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Tinnitus

Introduction

Tinnitus is the medical name for the perception of noise in one ear, both ears or in the head.  The noise comes from inside the body rather than an outside source. 

People with tinnitus can experience different types of sounds. Most people describe it as a ringing sound, but other sounds may include:

  • buzzing,
  • humming,
  • whistling, or
  • music.

Sometimes, the noise associated with tinnitus beats in time with a person's pulse. This is known as pulsatile tinnitus.

Tinnitus is often worse at quiet times, such as when you are trying to get to sleep. This is because there is less background noise to mask or distract you from the sounds associated with tinnitus. Tinnitus may also be more noticeable when you are tired.

Tinnitus is a symptom rather than a condition in itself.  The sounds are usually only heard by the person who has tinnitus, although in a few, rare cases they can also be heard by other people. 

Temporary tinnitus can be caused by a cold, prolonged exposure to loud noise, such as at a music concert, or following a blow to the head.

How common is tinnitus?

Tinnitus is a common condition. A 2007 study carried out by The Royal National Institute for Deaf People (RNID) found that one in seven people in the UK have experienced tinnitus.  Long-term tinnitus is much less common, affecting about one in 100 people.

Outlook

Many people learn to live with tinnitus but it can have a significant impact on a person’s everyday life.  For example, it can affect concentration and cause sleeping problems and depression.

There is currently no cure for long-term tinnitus. Therefore, the aim of treatments, such as sound therapy, relaxation therapy and cognitive behavioural therapy (CBT), is to help people effectively manage their symptoms. For more information, see Treating tinnitus.

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Symptoms

The symptoms of tinnitus can affect different people in different ways, and the severity of the noises that are heard can range from mild to severe. 

Some people with tinnitus are more sensitive to normal, everyday sounds than others. For example, a person with tinnitus may find that a radio or television is painfully loud when it is at a normal volume for most people.

Types of tinnitus

For some people, tinnitus can be a low frequency noise, such as humming, murmuring, rumbling or deep droning.

Other people with tinnitus experience musical hallucinations, where they repeatedly hear musical tunes or songs in their head.

Pulsatile tinnitus is characterised by rhythmical noises that beat at the same rate as your heart. This type of tinnitus usually has a specific cause, such as high blood pressure (hypertension), or glue ear (serous otitis media).

The different types of tinnitus are described in more detail below.

Low frequency noise

People who constantly hear low frequency noise often think that it is coming from an external source rather than from inside their head or ears (tinnitus).

Sources of external low frequency noise include:

  • road and air traffic noise,
  • underground gas pipes,
  • those inside your home, such as fans and fridges, and
  • air-conditioning units.

The wind, sea and thunder are natural sources of low frequency noise.

To determine where the noise that you can hear is coming from, ask other people whether they can hear it. If they can also hear the noise, it is unlikely that tinnitus is the cause.

If you can only hear the noise when you are in one place, it may be coming from an external source, whereas if you can hear it all the time, you may have tinnitus. Stress or a recent illness may be related to your symptoms.

If you have tinnitus, it may be more noticeable at certain times, or in certain situations. For example, if you have mild tinnitus, you are more likely to notice it when you are in quiet places because noisy environments can mask the sounds.

Some cases of tinnitus may also be related to your posture. For example, you may experience sounds when you are lying or sitting down or when you turn your head. Following these types of movements, pressure changes in your nerves, muscles, or blood vessels may affect the noises associated with tinnitus.

Musical hallucinations

Musical hallucinations are more common among people with long-term tinnitus and hearing loss. They are also sometimes experienced by people who have normal hearing, and those who have an increased sensitivity to sound (hyperacusis).

Certain prescription medication can sometimes trigger musical hallucinations. However, the hallucinations will usually stop when you stop taking the medication. See your GP if you think that the medication you are taking is causing your musical hallucinations. They should be able to prescribe an alternative for you.

