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(Almost) everything you need to know about tinnitus

What Is Tinnitus?
Tinnitus is a common medical condition affecting approximately 15% of the global population (i). It is a bothersome neurological issue causing people to experience a sound or noise that does not have an external source. Although it is more common in adults, it can affect people of all ages – even children.


Tinnitus is most often described as a ringing in the ears, but it can vary significantly from person to person and take many forms such as ringing, roaring, clicking, buzzing, humming, hissing and even cricket-like sounds. For those living with tinnitus, it can be experienced intermittently, or it can persist all day long. For many, it can become particularly bothersome at night, when it gets quieter.


In mild cases, it’s an issue that the person can learn to live with. In more severe cases, tinnitus can result in significant stress, negatively impacting the person’s quality of life. Though no cure has been found yet, there are both well established and emerging paths towards the effective management of tinnitus, ranging from information to support, counselling and various forms of treatment and therapy, some of which are very promising.


Types of Tinnitus
The experience of tinnitus varies greatly from person to person. It may present itself in just one ear or both ears, the latter of which is more common. Unilateral (one ear) tinnitus often requires further investigation as it is more likely to be a sign of an underlying health condition. There are then cases where the sound will be perceived as coming from the centre of the head as opposed to the ears, making it difficult to pinpoint the exact location.


Tinnitus may be experienced as a single noise or tone or described as having two or more components (multiple tones). The noise may also be continuous or in cases of what’s known as ‘pulsatile tinnitus’, the noise may present itself in a rhythmic pattern, sometimes in sync with the heartbeat. Although ‘tinnitus’ comes from the Latin word for ‘ringing’, it can take a variety of forms including buzzing, whistling, hissing, whooshing, or humming. Some people become aware of their tinnitus only when they are in quiet environments, whilst many others will experience it even in noisy environments. For some people, their individual experience of tinnitus will also vary; the loudness of the condition, the pitch and the quality of their tinnitus can change day to day.


Diagnosing Tinnitus
There are two different categories of tinnitus: Subjective and Objective tinnitus. Subjective is the most common type of tinnitus and is only audible to the individual who is experiencing it. It’s estimated, by the Americal Tinnitus Association, that the vast majority of cases, approximately 99%, are cases of subjective tinnitus (ii). This means that during an examination, a healthcare professional would not be able to hear it. It can be initiated by issues in the outer, middle or inner ear. It can also stem from problems with the hearing nerves or from the nerve signals into your brain that interpret sound.


Objective tinnitus, on the other hand, can often be audible to both the individual who experiences it as well as their clinician/doctor. Objective tinnitus is quite rare.


In some cases tinnitus can also come about spontaneously, and then disappear as suddenly as it began. Whether it’s a short bout of tinnitus that comes and goes within minutes or the kind of tinnitus that is experienced all day every day, it’s important to remember that despite the distress it may cause to a person, tinnitus is generally not life threatening.


What Causes Tinnitus?
Tinnitus can occur due to a variety of causes related to dysfunction along the human auditory system (our hearing system) from the outer ear up through the auditory nerve and the brain itself but is most often associated with some type of hearing loss.


With subjective tinnitus, some of the most common causes include:


• Age-related hearing loss which is called presbycusis.

• Exposure to a noisy environment that can cause noise-induced hearing loss.

• Head or neck injuries or trauma to the head or neck that can affect the inner ear, its nerves and the brain function linked to hearing.

• Temporomandibular joint (TMJ) disorder, which is a pain in the jawbone that can cause swelling of the joint and in some cases lead to tinnitus.

• Some medications, for example antibiotics and antidepressants, which can trigger tinnitus symptoms or make them worse depending on the type and dosage of the drug.

Objective tinnitus is believed to be caused by an underlying medical condition such as:

• A blood vessel disorder that is known by those in the medical field as ‘pulsatile tinnitus’. This can arise because of high blood pressure or a build-up of cholesterol and other deposits in the blood vessels close to your ear. This causes your ear to hear the beats of the blood as it moves forcefully through the vessel.

The Impact of Tinnitus
Tinnitus affects people in different ways. In milder cases, those living with tinnitus are not particularly bothered by it; at the very most they may find it only somewhat annoying. Fortunately, these people learn to live with it. But for a lot of people, where the tinnitus is severe and perhaps constant, it can cause significant stress, negatively impacting their quality of life.


The initial onset of tinnitus is quite often linked with stress, which can lead to negative thoughts and emotions, particularly if the tinnitus persists. Tinnitus also becomes more of a problem when it is perceived as a threat, appears continuously intrusive, or when patients have difficulty coping. Tinnitus can lead to a repeating cycle of annoyance, mood changes, fear, and anxiety, all of which are associated with tinnitus severity.


The Vicious Cycle of Tinnitus
Our brain’s primary role is to ensure our survival. The human brain often classifies this tinnitus percept as something negative and, due to human nature, places more focus and importance on what the brain deems threatening or negative.


This negative association is reinforced when tinnitus is first experienced; in some cases, an unpleasant or traumatic event may have occurred at the same time. Anxiety and annoyance caused by the event are then linked to the tinnitus itself, which in turn, causes the tinnitus to become more of a problem.


It is not always linked with a negative event, however. For some, regardless of how or why it has come about, the continuous presence of tinnitus symptoms can understandably lead to anxiety and stress. Once this negative connection is established, a vicious cycle can begin that affects the emotional centre of the brain, known as the limbic system. When tinnitus is perceived, it can prompt several emotions, including fear, danger and unhappiness. These can in turn cause emotional reactions such as anxiety and stress, thus reinforcing the tinnitus and making the cycle repeat itself to worsen the overall tinnitus experience. For this reason, working on the person’s mindset is a crucial aspect of managing the tinnitus overall.


If you want to better understand tinnitus, visit the Understanding Tinnitus section of our website. To find out more about the Lenire device, which can help you manage your tinnitus, find a Lenire clinic near you below.


References:

(i) https://www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156

(ii) https://www.ata.org/understanding-facts

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