Tinnitus is the name given to sound or noise heard in the head that does not come from an external source. Tinnitus comes from the Latin word tinnire which means “to ring”, but not everybody will hear their tinnitus as a ringing sound. Some people describe a buzzing, hissing, humming, or chirping sound, while others may even hear it as music!  Tinnitus can range in volume and pitch and can be heard in one or both ears or in the head. Some people describe more that one sound and the sound can come and go or vary in intensity.

Tinnitus is a symptom and not a disease, and there are various underlying causes. Common causes are hearing loss or earwax build-up; tinnitus can also be due to head injuries or can even originate in the jaw or neck.

Two types of tinnitus

The most common type of tinnitus is Subjective Tinnitus. This is awareness of sound in the head or ears in the absence of any corresponding external sound. Objective Tinnitus – is when sounds are generated from within the body and can be heard by an external examiner. These sound may be generated by blood flow or muscle movement, or the opening and closing of the eustation tube, they are also known as Somatosounds.

Most people will experience tinnitus at some time in their lives, in fact, it has been said that nearly everyone hears tinnitus if they are in an anechoic chamber (very quiet room).  If the tinnitus lasts for less than 5 minutes and shows no particular pattern, then it may not be significant clinically. Think of it as a one-off twitch in your eyes.

Tinnitus may seem like it is coming from your ears, but it usually originates in the brain. Tinnitus can be influenced by attention, emotions, and stress.

Tinnitus is Normal and Common

Tinnitus can be heard by at least 98% of people in a quiet room. People with no detectable hearing loss may experience tinnitus; although it is most common when some temporary or permanent hearing loss is present.  About 20% of the population report experiencing tinnitus on occasion with around 1% experiencing significant annoyance from their tinnitus.

What Causes Tinnitus?

Awareness of tinnitus often follows a change in the function of the regions of the brain associated with attention or emotion, or it may occur after a change in the hearing system. Here are some common causes of tinnitus:

• Temporary threshold shift: You may have been to a loud music event and experienced tinnitus when you are going to sleep that night or even the next day. It is likely you also have a temporary hearing loss (temporary threshold shift). This is a sign that the music – or noise was too loud. Often tinnitus after noise exposure goes away after a day or two and the hearing levels return to normal. The tinnitus is a sign that the noise was too loud for you and it is important to wear hearing protection if you are in a similar situation again. Frequent noise exposure causing temporary threshold shifts can lead to permanent threshold shifts – or noise-induced hearing loss.

• Noise-induced hearing loss: noise-induced hearing loss is fairly common. It may occur from noise exposure over many years like machinery in a factory or music and events, or from a single event (like shooting). One or both ears may be affected. Noise exposure usually causes hearing loss in the higher frequencies. Tinnitus is a common symptom for those who have noise-induced hearing loss and is one of the reasons to protect your hearing in nosy environments.
• Hearing loss: any people who have hearing loss also have tinnitus. One of the theories of tinnitus is that the brain is expecting to hear a sound and when there is hearing loss stopping the brain from receiving its normal signal it creates its own signal which is tinnitus. It is common that when we stimulate the brain with sound in the frequencies of the hearing loss, the tinnitus will go away. This sound could be background noise, or it could be hearing aids that compensate for the hearing loss.
  When wearing hearing aids people often find their tinnitus is relieved, some times if returns, when they take the hearing, aids out at night. Over time, with regular hearing aids use, many people report that the tinnitus drops away overall, even when they are not wearing their hearing aids.

• Ear wax blockage – where the wax is touching your eardrum: if the wax build-up is the only cause of the tinnitus, it will likely resolve once the wax is removed.
• Injury or infection involving your ears: these conditions can affect your hearing by blockage and cause tinnitus. The tinnitus should get better in most cases after these conditions are treated.
• Jaw joint issues: this is more likely if you have pain or popping of the joint when you eat or talk. The joint has some common nerves with the ear and it is easy to confuse with pain in the ears.
• Neck stiffness:  In some cases, neck stiffness can lead to tinnitus.

• Fluttering or clicking: Twitching spasm of muscles in and around the ear may lead to these sounds.
• Pulsing sounds: this pulsing pattern may be in the rhythm of your heartbeat. You may be hearing the blood flow in blood vessels near your ear.

What is the origin of tinnitus?

Where does the tinnitus sound come from?

Some details of how tinnitus occurs are still unclear, but we do know why it occurs when there is a hearing loss. Current research suggests the phantom sound is not generated in the ear but from neurons and the brain. Your brain has a memory of what things should sound like (called auditory memory).

