What is tinnitus?

Tinnitus ("tinn'- nit - us" or "tin - night - us") is a subjective experience. It is often referred to as a "phantom sound" because one hears sound when there is no external physical sound present.  People experience it as head noise or ear-ringing and use a variety of terms to describe it, such as hissing, rushing, ringing, roaring or chirping.

What causes tinnitus?

The most common cause of tinnitus is exposure to excessively loud noise, either a single intense event (like a shotgun blast) or long-term exposure either on the job (musicians, carpenters, pilots) or during recreational activities (shooting, chain saws, loud music).  Tinnitus can also result from physical trauma to the head or neck.  A small percentage of tinnitus cases arise from medical conditions.  Hypertension (high blood pressure), acoustic neuroma (tumor on the hearing nerve), thyroid disease, vascular disorder, temporomandibular joint (TMJ) disorder, ear infection, impacted cerumen (ear wax), nutritional deficiency, aneurysm, multiple sclerosis and other disorders can produce the symptom of tinnitus.  Prescription and over-the-counter drugs can cause or exacerbate tinnitus.  Over 200 drugs listed in the Physician's Desk Reference ("PDR") cite tinnitus as a side effect!  In some of these cases, the tinnitus will lessen or disappear when the offending drug is discontinued.

How many people suffer from tinnitus?

It is currently estimated that 50 million American adults have tinnitus to some degree.  Of that number, approximately 12 million have it severely enough to seek medical help.

What treatments are available for tinnitus?

Several forms of treatment are currently available and several other experimental approaches hold promise for the future.  These include:

• Amplification.  Hearing aids can reduce or even eliminate some forms of tinnitus.  If a patient has a hearing loss and the tinnitus is in the medium or low pitches, often a hearing aid will provide relief.  The hearing aid renders the patient capable of hearing ambient environmental noises instead of the tinnitus.
• Masking units. These devices resemble hearing aids and present a selected band of noise to the patient's ear(s).  This external "shh" sound is often immediately perceived as a more pleasant sound than the internal tinnitus sound.  A "tinnitus instrument" is a unit that combines both a masker and a hearing aid.  Bedside sound devices, audio tapes and even FM-radio static can produce a masking effect.  Some patients experience "residual inhibition"-- the reduction or elimination of tinnitus-- after the masking noise is removed.  The period of residual inhibition is usually very short, often less than one minute.
• Tinnitus Retraining Therapy (TRT).  TRT is a treatment program designed to retrain the brain so that "habituation" to tinnitus can occur. TRT combines directive counseling and sound therapy by having the patient wear sound generators that emit a stable, low-level broad-band noise. 80% of those undergoing TRT experience success within 18-24 months.
• Drug therapy.  Many drugs have been investigated as possible relief agents for tinnitus.  They include anti-convulsants, tranquilizers, anti-anxiety medications, vasodilators, and antihistamines.  These and other drugs have helped some patients effectively manage their tinnitus. It is also well established that Lidocaine, an anesthetic, offers complete or partial tinnitus relief for a large number of patients.  However, Lidocaine is not a drug of choice for treating tinnitus because it must be administered intravenously, its side effects can be serious and its tinnitus-reducing effect is not long-lasting.  Research continues in an attempt to identify a safe, orally administered drug that has an effect comparable to Lidocaine.
• Biofeedback.  This is a relaxation process in which one learns to control his or her physiological reaction to stress.  Since stress seems to aggravate tinnitus, control over one's reaction to stress often helps minimize the tinnitus.
• Dental treatment.  Persons with temporomandibular joint (TMJ) problems associated with tinnitus can be treated with effective relief provided for some who suffer from this dual problem.  Symptoms of damage to this joint (located just below the ear) include tinnitus, jaw-clicking and ear pain.
• Counseling.  Therapies such as cognitive therapy, behavioral modeling, patient education and support groups have proven useful for many patients who are struggling with tinnitus.
• Cochlear implants.  These surgically implanted devices are designed for people with little or no usable hearing.  Some of these patients report post-operative improvement in their tinnitus.  Research is ongoing to determine if a type of implanted stimulus can be devised for people with tinnitus and normal hearing.
• Electrical stimulation.  This experimental therapy involves electrical energy transmitted to the cochlea via electrodes placed near the ears.  While a degree of success has been noted, some have reported worsening of their tinnitus with this therapy.
• Other treatments.  Some patients have found tinnitus relief through hypnosis, acupuncture, cranio-sacral therapy, chiropractic care, naturopathic treatments and control of allergies.

The actual mechanism responsible for tinnitus is not yet known.  We do know that it is a real-- not imagined-- symptom of something that has gone wrong in the auditory or neural system.  There is reason to be hopeful because current research efforts are using a physiological model that may soon provide the necessary information for identifying causes of tinnitus.

Does tinnitus mean that one is going deaf?

No.  Tinnitus is often an indication that there has been some kind of damage to the auditory system, but it does not mean the patient will become deaf.  Tinnitus does not cause hearing loss, and hearing loss does not cause tinnitus, although the two often exist together.

What makes tinnitus worse?

• Loud noise.  Avoid loud sounds at all costs! Use power tools, guns, motor cycles, noisy vacuum cleaners, etc., only with appropriate hearing protection.
• Excessive use of alcohol or so-called recreational drugs can exacerbate tinnitus in some individuals.
• Caffeine, found in coffee, tea, chocolate and some cola drinks, can also increase tinnitus.
• The vascular effects of nicotine, found in tobacco products, are associated with an increase in tinnitus.
• Aspirin, quinine, some antibiotics and hundreds of other drugs are causative tinnitus agents and can make existing tinnitus worse.  If you are prescribed medication, always inform your physician of your tinnitus and discuss the drug and dosage options.  ACA can provide you and your physician with information regarding drugs that affect tinnitus.
• Stress.  Many people notice a reduction in the volume of their tinnitus when they are able to control their stress levels.

Many patients ask if cutting or severing the hearing nerve will eliminate their tinnitus.  This permanent, deafness-producing procedure is not yet reliable for tinnitus relief.  In fact, the surgical destruction of a person's hearing most often leaves the tinnitus as the only sound heard.