results from changes in the brain’s neurons. To date, there is no conclusive evidence to support either view.
Tinnitus is not a disease; it’s an underlying condition caused by an injury or illness.
Tinnitus may also be a symptom of damage to your hearing, such as age-related hearing loss (presbycusis) or even a physical injury.
The exact origin of sound perceived from tinnitus remains unknown, and there is no cure. However, treatments are available, and numerous known causes, triggers, and contributing factors exist.
With normal hearing, you hear authentic sounds — birdsong, conversation, car horns — or silence. If you live with tinnitus, the ringing in your ears disrupts normal hearing, making it harder to hear everyday sounds and experience silence.
There are two main categories of tinnitus and several types of tinnitus.
Types of Tinnitus
Tinnitus is unique to each individual. However, there are similarities in the experiences people report and common symptoms and causes of tinnitus.
There are two main categories of tinnitus:
- Objective tinnitus.
- Subjective tinnitus.
Objective tinnitus is when someone else can listen to the noise you can hear. An audiologist can hear objective tinnitus with a stethoscope or sometimes by simply listening closely to your ear.
This type of tinnitus is rare and, in most cases, is caused by a problem with blood flow in large veins or arteries. Various things, including high blood pressure, an aneurysm, or a blockage, can cause vascular noises.
Subjective tinnitus is when only you can hear the noise in your ears. This type of tinnitus is much more common and can have many causes.
There are also more specific types of tinnitus, some of which are subjective or objective or can be either.
Somatic tinnitus is associated with changes in the somatosensory system. The somatosensory system is a complex network of sensory neurons that responds to changes at the surface or inside the body. These changes can include movement, pressure, touch, temperature or pain.
Somatic tinnitus is often described as a “creaking,” “popping”, or “clicking” sound. Bones, joints, muscles or skin problems can cause somatic tinnitus. It can also be caused by damage to the nerves that connect the body to the brain.
While there are many potential causes of muscle spasms, the most common cause is stress. When under pressure, your body goes into “fight or flight” mode, increasing muscle tension. This can then cause the muscles in your ear to spasm, resulting in somatic tinnitus.
Pulsatile tinnitus has a perceived rhythmic pulsing noise or whooshing sound. The sounds usually relate to blood flow and follow a rhythm that matches your heartbeat.
Blood flow abnormalities, middle ear problems, head trauma, tumours or other growths that press on blood vessels or nerves can cause pulsatile tinnitus.
Neurological tinnitus occurs when there is damage to the nerves that carry information from the ear to the brain, called the auditory system.
The auditory system consists of the ear, the auditory nerve, and the brain. Tinnitus can be caused by damage to any of these parts of the system.
Neurological tinnitus is often associated with other conditions that affect the nervous system, such as Meniere’s disease, vestibular neuritis, and acoustic neuroma.
Musical tinnitus is a condition that can be experienced by anyone, though it is more commonly found in those who are hard of hearing or deaf. The condition is usually benign, but in some cases, it can be disabling.
Musical tinnitus is the experience of hearing music when none is being played. The music can be heard in one or both ears and can be continuous or intermittent. The music may be familiar or unfamiliar, and it can be pleasant or unpleasant. Sometimes, the music may be accompanied by other auditory hallucinations, such as voices.
Musical tinnitus is thought to be caused by changes in the auditory system. It is important to note that musical tinnitus is not a mental health disorder. Treatment for musical tinnitus typically focuses on managing the underlying cause if one can be identified.
In cases with no underlying cause, management focuses on coping and adaptability strategies.
The most common associated symptoms of tinnitus are:
- trouble concentrating
- not being able to sleep
- difficulty understanding speech.
Tinnitus is not just a noise you hear–it can also make you feel unhappy or worried. Tinnitus activates the limbic and autonomic nervous systems. The limbic system governs our emotions, while the autonomic nervous system controls our automatic functions like breathing and heart rate.
Most patients with tinnitus have trouble sleeping because they worry about it, making it hard to fall asleep again if they wake up at night.
During sleep, people with tinnitus have pronounced neuronal activity in the auditory pathways because their auditory system constantly scans the sound environment.
Some things can make tinnitus symptoms worse. These include:
- being around loud noises
- being in a quiet place
- feeling stressed
- not sleeping well
- feeling tired.
Causes of Tinnitus
Tinnitus is not a disease in and of itself but rather a symptom that can result from various underlying causes. In some cases, tinnitus is idiopathic, meaning the cause is unknown.
