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Understanding Tinnitus

Patient’s Guide to Understanding Tinnitus

By Darrel Feaks, Au.D.


We hear with the brain, not the ear. When sound enters the ear, nerve impulses are created by the inner ear and sent to the brain via the auditory nerve. The brain interprets these impulses as meaningful sound.


Tinnitus is a sound heard by the person that is not created in the environment. How this sound is described varies widely with people. Some people describe it as a buzz, a whistle, a cricket, a motor running, steam etc. When the tinnitus creates a negative, fearful response from the person, it has the potential of interfering with the activities of daily living.


Damage to the sensitive hair cells in the inner ear is believed to be the most common cause of tinnitus. Theses hair cells can be damaged by the aging process, exposure to excessive noise, diseases of the ear, tumors, reduced blood flow to the ear, and chemo and radiation therapy for cancer. Other causes are wax in the ear canal, high blood pressure, and some medications such as excessive use of aspirin. It can be coming from the brain itself. For a small percentage of people, problems with the jaw joint can be responsible.


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When sound from the environment enters the ear, the brain is able to attach meaning to it. Damaged hair cells in the inner ear create a sound that is not recognizable to the brain. The word for this “different sound” is tinnitus. When the person hears this “different sound”, they often think they have a serious illness, they are going to lose their hearing, or they have a mental disorder. The tinnitus is viewed as a threat and creates fear. The resulting fear attitude, tension and frustration created by these thoughts makes the tinnitus louder. The perception of tinnitus is closely related to the limbic and autonomic systems of the brain. The limbic system controls the emotions, the autonomic system is responsible for the “fear” factor or the fight or flight response.


Approximately 15% of the adult population, 40-50 million people, has some form of tinnitus. A small percentage, approximately 10-15% has debilitating tinnitus. Research studies have placed a group of normal hearing people in a sound proof room. Thinking they were having some type of hearing test, they listened intently. Many would report hearing some type of sound. The sounds reported to be heard, were created in the nerve pathways to the brain. The sounds they describe are very similar to those described by people who have tinnitus. However, during their daily living, environmental sounds mask the tinnitus so it is not heard.


No. The vast majority of people have what is known as “subjective” tinnitus meaning that no one else can hear it. Very few people have “objective tinnitus” that can be heard by other people.


The first step is to see an Ear, Nose, Throat physician for a medical examination and a hearing test. This is especially important if the tinnitus is only in one ear. Most people who have tinnitus have some degree of hearing loss. The ENT physician can determine if there is a medical reason for the tinnitus. It is very beneficial to understand what causes tinnitus. A careful explanation of the hearing test results by the physician or audiologists will help explain how the ear works and how a hearing loss can cause tinnitus. Knowing that a serious medical condition is not present can remove enough anxiety so the tinnitus is no longer bothersome. The tension and frustration experienced by people bothered with tinnitus is often related to the associated hearing loss interfering with communication. Properly fit amplification often provides relief from the tinnitus.


At the present time, there is not medical treatment available that helps everybody. Medication that reduces anxiety is beneficial for some people.


No. The tinnitus itself will not cause you to lose your hearing.


There are many things the person can do can to get relief from their tinnitus.

  1. Since research has supported the main cause for tinnitus is noise exposure, avoid loud sounds. Wear ear protection if you are going to around loud sounds.
  2. Some people claim their tinnitus interferes with their ability to hear. The wearing of proper amplification often provides relief. Amplification, in addition to making communication easier and reducing tension, masks or reduces the loudness of the tinnitus while the aid is worn.
  3. Try not to dwell on your tinnitus. The more you think about it, the louder it will sound to you.
  4. Keep your mind occupied with other things. Notice when you are occupied with pleasant activities, you will not be aware of your tinnitus.
  5. Avoid very quiet environments. The absence of noise will make the tinnitus more noticeable.
  6. Because it is quite, falling asleep is often a problem for many people with tinnitus. There are CD’s available that produce different sounds that will push the tinnitus into the background so it is not as noticeable. For example sounds of the ocean, nature sounds, etc. will mask or reduce the loudness of your tinnitus so you can fall asleep. The sound is played just loud enough so the loudness of the tinnitus is reduced allowing the person to fall asleep.
  7. Tinnitus can create considerable stress and frustration. The person needs to learn how to relax. Help from a counselor trained in stress reduction may be needed by some individuals.
  8. Food or drinks that have caffeine such as tea, coffee, coca-cola, chocolate, alcohol, tonic water, nicotine, can temporarily worsen tinnitus. Avoid excessive salt as well. Smoking is especially harmful because it narrows blood vessels that supply oxygen to the delicate hearing mechanism. Avoid high amounts of non-steroidal anti-inflammatory drugs (NSIAD’s) such as aspirin, ibuprofen, Motrin and Aleve.
  9. People who have normal hearing can also have debilitating tinnitus. When stress reduction techniques, monitoring food and beverage intake etc. is not sufficient, tinnitus retraining therapy (TRT) can be beneficial. TRT is a process where noise generators are used. The generator is worn like binaural hearing aids. It produces a wide band noise meaning it has many frequencies. The purpose of the noise is to create an environment that pushes the tinnitus into the background. It is still audible, but not as distracting as it was. Because tinnitus creates fear (a function of the autonomic nervous system), the goal of TRT is to retrain this system to accept the tinnitus as “just another sound”. When this happens, the fear, anxiety, and frustration is substantially reduced. This process may take as long as two years and must be administered by an audiologist who has received special training.