Understanding Tinnitus. Tinnitus is a very frequently occurring experience, for which there are few treatment options.
Tinnitus is a common medical condition, affecting 10-15% of the population. In simple terms, it is the perception of sound when there is no external source of sound present. For some, tinnitus is an issue that builds gradually. For others, it can present itself quite suddenly. It can be a temporary affliction or one that, unfortunately for some, becomes an ongoing issue.
300 Million People are affected by tinnitus around the globe.
60% of skilled workers over the age of 60 reported a noise in their ears.
Currently, there are over 1.9 million U.S. Veterans who receive compensation for tinnitus.
People’s experience of tinnitus differs greatly. Most commonly, you will hear it described as an irritating ringing in the ears. You will also hear it described as a buzzing, humming, hissing, or whistling sensation. It can present itself in one or both ears, in the head or even outside the head in certain cases. For many, it’s a constant or fluctuating sound that they will hear all day long - even more so when it’s quiet (such as at night, when there is less external sound to dull it down) - but for others it may be something that comes and goes. Some sufferers will report hearing one single sound whilst others can hear a multitude of sounds. On top of all of these common variations, the sound itself can also vary in both pitch and loudness.
Who gets Tinnitus?
Though not as widely discussed as some other health concerns, the reality is that around 10-15% of a population will experience tinnitus. To put that into context, if you take the latest population figures from the US (which, in 2019, was just over 328 million), that’s 32-49 million people who will live with tinnitus symptoms. People of all ages can get it; even children. Statistically though, it’s more common in adults as it tends to be associated with hearing loss which is believed to increase with age. Many people get tinnitus for a short period of time (‘acute tinnitus’ is tinnitus that lasts for a maximum of three months). It can manifest after being exposed to loud music, perhaps at a concert or via headphones, but it can also arise due to an excess in ear wax, or as a result of a cold or a flu. In a lot of these cases, it will pass, but for some, it doesn’t go away. Within that 10-15% of people who experience tinnitus, for up to 15% of them, it will be a chronic and bothersome issue.
Types of Tinnitus
Generally speaking, there are two types of tinnitus: Subjective Tinnitus and Objective Tinnitus.
Subjective Tinnitus is tinnitus that only the person themselves can hear. This is the most common type of tinnitus, encompassing any and all of the aforementioned symptoms.
Objective tinnitus is tinnitus that your GP can hear when they do an examination and put a stethoscope to the ear. This rare type of tinnitus may be caused by a blood vessel problem or ear muscle contractions.
Lenire is a bimodal neuromodulation treatment that focuses on Subjective Tinnitus; as such, we will refer only to Subjective Tinnitus below.
What causes Tinnitus?
Hearing loss, as a result of ageing, is by far the most common cause of tinnitus. Other common causes of tinnitus can include eardrum perforation, middle ear infection, Ménière’s disease, acoustic trauma caused by sudden exposure to loud noise, certain medications, head injury, temporomandibular joint disorder (TMJ) and stress.
Less commonly, tinnitus is linked to hearing loss caused by a blockage or ear condition that affects the outer or middle ear and stops sound waves from passing into the inner ear.
Regardless of how you arrive at a hearing loss issue - be it due to ageing, injury, exposure to loud noise, etc - tinnitus is believed to then come about as a result of ‘neuroplasticity’ which happens in the brain. Neuroplasticity is the ability of the brain to change or rewire itself, throughout an individual’s life. Neuroplasticity can sometimes be very helpful (adaptive) - for example, the ability to enhance our memory or learn an instrument. With tinnitus, however, it is neuroplasticity that does not benefit the individual. This is known as ‘maladaptive neuroplasticity’, resulting in an imbalance of events in the brain that can lead to unfavourable or bothersome health or neurological conditions, such as tinnitus.
Here’s how it happens: following hearing loss, the brain attempts to rewire itself. This rewiring happens when our brain cells find that they have been deprived of the sound they’re used to - in other words, they’re lacking in ‘acoustic activation’, resulting in changes to the auditory pathways between the ear and the brain. For reasons that are not fully understood, it is believed that these altered brain patterns - caused by unhelpful neuroplasticity - are what gives rise to the experience of tinnitus in most people.
What to Do if You Have Tinnitus
For a lot of people, identifying the specific cause of their tinnitus symptoms proves difficult. For this reason, it’s important that patients experiencing tinnitus go and see their GP for a full examination in order to diagnose the underlying cause. In some cases, resolving the cause may alleviate the perception of tinnitus, such as an ear infection.
If the GP cannot find an underlying cause, patients may be referred onto an ENT Consultant for further investigation. An MRI / CT scan may be carried out to further clarify the problem. Patients may also be referred on to an audiologist to have their hearing assessed.
Audiologists who specialise in tinnitus can also explain to people the different types of treatments and management techniques available and highlight those which they deem as most suitable to a particular individual.
Is Tinnitus a Problem?
The majority of people who have tinnitus are not particularly bothered by it; they may find it only mildly annoying and ultimately learn to live with it. For some people, however, living with tinnitus can have a serious impact on their quality of life, triggering anxiety, stress, depression and interfering with hearing, sleep and concentration. Whether it’s mild or severe, the good news is that tinnitus is not a life-threatening condition.
Fortunately, the majority of people find that their tinnitus gets better over time. This is because the brain gradually learns to ‘filter it out’ and not pay attention to it. This process is called ‘habituation’. Habituation is one of the main goals of tinnitus treatment and management therapies.
There is currently no cure for tinnitus. That being said, treatment and management therapies are available that can help reduce the impact of tinnitus so that people can live a normal active life. The aim of treatments, such as sound therapy, relaxation therapy and cognitive behavioural therapy (CBT), is to help people effectively ignore or manage their tinnitus to the point where it is no longer a problem. Some treatments also aim to reduce the stress that can be associated with tinnitus.
Of course, if there is an underlying cause of tinnitus that can be easily treated, such as an ear-wax blockage or an ear infection, treating this may get rid of the tinnitus.
Audiologists may recommend one or more of the following options: sound therapy, including sound generators and hearing aids, relaxation exercises such as yoga, Cognitive Behavioural Therapy, Tinnitus Retraining Therapy, or Neuromodulation Treatment.
Whichever treatment path is recommended to you, it is important to understand that it can take time for things to improve, be it the stress associated with tinnitus or the tinnitus symptoms themselves. If you are living with tinnitus, working on your mindset or your perception of the tinnitus is key. The goal of all treatment plans is essentially the same: to break the negativity associated with tinnitus. Some immediate relief may be achieved, but ultimately the aim is to become more comfortable with the tinnitus, to realise that it’s not life threatening and, most importantly, that patients are always in control of their response to it.
What’s recommended for each patient will depend on the nature of their tinnitus, how it impacts them and whether they have any other underlying problems, like hearing loss, or stress. It may also depend on what is comfortable or acceptable for each patient.
How has tinnitus affected you ?
It can be very bad at night-time or in the morning, that’s when it’s at its worst.
Edward, Clinical Trial Participant
How has tinnitus affected you ?
I wouldn’t go to parties, or things like that in pubs and nightclubs…that had loud exposure or loud music….I just couldn’t do it.
Noel, Clinical Trial Participant