Tinnitus

What is tinnitus?

“Tinnitus” refers to noises that are heard in the ears. They can range from the sounds of buzzing, crickets, ringing, crackling, clicking, or heartbeats.

Why does tinnitus occur?

By far the most common cause of tinnitus is hearing loss. This tinnitus is a ringing or buzzing sound in both ears. Tinnitus can occur even if there is no perceived hearing loss or if a hearing test (e.g. an audiogram) is normal. This is because some people with really good hearing can have a minor hearing loss that still puts them in the normal range of a hearing test. It can also occur in the ultra-high frequencies that are not important for speech and communication. These frequencies are not tested on a routine hearing test.

Much less commonly, tinnitus can also occur from normal anatomical variations, medical issues such as sinus problems, Eustachian tube dysfunction, anemia, malfunctioning thyroid, or medications. Other issues may produce tinnitus that is in only one ear or sounds like the heartbeat. These patterns of tinnitus require further medical workup, usually with imaging such as MRI and CT scans.

When is tinnitus a medical concern?

Tinnitus is most often the result of hearing loss. In this case, the noise is actually created by the brain, not the ears. When the ears are damaged, they do not send a full signal to the brain. The brain then replaces this missing information with an “artificial” sound…and this is what you know as tinnitus. It is similar to phantom limb pain experienced by amputees who can still feel their missing limb.

Hearing loss should be addressed as untreated hearing loss can have severe health consequences.

Tinnitus is a medical concern that must be evaluated when it is only in one ear or is in sync with or sounds like your heartbeat.

What can I do about tinnitus?

First, tinnitus should be evaluated by a physician. This will confirm the likely cause of the tinnitus.

Treating underlying hearing loss can improve tinnitus as well as helping general health.  If tinnitus is from hearing loss, you can cover it up or “mask” it with white noise. Many patients self-treat this way by using a fan, a white noise generator, background music, etc. This is a helpful strategy because many patients become focused on their tinnitus. There are a variety of smartphone apps that can generate various noises so that you may stream them to an external speaker. “Zen Tinnitus” by Widex and "ReSound Tnnitus Relief" by ReSound are great apps to get started with.

Paying more attention to the tinnitus makes it seem more prominent. This can create a vicious cycle that makes tinnitus subjectively louder. This is particularly common in patients who are prone to anxiety and depression. For these patients, tinnitus retraining therapy can be beneficial in breaking this cycle. This talk therapy is cognitive behavioral therapy and is administered by our audiologists.

Tinnitus is also more prevalent in those with anxiety and depression. Screening and treating these are essential to improving tinnitus. Promoting wellness and stress relief is also helpful to alleviate the frustration of tinnitus. As far as possible, reduce stress in other areas of your life. Here are some research proven ways to promote wellness and stress relief:

• Get restful and quality sleep. Use a white noise generator (see above) to cover up the tinnitus. Avoid caffeine, alcohol, nicotine 4 to 6 hours before bedtime. Darken your bedroom and keep it cool between 60-75ºF. Do not use your phone or computer within a few hours of going to bed. Go to bed at consistent times every day. Have a consistent, relaxing pre-sleep routine. Go to sleep when you’re truly tired and don’t watch a clock.
• Exercise daily. Take a 20 minute walk daily—through nature, if you can.
• Establish daily routines and stick to them.
• Get back into a hobby and actively schedule time to work on it.

Sometimes medications can cause tinnitus. Medications for anxiety and depression are the most common culprits. Reviewing this helpful list of medications can identify tinnitus-causing medications. Be sure to consulting your primary care provider before stopping prescribed medications.

Severe tinnitus is tinnitus that does not respond to the techniques above. For severe tinnitus, we highly recommend Dr. Richard Tyler's telephone tinnitus clinic. Dr. Tyler is one of the leading scientists in the world for the treatment of tinnitus. He is located at the University of Iowa in Iowa City. The Otolaryngology Department at the University of Iowa is one of the leading institutions for tinnitus research in the world.

Check out our tinnitus resources here.