Tinnitus: Symptoms, Diagnosis and Treatment
Imagine a radio playing inside your head and you can’t shut it off. It makes ringing, chirping, hissing, buzzing, clicking, roaring and maybe even shrieking sounds—or sometimes a combination of sounds at varying degrees of loudness. If you can imagine this happening in one or both ears, you have some idea of what it’s like to have tinnitus. This is a hearing problem that can impact concentration, memory and sleep. It can be deeply disruptive, even leading to emotional anxiety and depression in some people.
It’s not uncommon to experience a temporary bout with tinnitus, maybe after a loud concert. But roughly 20 million people have burdensome chronic tinnitus, and 2 million have extreme cases.
The condition is especially common among certain types of people. “It is the number one disability in our veteran population,” says Douglas M. Hildrew, MD, a specialist for Yale Medicine Otolaryngology, explaining that exposure to the loud sounds of gunfire and explosives puts them at risk. The condition also affects significant numbers of first responders, construction workers, musicians, people who work in factories and anyone else who is exposed on a regular basis to loud noise without appropriate hearing protection. “Tinnitus can range from a minor nuisance to a career-altering or life-changing disability. It’s really something we need to take seriously,” Dr. Hildrew says.
What is tinnitus and what causes it?
It may help to know that tinnitus is a symptom, not a disease. Researchers believe the noises people hear inside the head are the brain’s reaction or way of adapting to some sort of damage in the ear. Tinnitus is sometimes, but not always, accompanied by hearing loss, which is why it is especially common among senior citizens.
Tinnitus may be a sign of an easily fixed problem, such as wax or a foreign object in the ear canal. It can also be a symptom one or more of the following underlying conditions:
- Neurological disease
- Cardiovascular disease
- Ear and sinus infections
- Thyroid disease
- Heart and blood vessel problems
- Hormonal changes (in women)
- Temporomandibular joint disorder
- Sinus pressure
- Head injury
- Meniere’s disease (a disorder of the inner ear that also causes room-spinning vertigo)
- A side effect of certain prescription drugs, especially ototoxic drugs (drugs that have a sometimes toxic effect on the ear and the nerve supply of the ear), including non-steroidal anti-inflammatory drugs, and some antibiotics and cancer medications, among others.
How is tinnitus diagnosed?
Tinnitus can be difficult to diagnose, because in most cases only the patient can hear the sound or sounds. A rare type of tinnitus called pulsatile tinnitus, which is marked by pulsating sounds and is often linked to vascular problems, can be seen and/or heard by doctors using special equipment, including magnetic resonance angiography (MRA) or angiography.
A primary care doctor will try to determine if the problem is being caused by a medical condition or medication. He or she may send you to an otolaryngologist (also known as an ear, nose and throat [ENT] specialist), who will examine your head and neck area and thoroughly test for hearing loss that may be accompanying the tinnitus. He or she may give you a test such as a tympanogram, which measures the stiffness and functioning of the eardrum in the middle ear. Hearing tests are typically noninvasive and not painful.
How is tinnitus treated?
There is no cure for tinnitus. While treatment depends, in part, on the underlying cause, a doctor or audiologist can help people with tinnitus learn to live with the problem and achieve a good quality of life. Some helpful approaches include the following:
Hearing aids, including cochlear implants: If you have a hearing problem, treating it can make tinnitus less noticeable. Specialists often recommend a cochlear implant hearing aid for people with tinnitus who have serious hearing loss. These small devices are surgically implanted inside the ear, where they can use electrical signals to send external sounds directly to the auditory nerve.
Sound generators: This solution can be as simple as keeping a machine on your night table that produces relaxing sounds such as waterfalls or “white noise.” There are also wearable sound generators, or “masking devices,” that fit in your ear that can play soft sounds or music just loud enough to mask the tinnitus noise.
Acoustic neural stimulation: A device the size of your palm works through a pair of headphones to deliver a broadband acoustic signal embedded in music. This relatively new treatment can stimulate change in the neural circuits and make you less sensitive to tinnitus.
Medications for anxiety and depression: These medications can help with such tinnitus-related problems as distress, irritability, mood and the loss of sleep that can make it difficult to function.
Counseling: A counselor who is knowledgeable about tinnitus can help you better understand the problem and guide you in developing new ways to react to the sounds. Since tinnitus comes from within the mind, tremendous gains can be had with a trained psychiatrist or psychologist through disrupting “the cycle of the fixation.”
“The way we think of tinnitus is that it's really a form of anxiety—tinnitus causes anxiety, which causes tinnitus—and then you become stuck in this feedback loop,” Dr. Hildrew says.
How is Yale Medicine outstanding in its treatment of tinnitus?
Our Hearing & Balance Surgery Program has a caring team of multidisciplinary specialists that can provide innovative solutions to help diagnose, treat and manage a range of congenital and acquired disorders that affect hearing. Yale Medicine ear, nose and throat doctors are up to date on the latest research and treatments for tinnitus and can provide a realistic and effective treatment plan.