When the brain notices a reduced or degraded input of sound due to hearing loss, it tells the nerves that send the signal from the ear to the brain to work a bit harder. It is believed that this generates the phantom sound.

How tinnitus can get worse

If a person focuses on their tinnitus and thinks of it in a negative way, then a strong emotional association can occur. This may make the tinnitus more debilitating. So focusing and worrying about the tinnitus makes it more likely it is to become an overwhelming problem.

An interesting fact

People who were born with hearing loss do not get tinnitus because their brain has never developed a memory of a corresponding sound. 

How your Audiologist can help with your tinnitus?

• Check your ear canals are clear and healthy: When looking in your ear we will check for:
  • the build-up of wax or other debris (there have been instances of finding the end of an earbud or even an insect!)
  • make sure you do not have an ear infection
  • Check that you that your eardrum looks intact and health.
  • An earwax blockage can be cleared in the clinic and often leads to instant relief from tinnitus.
• Take a thorough history: Ask the right questions so we can exclude the more serious causes of tinnitus.
• Diagnostic hearing assessment: Test your hearing to identify any hearing loss and then discuss a management plan – often helping you hear better, helps your tinnitus.

In the past, some tinnitus sufferers have been told “there is nothing you can do”, or you just have to live with it”, that is not true. There are strategies to help you manage your tinnitus and reduce the level of intrusiveness.

• Understanding the cause of your tinnitus: Have a full diagnostic hearing assessment to rule out any medical reasons. This will give peace of mind.
• Reduce the attention you give your tinnitus: The best thing you can do to help relieve tinnitus is to ignore it as much as you can. You can train your brain to pay less attention to tinnitus. A way to do this is: when you notice tinnitus, acknowledge it is there then, move on and think about something else. It is possible to habituate to your tinnitus, in a similar way to people who live near train tracks, stop noticing the trains go by.
• Hearing aids: When you have hearing loss, getting hearing aids will provide your auditory system with the sounds it is missing. Some people notice their tinnitus disappears immediately as soon as we put hearing aids on for them. Other need to wait a few months for their brain to adjust to hearing sound again. In the beginning, most people report that their tinnitus is only improved while they are wearing their hearing aids and it comes back when they take them off. However, often over time, with the consistent wearing of the hearing aids, the tinnitus reduces overall. It is believed that the hearing aids help restore the internal volume in your brain, so it matches up with your brain’s auditory memories again.

• Avoid very quiet environments: For many, their tinnitus is its most bothersome at night or other times when it is quiet. The easiest treatment for tinnitus is therefore to add soft sound to your environment. Relaxing nature sounds, classical music or having a fan on are commonly used to achieve this.
• Tinnitus masking: Having background noise like music or the radio on in the background will give your brain something to focus on other than the tinnitus, and it can “mask” tinnitus. Masking may be more effective if it is close in pitch to your tinnitus. For example, ocean waves are more effective at masking low pitched rumbling tinnitus sounds and raindrops more effective for mid to higher-pitched tinnitus. Explore what works for you. There are many apps you can download on your phone that can help you identify the pitch of your tinnitus and provide soundtracks of distracting sounds.

• Learn to love your tinnitus: Turn your tinnitus into a comforting sound. For example, imagine you are camping and can hear the sea in the distance, or the wind in the trees. Make the emotional connection to your tinnitus positive.
• Meditation and calming relaxation: It is common to have increased tinnitus linked to stress. Calming the autonomic nervous system may go a long way to reducing the effect of your tinnitus.  There are various techniques like breathing exercises and guided meditation which can be helpful to leed you towards relaxation and positive thinking. There are many apps you can download for your phone.
• Medication: As of 2020, the evidence to determine whether medication is useful in treating tinnitus is very weak.
• Maintain good sleep practices: Regular bedtimes and avoiding big meals and caffeine before bed. A sound generator or tinnitus app on your bedside that plays different sounds and help reduce tinnitus as you go to sleep.
• Live a healthy lifestyle: A healthy diet or daily exercise will make you feel stronger and better able to cope with tinnitus.
• Wear hearing protection: Noise is a very common cause of tinnitus.

Tinnitus is a common symptom that can occur with and without hearing loss.  The best way to manage tinnitus is to give it a very low priority, attending to it as little as possible. When you first notice tinnitus, it is worth seeing your Audiologist to get a better understanding of your tinnitus and to rule out any underlying causes that may need a further referral. If you have hearing loss, hearing aids may help to restore the internal volume in your brain and reduce the tinnitus. Otherwise, reducing stress and calming your autonomic nervous system with medication as well as avoiding very quiet environments may help you live in harmony with your tinnitus.