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That annoying sound no one else hears

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November 8th, 2016

“Approximately 40 million people in America have constant tinnitus, and 99.9 % of them also have hearing loss.”

Ringing, roaring, buzzing, clicking, hissing—these are some of the ways people describe tinnitus, also called ringing in the ears.

“Approximately 40 million people in America have constant tinnitus, and 99.9 % of them also have hearing loss,” says Dennis Fitzgerald, M.D., physician and assistant professor of otolaryngology at Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, Pa. “Hearing loss is a symptom and tinnitus is a symptom. One doesn’t cause the other, they just coexist.” 

Why it happens

“Tinnitus is a problem with the hair cells of the inner ear,” Fitzgerald explains. “These cells normally change sound vibrations into nerve impulses, which then travel to the brain where sound is perceived. With tinnitus, the hair cells become unstable and begin to send impulses to the brain on their own. Thus, you perceive sounds that aren’t actually there.”

Tinnitus can have many underlying causes—long-term or sudden exposure to loud noise (the most common cause); sinus infections; or, less commonly, heart or blood vessel disease, brain tumors, or thyroid abnormalities. “Tinnitus can be caused by something as minor as earwax obstructing the ear canal,” says Denise Zwahlen, M.D., medical director at Tallgrass Creek, an Erickson Living community in Overland Park, Kans. “There can also be no apparent explanation.” 

Certain medications have been found to cause tinnitus as a side effect—over 200 of them, in fact. “People with tinnitus should bring a complete list of prescription and over-the-counter medications to their doctor in order to determine if any of them are associated with their symptoms,” Zwahlen says. 

“Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) are often implicated in hearing loss and tinnitus,” Fitzgerald says. 

According to the American Speech-Language-Hearing Association, drugs that damage hearing, such as chemotherapy and certain antibiotics, may cause tinnitus.

Living with tinnitus

Studies show only about half of people with tinnitus discuss it with a doctor. “Start with your primary care doctor,” Zwahlen says. “Some tinnitus can be reversed, depending on the cause.” Some people may need to see an ear, nose, and throat doctor (otolaryngologist) or an audiologist for an evaluation. There is no cure for chronic or long-term tinnitus, but you have several options for managing it. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), hearing aids are often helpful for people with tinnitus accompanied by hearing loss. The better you can hear, the less you may notice tinnitus. Cochlear implants can work the same way for people with severe hearing loss. 

Counseling is another option that many researchers think is underused as a treatment. “Programs teach habituation techniques or brain retraining programs to reduce the intrusion of tinnitus into your life,” Fitzgerald says. “These programs are usually administered by special audiologists.”

If tinnitus interferes with your sleep, which is a common problem, you can use background noise from a sound machine or another source. “Having other sounds in the room, such as white noise from a fan, can mask tinnitus enough so you can sleep,” Zwahlen says. Your doctor may also prescribe medications to help you sleep.

Tinnitus can have a significant effect on quality of life, so some people need to seek out other treatments. For example, small wearable electronic sound generators are available that emit soft pleasant sounds to help mask tinnitus. A new technique called acoustic neural stimulation is an option for people who have very loud tinnitus. This technique uses a palm-sized device and headphones to emit an acoustic signal embedded in music. It works by gradually desensitizing you to the tinnitus by stimulating changes in the brain’s nerve circuits. This technique is promising, as it has been shown to be effective in a significant number of study volunteers.  

Beware of over-the-counter supplements (such as zinc or antioxidants) or other remedies that claim to cure tinnitus. According to NIDCD, there is no scientific evidence that any of these are effective.

Red flags

Tinnitus can be a signal that something serious is going on. “If you have tinnitus or hearing loss in one ear, see your doctor right away. It may be a sign of a tumor,” Zwahlen says.

While considered a rare phenomenon, pulsatile tinnitus, in which you hear sounds that coincide with your heartbeat, it can be a sign of narrowing of blood vessels. In rarer cases, it could be a sign of a tumor or aneurysm. “Pulsatile tinnitus, especially when heard on only one side, can be a sign of a serious problem,” Zwahlen says. “You need to be seen by your doctor to establish a cause.”

Although scientists know some of the causes of tinnitus, they are still unsure about exactly what is happening in the brain that makes someone experience the illusion of sound. Several studies are focusing on brain stimulation, implantable devices, and ways to reset the nerves in the brain that are associated with tinnitus.

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