Ringing, Buzzing, or Humming – What is Tinnitus and What Can Be Done About It?
There are two types of tinnitus. Subjective and objective tinnitus.The most common form of tinnitus is subjective tinnitus which accounts for most tinnitus cases. It is the perception of noise in the ears or head in the absence of external noise. Put simply, it is a noise only the patient with tinnitus can hear, which can vary in loudness, pitch, and frequency. Objective tinnitus is the less common type of tinnitus. This is sound that can be heard by others or during a physical examination by a GP. This is an extremely rare type of tinnitus and may be caused by a blood vessel problem, a middle ear bone condition or muscle contractions. If a patient suffers from objective tinnitus they should consult with their GP as soon as possible for treatment and medical intervention. Tinnitus is the symptom of an underlying cause and is difficult for any one test to detect. There is a huge amount of variability in personal responses to the presence of tinnitus. For some patients, tinnitus is a non- bothersome, low volume sound in the background and for others the sound is loud, intrusive, emotionally unsettling and can impact their ability to function on a day-to-day basis. As such, tinnitus testing requires a tailored approach. Tinnitus testing often requires a battery of individual subset tests to help identify and help a patient habituate to the noise. Whilst there is no simple cure, like taking a tablet, the audiologist works with the patient to help uncover the possible trigger for their tinnitus. This helps to understand how it is affecting the patient’s life and provide them with tools and strategies to help habituate to the noise over a period of time. In simple terms, habituation refers to the ability to learn to tune out non-essential stimuli and focus on the things that really demand attention. By paying less attention to tinnitus sound, the sound becomes less and less bothersome and reduces the burden. Tinnitus tests require a combination of assessments to test the hearing pathways as well the patient’s thinking patterns and psychological impact of tinnitus on their life.
Tinnitus tests often include:
- A thorough examination of the ear to ensure there are no barriers to the hearing pathway i.e., wax, infections, bony growths, fluid etc.
- An assessment of the hearing through audiometry testing. The three parts of the ear: outer, middle, and inner ear are assessed.
- In some cases, MRI testing may be recommended to ensure no abnormal anatomical, underlying medical pathologies such as inner ear tumours which may be responsible for the tinnitus.
- An assessment of the clarity of the hearing through speech discrimination tasks.
- A quality-of-life questionnaire to determine the burden on the individual’s quality of life
- Sound stimulation whereby certain sounds are played in the affected ear to determine if the patient is less or more aware of their tinnitus.
What Are Possible Causes of tinnitus?
Causes of subjective tinnitus may include but are not limited to the following:
- Head/neck/spine trauma
- Hearing loss
- Ear wax build up
- Certain medication use
- Neurological diseases- such as Multiple Sclerosis, growth of acoustic neuromas
- Middle ear pathology- such as ear infections, Eustachian tube dysfunction
- Meniere’s disease
- Temporomandibular joint disorders
- Psychosocial issues- sleep disturbance, anxiety/depression, stress etc
For most people with tinnitus, their tinnitus can also be accompanied by some level of hearing loss. 90% of those with tinnitus, have some degree of hearing loss. The change in hearing is known to alter the neural pathways from the ear to the brain and this is thought to trigger the onset of subjective tinnitus. The worse the hearing loss, the less the patient hears environmental sounds around them, and the louder the sound of tinnitus is inside their head. For patient’s with a permanent hearing loss, hearing devices are usually the best way to reduce the awareness of tinnitus. When hearing aids are fitted for the first time, and sounds are boosted to the level they should be heard. Therefore, the internal tinnitus noise will become less noticeable. In addition to this, once the patient has adapted to the amplification provided through hearing devices, the patient will notice a significant reduction in stress and fatigue which are tinnitus aggravators.
Tinnitus tests are therefore important in the diagnosis of hearing loss, subjective or objective tinnitus, possible triggers for the onset of noise, intervention, and treatment. These are important in helping the patient habituate and become less affected by the tinnitus.