What is Tinnitus?
- Tinnitus is not a disease in itself – it is a physical condition experienced as noises or ringing in a person’s ears or head when no such physical noise is present
- It is one of the most common symptoms to affect humanity
- It is a symptom of a malfunction of the auditory process
- There are similarities between phantom pain and tinnitus
- Approximately 17-20% of the adult population has tinnitus (In excess of 2 million people in Australia).
- Types of tinnitus: temporary, permanent, intermittent, pulsatile and ‘disco’
- Some of the common sounds associated with tinnitus are ringing, buzzing, roaring and humming
- Not everyone who has tinnitus ‘suffers’.
- The science tells us that those who suffer do not have different tinnitus from those who do
- Over 50 sounds have been reported
What triggers Tinnitus?
There are many possible triggers of tinnitus. Among the most common are:
- exposure to excessively loud noise
- extreme stress or trauma
- age-related hearing loss
- some prescription and non-prescription drugs
- sleep deprivation
- hormonal changes in women (particularly perimenopause & menopause)
It is important to consult your doctor and an Ear, Nose and Throat (ENT) specialist to establish whether there is any underlying treatable medical reason for your tinnitus.
Mechanisms of Tinnitus
When the brain first hears tinnitus it attempts to classify the sound from its stored data of sounds with which it is familiar. When no ‘match’ can be made from previous experience, the brain focuses on the sound to such an extent that the sound is effectively magnified and the brain gives it a level of importance it does not deserve.
This happens in the same way as when you are alone in your house at night and you hear the sound of a blind knocking against a window sill, or the floor boards expanding or contracting. Your senses go into a state of high alert, and the sounds are given unnecessary significance. This is because the limbic system within the brain is interpreting the sounds as signals of possible danger.
In the same way, whenever you are aware of your tinnitus, your brain automatically interprets the sounds as a sign that something is terribly wrong, or as a danger signal. If this continues, your mind becomes obsessed with the sound, continually focusing on it and thus maintaining your body and mind in a state of high alert.
If this fearful pattern of thought is left unchecked, the negative response to the sound is reinforced. This ‘programming’ of the brain must be corrected so that you learn to manage your tinnitus rather than letting it manage you.
Tinnitus in the early stages
Tinnitus can be extremely debilitating in the early stages and affects your ability to work or cope with normal life activities. People with tinnitus may suffer from:
- extreme distress (this is common)
- frequent mood swings, depression or anxiety attacks
- tension, irritability or frustration
- poor concentration
- sleep problems
Extreme distress, especially in the early stages, is common. However, the tinnitus does not cause these problems directly. It is your emotional response that causes the problems. Modifying your emotional response eliminates the majority of these problems.
Thoughts of suicide are common when a person is in the early stages of tinnitus. If you are experiencing this level of distress, call Lifeline (Tel. 13 11 14) or the Suicide Call Back Service (Tel. 1300 659 467).
When you first learn you have tinnitus it is important you do the following things:
- consult your doctor, an audiologist (hearing specialist) or an ear, nose and throat specialist to check that you do not have an underlying medical condition
- learn all you can about tinnitus from reputable sources
- accept that you have tinnitus – once you have done this, you are halfway to mastering it
- understand that you may be depressed and tired in the early stages, but that this will pass as you learn to manage the condition
Remember that, in time, you really can learn to manage your tinnitus and reduce the negative emotional effects it has on you.
Critical Factors Affecting Tinnitus in the Early Stages
The following factors have a big effect on how a new tinnitus sufferer manages their tinnitus:
- the quality of the medical examination
- comments made by members of the medical profession
- the accuracy of the information given to the patient
- whether the patient is made aware of the tinnitus support services available
- whether the person receives appropriate counselling
Does everyone have tinnitus to some degree?
- Virtually everyone is able to hear their own tinnitus if placed in a quiet enough place (such as a recording studio).
- About 1 in 4 adults regularly hear their own tinnitus in quiet surroundings, especially in bed at night; of these about 1% have severely distressing tinnitus.
Why do we become aware of tinnitus in normal situations?
