Tinnitus (ti-NIGHT-us or TIN-i-tus): The perception of sound when no sound is present.
“There is nothing that can be done about the ringing in your ears, so you must learn to live with it.”
Ringing in the ears is successfully treated in over 90% of patients. Almost all of us have experienced at some time in our lives a ringing sound in our ears. You may have experienced it after exposure to loud noise in the environment around you, such as loud concerts, engine noise, or firearms. This ringing sound can also occur for other reasons, like taking certain medications (even aspirin) or perhaps during a very stressful time in your life. The sound in your head is called tinnitus. The word is derived from the Latin word for ringing. It is often a constant sound and can be particularly bothersome at night. It is usually present in both ears but can also occur in only one ear. It is estimated that over 30 million people in the U.S. suffer from this condition. In my years of practice, I have heard patients use many different comparisons to describe the tinnitus sound that they hear in their heads:
Crickets, Roaring, blowing, ocean like noise, high tension wire noise, and many other sounds.
Believe it or not, there is a type of tinnitus which is heard not only by the patient, but also can be heard by the examiner. It is called “objective” tinnitus and is rare. The most common type of tinnitus is a continuous sound which is heard in both ears. It is usually described as a high pitched ringing sound and is almost always subjective rather than objective. Patients usually says it is worse at night or when they are in a very quiet room. Occasionally it has been known to be louder than the patient’s own voice. In these cases, the patient is usually quite distressed or even depressed because of it. When high pitched tinnitus is present there is often an associated high frequency “nerve” hearing loss.
There are several things that can cause or worsen tinnitus. Many over the counter medications can cause or worsen existing tinnitus, products like aspirin, Pepto Bismol and Alka Seltzer, which may contain salicylates, the group name for drugs of this type. Of course aspirin is also a powerful medication to help prevent heart attacks, so I usually do not recommend that patients discontinue aspirin products without first speaking to their primary care physician about the risks and benefits of aspirin therapy. Other common factors that contribute to making tinnitus worse are nicotine containing products, caffeine, increased stress, and depression. Nicotine and caffeine are stimulants and I always advise patients to quit smoking or chewing tobacco, whether or not they have tinnitus. Doing so can also help to reduce symptoms of tinnitus. I also advise patients to discontinue caffeine containing products or at least switch to half-caffeinated beverages to decrease their caffeine consumption. There is a recently published study (2014) in which the researchers found that women who consumed 6-8 cups of coffee daily actually had improved tinnitus! So the role of caffeine restriction remains unclear in the treatment of tinnitus.
Individuals who have lots of life stress also more commonly suffer the worst tinnitus symptoms. Usually when they go away on a stress-free vacation, the tinnitus is less noticeable or absent. In this case, I often counsel patients to reduce their current stress level as much as possible. This can be achieved in a variety of ways:
- Picking up a relaxing hobby
- Biofeedback methods
- Stress relieving medication
Temporomandibular [tem-puh-roh-man-dib-yuh-ler] joint arthralgia
A condition related to dental problems usually caused by clenching or grinding the teeth. The grinding often occurs at night (when you may not even know you are doing it), and it can also be caused by missing teeth and/or dental malocclusion. It is usually treated by correcting the underlying dental problem, including a soft diet or a dental device to prevent tooth grinding.
There is a condition called “Meniere’s Syndrome” an inner ear condition in which patients suffer from tinnitus (usually in only one ear) associated with a changing hearing loss, a “plugged” feeling in the ear and dizziness. It is primarily treated by sodium restricted diet and diuretics (water pills).
In patients who have both tinnitus and associated high frequency hearing loss, by far the most effective treatment for both conditions is hearing aids. I have seen excellent results of 80-90% reduction in tinnitus with hearing aid use in these patients. The hearing aids can be programmed specifically to fit the high frequency hearing loss pattern, which is usually at the same frequency as the tinnitus. The hearing aids selectively amplify sounds in these frequencies which are naturally in the patient’s environment, resulting in not only better hearing but reduction or elimination of the tinnitus.
There is another option to treat tinnitus called tinnitus retraining therapy (TRT). This treatment can take many months. Its purpose is not necessarily to reduce or eliminate the tinnitus, but to train the brain to ignore the sound and push it to the background. It can be very successful in highly motivated patients.
If patients are looking for other remedies there are several over-the-counter options to curb the irritation of tinnitus. Most are herbal remedies which are sprayed into the nose, taken orally or placed as drops into the ear canal. These products may contain several different herbal substances, vitamins or minerals and can be effective in some patients to reduce tinnitus. These products are not regulated by the U.S. Food and Drug Administration.
Tinnitus is NOT something you must live with. It can successfully be treated (reduced or eliminated) in most patients. Tinnitus usually has associated hearing loss, but not always. It is worsened by aspirin products, nicotine, caffeine (possibly), stress, TMJ problems, Meniere’s syndrome and depression. There is almost always something that can be done to help tinnitus, including discontinuation of certain medications, discontinuation of nicotine and caffeine (controversial), use of special hearing aids, biofeedback, life stress reduction, treatment of depression, tinnitus retraining therapy and herbal remedies.
Finally, there is a wonderful organization that has helped thousands of patients with tinnitus. It is called the American Tinnitus Association (ATA) – www.ata.org.
For more information on tinnitus and hearing loss, purchase a copy of my new book, “Hearing Loss: Facts and Fiction – 7 Secrets to Better Hearing” .