As with other forms of tinnitus, sometimes there is no apparent reason for musical hallucinations. However, stress can sometimes be a trigger.

Pulsatile tinnitus

Pulsatile tinnitus is a type of tinnitus where you hear rhythmical noises that beat in time with your pulse. Pulsatile tinnitus is usually caused by either:

  • blood flow changes in the blood vessels near your ear, or
  • becoming more aware of the blood flow near your ears.

The blood flow through an artery can sometimes become restricted. This can occur due to a build up of fatty deposits (plaques) on the inside wall of the artery that cause the artery to narrow (atherosclerosis). The narrowed artery prevents the blood from flowing smoothly and causes it to become noisy.

If you have impaired hearing or a hearing condition, such as a perforated eardrum, your awareness of sounds that come from inside your body, such as your blood flow, may be increased. This is because your hearing becomes more sensitive and internal noises are not drowned out by external sounds. 

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Causes

Most causes of tinnitus are benign (not harmful), and the symptom is most commonly associated with old age. However, tinnitus is starting to affect a growing number of younger people the general increase in noise levels in today’s society.

Nerve damage

The most common cause of tinnitus is damage to the sensitive hearing nerves inside the inner ear. 

Sounds pass from the outer ear, through the middle ear, and on to the inner ear, which contains the cochlea and the auditory nerve. The cochlea is a coiled, spiral tube that contains many sensitive hair cells. The auditory nerve transmits sounds to the brain.

If the tiny nerves in the ear are damaged or destroyed, an abnormal stream of impulses is produced that the brain interprets as a sound. These impulses cause the noise that is associated with tinnitus.

In older people, tinnitus is often caused by natural hearing loss (presbyacusis), which lessens the sensitivity of hearing nerves.  In younger people, tinnitus can sometimes occur as a result of hearing damage that is caused by excessive noise.

Other causes

The exact cause of tinnitus cannot always be identified, even after examination by a specialist. However, as well as natural hearing deterioration and hearing damage, there are a number of other causes of tinnitus. These include:

  • a build up of earwax in the ear causing it to become blocked
  • middle ear infection (otitis media)
  • glue ear (serous otitis media)
  • otosclerosis, a hereditary condition where an abnormal  bone growth in the middle ear causes hearing loss
  • Ménière's disease a condition that affects a part of the inner ear, known as the labyrinth, and causes problems with balance
  • anaemia, where a reduced number of red blood cells causes the blood to become thinner, and to circulate so rapidly that it produces a sound

Rarer causes

Less commonly, tinnitus may also develop as a result of:

  • exposure to sudden or very loud noise, such as gunfire or an explosion
  • acoustic neuroma.  A rare, benign growth that affects the hearing nerve in the inner ear
  • impacted wisdom teeth, when wisdom teeth have not completely moved into the normal position
  • adverse reactions to certain medications such as antibiotics, diuretics, aminoglycosides, quinine and aspirin, (this is more likely when the dosage is exceeded)
  • solvent abuse, alcohol abuse and other forms of drug abuse

Stress is not a direct cause of tinnitus but it can sometimes make the symptom worse. For example, some people have reported that their tinnitus was worse during stressful events in their life, such as bereavement.

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Diagnosis

If you are having problems with your hearing, it is important you see your GP. They will examine your ears and may refer you to the ear, nose and throat (ENT) department at your local hospital.

Tinnitus is a symptom that can be caused by a wide range of different health conditions, many of which are easily treatable, such as high blood pressure (hypertension), an ear infection, or a build up of earwax.

Ruling out underlying conditions 

If there is no obvious cause of your tinnitus, your GP may refer you to an ENT specialist, such as an otolaryngologist (a specialist in treating conditions that affect the ears and voicebox) for further testing.

The specialist will do a number of tests to rule out any underlying cause of your tinnitus and to make an accurate diagnosis.