There are a variety of possible causes of tinnitus, but hearing loss is the most common, followed by exposure to excessive noise. Other possible causes include earwax buildup, an infection, or an injury to the head or neck. In some cases, tinnitus may indicate a more serious underlying condition.
Otologic causes are related to the ear and include the anatomy and physiology of the ear and disorders that can affect it.
Otologic research helps us to understand how the ear works and how to treat and prevent conditions that can cause deafness, tinnitus or dizziness.
Otologic causes of tinnitus include:
- noise-induced hearing loss
- presbycusis, or the loss of hearing that accompanies aging
- impacted earwax or cerumen
- abnormal growth of bone in the middle ear (otosclerosis), commonly known as surfers ear.
- inflammation of the ear (otitis)
- sudden sensorineural hearing loss (SSHL), commonly known as sudden deafness
- Meniere’s disease which affects the inner ear, causing problems with hearing and balance.
There are many potential causes of neurological tinnitus, but the most common is damage to the auditory nerve. Head or neck injury, stroke, or tumour can cause auditory nerve damage. Other potential causes include problems with the blood flow to the brain, certain medications, and diseases like multiple sclerosis.
Several infectious and inflammatory processes can cause tinnitus. One of the most common is otitis media, an infection of the middle ear. Otitis media often occurs in children, but adults can also be affected.
Other infectious causes of tinnitus include
- Lyme disease
- meningitis, and;
A bacterial infection transmitted by tick bites causes Lyme disease. Symptoms of Lyme disease include fever, headache, and fatigue. Lyme disease can lead to severe complications, such as neurological problems and joint inflammation, if left untreated.
Meningitis is an inflammation of the membranes that surround the brain and spinal cord. A viral or bacterial infection can cause it. Symptoms of meningitis include fever, stiff neck, and headache.
Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. Syphilis can cause many symptoms, including rash, fever, and muscle aches. If untreated, syphilis can damage the brain, heart, and other organs.
Medicines and Substances
Some everyday substances and medicines may have the side-effect of causing or worsening tinnitus. Usually, this goes away when you stop taking the medication or cut down on the substance.
- nicotine, caffeine and alcohol
- some antibiotics
- some cancer medications
- high-dose aspirin
- quinine (often used for malaria)
- some diuretics (used to treat water retention).
4 Conditions That Can Trigger Tinnitus
Your body’s systems are interwoven and delicately balanced. A health condition primarily affecting one part of your body may have surprising knock-on effects, including tinnitus. Conditions that are linked to tinnitus include:
1. Disorders of the Jaw Joint
Disorders of the temporomandibular joint can trigger tinnitus. This joint is where your lower jawbone connects with your skull just in front of your ears on either side of your head.
2. Cardiovascular Diseases
Cardiovascular diseases that may trigger tinnitus by disrupting blood flow include high blood pressure, atherosclerosis, heart disease, and malformations of the small arteries.
3. Neurological Disorders
Neurological disorders that may trigger tinnitus include Meniere’s disease, multiple sclerosis or migraine headaches.
Stress may be present at the onset of tinnitus and may worsen existing tinnitus.
7 Tinnitus Treatment Options
There are treatment options that may reduce the severity of your tinnitus.
1. Earwax Removal
Impacted earwax has a simple solution: If your tinnitus results from a build-up of earwax blocking your ear canal, removing the earwax will help.
2. Managing Medications
All medicines have side effects; some drugs can cause or worsen tinnitus. Reducing the dose or swapping it for different treatments may be possible. Talk to your doctor if you’ve noticed a link between a specific medication and tinnitus.
3. Hearing Aids
Age-related hearing loss is the most common cause of tinnitus. A hearing aid may improve your tinnitus and hearing if you have hearing loss. Sometimes, the hearing aid is all you need, and sometimes it’s one of several techniques used to manage your tinnitus.
If you need a hearing aid, you’ll get the most benefit by wearing it throughout your waking hours. It can seem very odd at first, but you will get used to the device’s feel and the sensation of everyday sounds. And your audiologist will follow up with you regularly to check that the device is working, fitting well and meeting your needs.
4. Cognitive Behavioural Therapy
Cognitive behavioural therapy (CBT) can be the most effective treatment for tinnitus. That may seem unusual since it’s about your thinking processes rather than your hearing. And yet, CBT has significantly improved the quality of life for people with tinnitus.
