Tinnitus in adults

Tinnitus or ringing has a medical name – tinnitus. The complaint is usually described as a noise, ringing in the ears, but may also sound like a roar, click, hiss, or buzz. The sound can be quiet or loud, high or low. The person may hear noise in one or both ears. Approximately 10% of the adult population in our country experienced tinnitus last year that lasted at least 5 minutes. This is almost 8 million people.

Tinnitus is a subjective sensation that refers to sounds that come from within the body and not from an external source. The condition is often described as “ringing or buzzing in the ears”, although several different sounds can be heard, including:

• buzz;
• buzz;
• crunch;
• hiss;
• whistling.

Some people may hear sounds like music or singing, while others hear noises that beat in time with their pulse (pulsatile tinnitus). The patient may also notice that their hearing is not the same as before, or they are more sensitive to everyday sounds (so-called hyperacusis develops).

Tinnitus is rarely a sign of a serious underlying condition. For some people, tinnitus can come and go with only minor irritation. However, sometimes it can be continuous and has a significant impact on daily life. Severe cases can be very frustrating, affect concentration, and cause problems such as insomnia and depression. In many cases, tinnitus resolves gradually over time. But it’s important to seek medical help to see if the underlying cause can be found and treated, as well as ways to manage the problem.

Causes of tinnitus in adults

Tinnitus in itself is not a disease. This is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Sometimes it can be something as simple as a piece of earwax blocking the ear canal. But noise can also be the result of a number of medical conditions, such as:

• hearing loss due to too high a hearing load;
• ear and sinus infections;
• diseases of the heart or blood vessels;
• Meniere’s disease;
• brain tumors;
• hormonal changes in women;
• thyroid anomalies.

By the way, tinnitus is sometimes the first sign of hearing loss in older people. It can also be a side effect of medication. More than 200 drugs are known to cause tinnitus. It occurs when a person starts or stops taking them. People who work in noisy environments—such as construction workers, road crews, or even musicians—may develop tinnitus over time, when constant exposure to noise damages the tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called hearing loss due to excessive noise.

Military personnel exposed to bomb blasts can develop tinnitus if the shockwave of the blast compresses the skull and damages brain tissue in areas that help process sound.

Pulsatile tinnitus is a rare type of disorder that sounds like a rhythmic pulsing in the ear, usually in sync with the heartbeat. The doctor can hear it by holding a stethoscope to the neck or by placing a tiny microphone in the ear canal. This type of tinnitus most often occurs due to problems with blood flow in the head or neck. Pulsatile tinnitus can also be caused by brain tumors or abnormalities in the structure of the brain.

Even with all these conditions and causes, some people get tinnitus for no apparent reason. It is not usually a sign of a serious health problem, although if it is loud or does not go away, the noise can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional distress.

Symptoms of tinnitus in adults

Although a person hears tinnitus, its source is actually in networks of brain cells (which scientists call neural circuits). They parse and analyze the sounds that our ears hear. Tinnitus often starts in the ear but continues in the brain. Scientists still have not come to a consensus about what happens in the brain that creates the illusion of sound when there is none. Some people think that tinnitus is like a chronic pain syndrome in which pain persists even after a wound or fracture has healed.

Tinnitus may be the result of the neural circuits in the brain trying to adjust to the loss of sensitive hair cells by increasing sensitivity to sound. This explains why some people with tinnitus are overly sensitive to loud noise.

Noise can also be the result of a neural circuit imbalance, where damage to the inner ear alters signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of an abnormal interaction between neural circuits. The neural circuits involved in hearing are not just for sound processing. They also interact with other parts of the brain, such as the limbic region, which regulates mood and emotions.

Treatment of tinnitus in adults

The first step is to see a doctor who will check if something, such as earwax, is blocking the ear canal. The doctor will ask about your current health status, medical conditions, and medications to see if any underlying disease is causing tinnitus.

Diagnostics

If your local doctor can’t find any condition that’s causing tinnitus, you may be referred to an otolaryngologist (ear, nose, and throat doctor, or ENT). He will examine your head, neck, and ears and test your hearing to determine if there is hearing loss along with tinnitus. You may also be referred to an audiologist, who can also measure your hearing and evaluate your tinnitus.

Some people find that their tinnitus does not go away or gets worse. In some cases, it can become so severe that it can be difficult to hear, concentrate, or even sleep. Your doctor will look at ways to reduce the severity of the noise and improve your quality of life.

Modern treatments

There is no cure yet for tinnitus, but there are treatments that can help many people manage the condition better. Most doctors will suggest a combination of the following treatments, depending on the severity of your tinnitus and the areas of your life that it affects the most.

Hearing aids are often useful for people who suffer from hearing loss in addition to tinnitus. Using a hearing aid tuned to carefully control the level of outside noise can make it easier to hear. The better a person hears, the less he notices tinnitus.

Counseling will help you learn to live with tinnitus. Most counseling programs include an educational component to help the patient understand what is going on in the brain causing tinnitus. Some counseling programs also help change a person’s response to tinnitus. You can learn to do things on your own to make the noise less noticeable, to help you relax during the day or fall asleep at night.

Wearable sound generators are small electronic devices that fit in your ear and make a soft, pleasant sound that helps mask tinnitus. Some people want the masking sound to completely hide their tinnitus, but most prefer a masking level that is slightly louder than their tinnitus. The masking sound can be a soft shhh, random tones, or music.

Desktop sound generators are used as an aid to relaxation or sleep. By placing the device next to your bed, you can program the generator to play pleasant sounds such as waves, waterfalls, rain or the sounds of a summer night. If it’s a mild tinnitus, that may be all it takes to get you to sleep.

Acoustic nerve stimulation is a relatively new method for people whose tinnitus is very loud or does not go away. She uses a palm-sized device and headphones to transmit a broadband acoustic signal embedded in the music. The treatment helps stimulate changes in the neural circuits of the brain, which ultimately reduces sensitivity to tinnitus. The device has been shown to effectively reduce or eliminate tinnitus in a significant number of volunteers.

Cochlear implants are sometimes used in people with tinnitus and severe hearing loss. A cochlear implant bypasses the damaged part of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device emits external sounds that help mask tinnitus and stimulate changes in nerve circuits.

Your doctor may also prescribe antidepressants and anti-anxiety medications to improve your mood and help you sleep.

Prevention of tinnitus in adults at home

Noise-induced hearing loss, resulting from damage to the sensitive hair cells of the inner ear, is one of the most common causes of tinnitus. Anything you can do to limit your exposure to loud noise – turn down the volume, use earplugs or headphones – this will help prevent tinnitus or hearing loss.

Popular questions and answers

Questions regarding the treatment of tinnitus we discussed with general practitioner, endoscopist, head of the organizational and methodological office Lidia Golubenko.