Tinnitus Support

What is tinnitus

Tinnitus is a sensation or awareness of sound that is not caused by a real external sound source. It can be perceived in one or both ears, inside the head or in the person’s immediate environment.

Although it is commonly assumed to be a ringing noise, tinnitus can take almost any form, including hissing, whistling, humming, or buzzing. Some people hear a single sound whereas others hear multiple noises. For some, the sound is constant: for others it is constantly changing.

A few people have tinnitus that has a musical quality or resembles distant, indistinct speech.

Some people have tinnitus that has a rhythmical nature. This may be in time with the heartbeat in which case it is called pulsatile tinnitus. Alternatively, the rhythm may be unrelated to the heartbeat and have a ticking, fluttering or tapping quality. Rhythmical tinnitus can occur on its own or can coexist with non-rhythmical tinnitus.

What causes tinnitus

There are still many unanswered questions about the exact cause – or causes – of tinnitus. What is apparent, however, is that we need to consider more than just the ear. Although most people with tinnitus have some degree of hearing loss, a significant number have normal ears and a normal hearing test: hearing loss is not essential to develop tinnitus.

Several studies have been performed where people who do not have tinnitus were placed in soundproofed rooms and told to listen intently. In this situation almost everyone becomes aware of a sound sensation. This is because, in the absence of external sound, the brain tunes into random electrical signals in the nerves of hearing and the auditory pathways within the brain itself.

Common triggers for this process are emotional shocks or loss of hearing, either gradual or sudden. However, in many people, the trigger is unknown. Once we become aware of the tinnitus signal, it draws the attention of those parts of the brain that deal with our emotions, making the tinnitus seem more distressing.

A few people have tinnitus that is attributable to a real sound, generated inside the body by blood flow or muscular activity. This type of tinnitus may be detectable by other people, either just by careful listening or by using a stethoscope. This kind of tinnitus is known as objective tinnitus.

What are the symptoms

Tinnitus is sometimes known as ‘ringing in the ears’, but if you have the condition you might hear:

Tinnitus is a symptom in itself.
humming sounds
hissing
whistling
clicking
roaring
whooshing
buzzing

How is tinnitus diagnosed

The first thing your specialist will do to diagnose your condition is to ask some questions about your symptom. This is actually all that is necessary to reach a diagnosis and there is no special ‘tinnitus test’. The specialist may ask questions about your sleep, concentration, and mood to determine how the tinnitus is affecting you.

Of course, your specialist will want to know as much as possible about your hearing and will perform a full examination of your ears. Other areas such as the nose, jaw joints and throat may be examined. If the specialist thinks that you may have objective tinnitus he or she may listen around your ear and neck with a stethoscope.

In almost all cases the specialist will arrange some tests. The most common test is a hearing test (pure tone audiogram). Because many people with tinnitus complain that their ears feel blocked, your specialist may request a test called tympanometry which measures the pressure inside the ears – this is quick and non-invasive.

There are some hearing tests that try to match the loudness and tone of a person’s tinnitus, but these tests can be difficult to perform and do not influence treatment greatly. Many specialists therefore do not request these tests.

For selected patients, the doctor may wish to order an MRI scan, particularly if the tinnitus is one-sided or if the hearing test is asymmetrical. For some types of tinnitus, particularly pulsatile tinnitus, other tests such as CT scans or ultrasound scans are sometimes utilised. Blood tests may occasionally be required but this is unusual in the diagnosis of tinnitus.

Monitoring and re-assessment

Tinnitus is such a variable symptom that it is extremely difficult to make any hard and fast rules regarding long-term management. This is a very individual decision that will be made by you and your specialist.

Uncertainties

There are many questions about tinnitus that remain to be answered, regarding both the mechanisms by which it is generated and the search for more effective treatments. Various research avenues are currently being explored, including the use of certain types of drugs and electromagnetic stimulation of the auditory system.

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