CBT is a psychological treatment where a trained professional uses relaxation techniques to reduce your stress levels, challenges your thoughts about tinnitus and helps you get used to its presence so that it bothers you less. You’ll usually have several CBT sessions with a mental health practitioner.
5. Sound Therapy
Before we can say it works, more studies are needed, but many people find it helps, particularly with acute tinnitus symptoms.
Sound therapy is the deliberate use of any sound that makes you less aware of your tinnitus or less bothered by it. Many people find tinnitus incredibly annoying in quiet environments, so they might play background music while reading or listening to nature sounds while falling asleep.
Most modern hearing aids also provide tinnitus sound therapy programs.
6. Tinnitus Retraining Therapy
Tinnitus retraining therapy (TRT) is a two-part treatment involving counselling and sound therapy.
Counselling helps to educate patients about tinnitus and how to cope with it, while sound therapy uses masking devices to help make the tinnitus less noticeable.
TRT has been shown to be effective in reducing tinnitus symptoms, and it may even help some people eventually stop noticing their tinnitus entirely. TRT may be worth considering if you’re struggling to live with tinnitus.
7. Relaxation Techniques
Living with any long-term condition can be challenging, especially since it comes in addition to life’s usual stresses. Making a deliberate effort to relax can help you manage your tinnitus in the long run.
Deep breathing exercises slow your heart rate and help you calm down. You can do them anywhere since there’s no special equipment required. Or you can download a relaxation app on your smartphone or join a tai chi or yoga class.
Continue doing those things that bring you joy. It’ll help to squeeze tinnitus to the edges of your life rather than allowing it to take centre stage.
Is There a Cure for Tinnitus?
Unfortunately, tinnitus has no cure, partly because it is not an illness but a symptom of another problem.
The goal of tinnitus treatment is to find relief from the symptoms. It’s similar to pain in this respect. Every individual’s perception and experience of tinnitus differs, making finding a treatment that works just for you more challenging.
How do you do that? There’s no one answer. Thankfully, there are several different treatment avenues that you can explore until you find something that helps you. Be patient — there’s often a bit of trial and error before you find the right option(s).
You may find alternative therapies and treatments for tinnitus on the internet and social media. Any treatment for tinnitus should be recommended by a healthcare professional such as your audiologist or general practitioner. Please exercise caution and maintain critical thinking when exploring unproven treatments not recommended by a qualified healthcare practitioner.
To help you judge between them, the British Tinnitus Association regularly reviews popular tinnitus treatments and guides you towards safe and effective ones. That can save you wasted time, money and dashed hopes.
So, what treatments are likely to be effective for you? It depends on the trigger(s) and cause of your tinnitus and what works for you as an individual.
Living With the Ringing in Your Ears
Tinnitus is a mild annoyance for some and very distressing for others.
People’s experience of tinnitus varies considerably. The noises can be constant, loud and in both ears or occasional, soft and only heard on one side. You might perceive one type of noise or several.
Living with the ringing in your ears can be frustrating and tiring. It can also be quite isolating. If you break your leg, your loved ones pitch in to help you with daily activities; they rally around with chicken soup if you get the flu. But tinnitus is like a hidden disability. You don’t look any different and may find that other people struggle to understand how hard your daily life can be.
If you have symptoms of tinnitus, get professional help. Start by talking to an audiologist or general practitioner, who may refer you to relevant specialists.
Secondly, be prepared to try a few different treatment options, as finding what works for you can take time.
Thirdly — and very importantly — continue doing things you enjoy. You might need to tweak things a bit (e.g. listening to some background music while you read), but it’s essential to carry on doing things that bring you joy.
Supporting Someone With Tinnitus
If your partner, friend or relative has tinnitus, encourage them to get help.
Because you can’t hear their tinnitus, it’s sometimes hard to remember that they need support. Each person’s experience is different, so the best thing you can do is talk about it — ask them what you can do to help.
Some people struggle in loud, echoey environments like bowling alleys, while others find their tinnitus more bothersome in quiet environments. Make plans together so the person with the condition can suggest a place that suits them.
You can also encourage them to attend other appointments and try different treatments until they find something that works for them. And try to be patient when they’re battling frustration, exhaustion or distress relating to tinnitus.
If you’re in a close relationship with someone with tinnitus, ensure you have your sources of support. It’ll help you care for them better in the long run. It’s not easy looking after someone with a chronic condition, and you’ll need to recharge your batteries occasionally.