- Almost everyone finds their tinnitus worse if tired or stressed (a headache is often worse then too)
- Quiet surroundings (less other sound to distract the hearing system)
- Anything which makes the hearing worse (wax impaction in the ear canals, exposure to high noise levels, ear infections, etc)
- Any inflammation in the neck, jaw joints, teeth or sinuses
- Certain medications – Some consistently make it worse (such as high doses of aspirin or quinine). Others, of which there is a long list, have occasionally been found to have an effect in isolated people. Of course, medications which have a side effect of damaging the cells of the inner ear, such as one family of injected antibiotics (such as kanamycin) and certain anti-cancer drugs, can cause permanent tinnitus
- Certain foods – like medications, there is a huge list of foods which occasionally make tinnitus worse. In particular, any foods which stimulate nerve excitability, such as caffeine in high doses, may make tinnitus seem louder
- For many people, talking about, thinking about and listening for their tinnitus. This is probably why many people with tinnitus notice it less when busy (some other people find talking about it very helpful).
What is central auditory gain and what is its relationship to tinnitus?
The auditory system has a mechanism that can increase the perceived loudness of things that we consider important or threatening. This mechanism is called central auditory gain.
In many situations this works to our advantage. A mother with a newborn child has been known to sleep through a thunderstorm but wake to the first sound of her new baby in another room. You have all probably experienced the situation where in a crowded social gathering, you hear someone mention your name elsewhere in the room. You have no idea what the other group of people are discussing, but you do hear the mention of your name. Often while driving our brain can seem to be in ‘auto pilot’, until the siren of an emergency vehicle instantly focuses our complete attention on our driving.
Unfortunately, this extraordinary mechanism of central auditory gain can also work to our detriment. If we are worried or even fearful of our tinnitus, not only may we be aware of it in quiet situations, but also due to the increased perceived volume, in a noisy environment.
Dr. Peter Tungland, an audiological physician in Britain, in a presentation at a tinnitus conference in Cambridge explained the problem in this way:
‘Many patients are already in a heightened state of arousal when they become aware of tinnitus. Most people start to worry, wondering if something is wrong with their hearing, if they have sustained damage in relation to a trauma or even thinking they may have a brain tumour. This of course, increases the arousal further, so there may be the need to check, consciously or unconsciously on the presence of the sound in order to monitor it. By checking and rechecking, the auditory pathway of the tinnitus identification passing through the brain becomes more and more used.
What started as a little track through the wood (brain) increases in size due to increased use. It may develop into a road or even a motorway, in neurological terms, because of the increased demand for neurological activity involving more and more neurons. It’s like any other learning process – with practice your brain becomes better at it.’
How does the brain respond to a malfunction in the auditory system?
Tinnitus can emerge and persist by simply hearing the first sounds of tinnitus and then worrying or even becoming fearful of the sound. However, I suspect that many people’s tinnitus is triggered by other factors, and then the worry and fear take over and the tinnitus becomes an entrenched problem.
Four common causes are exposure to excessive noise, periods of stress and trauma in one’s life, age-related hearing loss and many prescription and non-prescription drugs.
Tinnitus researcher Aage Moller, PhD, tried to determine what could be physically wrong in the cases of severe tinnitus and severe pain. In a paper presented at the 6th International Tinnitus Seminar in Cambridge, UK, 1999, Moller outlined his belief that pain and tinnitus are both caused by changes in the central nervous system as a consequence of the plasticity (changeability) of the central nervous system.
That means that the brain can alter its function either because of specific input or because of a deprivation of input.
In either case, the result can be chronic pain or chronic tinnitus.
Norman Doidge in his best-selling book, ‘The Brain That Changes Itself’, mentions that there are similarities between chronic pain and tinnitus.
Phantom limbs are troubling because they give rise to a chronic ‘phantom pain’ in 95% of amputees that often persists for a lifetime.
How do you remove a pain in an organ that isn’t there?
Doidge also mentions that the neuroplastician Edward Taub has begun collaborative experiments in the search for a cure for tinnitus that can be caused by plastic changes in the auditory cortex.
So it would seem that a certain part of the brain becomes over active in its response to a malfunction in the auditory system, thus generating the sounds of tinnitus.
Neuroplasticians believe the brain attempts to ‘re-wire’ itself to restore normal function, and it is this brain activity that gives rise to chronic tinnitus.
We now know that tinnitus is not an ear problem, but a brain problem.