They will look at your medical history and ask you about the type and severity of the noises you can hear. Tests used to help confirm a diagnosis include:

  • hearing tests
  • balance tests
  • ear X-rays
  • a blood test

Sometimes a CT scan (computerised tomography) or MRI (magnetic resonance imaging) scan may also be recommended.

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Treatment

Tinnitus can be caused by a wide variety of different health conditions. Therefore, the treatment that is recommended for you will depend on whether your tinnitus has an underlying cause.

For example, if your tinnitus is caused by a severe or long-term ear infection, antibiotics may be prescribed. If it is caused by a build up of earwax, then eardrops or ear irrigation (where a pressurised flow of water is used to remove the earwax) may be recommended.

However, in most cases of tinnitus there is no cure, and so treatment is aimed at managing the symptom on a day-to-day basis. Staff at specialist tinnitus clinics can give you information about tinnitus, and help you develop a strategy to manage it more effectively.

Some of the treatments that may be recommended are described below.

Sound therapy

Tinnitus is often most noticeable in quiet environments. Therefore, the idea behind sound therapy is to fill the silence with sounds that you find pleasant in order to distract you from the sound of tinnitus.

Some people find that having the radio or television on provides enough background noise to mask the sound of tinnitus. Others prefer to listen to more natural, relaxing sounds, such as the sound of the sea.

A sound generator may be useful if you do not have any hearing loss. It produces a constant, gentle sound (often described as white noise), and can help you to retrain your brain to ignore tinnitus. To do this, the volume should be positioned at just below the level of your tinnitus.

Counselling

Understanding tinnitus is an important part in learning how to manage it more effectively. Counselling is a talking therapy that helps you to learn more about your tinnitus and to find ways of coping with it.

A counsellor is someone who is trained to listen, talk through problems with you and help you to develop possible solutions. Talking about your tinnitus, and how it affects your everyday life, may help you to understand the condition better and perhaps lessen its effects.

Cognitive behavioural therapy (CBT)

CBT is the term used to describe a number of therapies designed to help treat problems such as anxiety, depression and post-traumatic stress disorder (PTSD).

CBT is based on the idea that a person’s thoughts affect the way that they behave. Treatment is therefore aimed at retraining the way a person thinks in order to change their behaviour.

If you have tinnitus, and your knowledge about it is limited, you may have certain ideas about it that make you anxious and distressed. However, if these beliefs are untrue, changing them may help to reduce your stress and anxiety.

Tinnitus retraining therapy (TRT)

The tinnitus retraining therapy (TRT) technique uses a combination of sound therapy and counselling to help people to cope better with their tinnitus.

TRT involves retraining the way that your brain responds to tinnitus sound so that you start to tune out of it and become less aware of it.

TRT should only be carried out by someone who has been trained in the technique. The number of recommended sessions of TRT can vary. Some people may only need to have a few sessions, whereas others may need to have several.

Self help

Some people are able to manage their tinnitus using a number of self-help techniques. Some self-help techniques that you may find useful are outlined below.

  • Relaxation. Stress can make your tinnitus worse. Regular exercise, such as yoga, may help you relax.
  • Listening to music. Calming music and sounds may also help you to relax and fall asleep at bedtime.
  • Sound generators. These are known as white noise generators or tinnitus maskers. They may be useful for drowning out the sound of tinnitus (see Sound therapy above).
  • Hearing aids. If you have hearing loss, using a hearing aid may help to override the tinnitus noise.
  • Support groups. Sharing your experiences with other people who have tinnitus may help you to cope better with the symptom. For details of the nearest tinnitus support group in your area, contact the Royal National Institute for Deaf People’s (RNID) tinnitus helpline on 0808 808 6666.

Medication

There is currently no specific medication to treat tinnitus. However, as tinnitus can sometimes cause anxiety and depression, medication such as antidepressants may sometimes be prescribed in combination with other forms of treatment, such as counselling.

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