Tinnitus is the perception of sound in the head or ear which has no external source. The sound may be a hissing, humming, whooshing or roaring sound. It may be constant or on and off and it may in volume.
It is not a disease or illness; it is a symptom generated by the rewiring or reorganization of the hearing system.
There are 2 types of tinnitus;
• Subjective tinnitus-sounds in the head or ear perceived only by the patient. This is majority.
• Objective tinnitus-sounds in the head or ear that are perceived by both the patient and other people. They are the minority. These sounds are usually caused by internal body process like blood flow or musculo-skeletal movement.
Tinnitus can be annoying: however, in the vast majority of patients it is not usually a sign of a serious problem. There are ways to mask and adapt to the symptoms to minimize the impact of tinnitus on daily life.
Tinnitus is common and can be present in any age group, from very young children to the elderly.
The most common and prevalent risk factor is exposure to loud sounds and noise, for example:
1. People exposed to music
2. People exposed to loud machinery
3. People exposed to loud bangs
4. People who listen to their headphones
It’s difficult to pinpoint the exact cause of tinnitus, but it’s generally agreed that it results from some type of change, either mental or physical, but not necessarily related to the ear.
Most commonly, tinnitus is caused by damage to cells in the inner ear. These cells, when damaged or stressed, change the signal sent to the brain. This then produces a sound heard only by the patient.
Please note that tinnitus is not a disease by itself and neither does its presence necessarily indicate one of the causes below.
1. Hearing loss
a. Age-related hearing loss (presbyacusis)
b. Noise-induced hearing loss
2. Exposure to loud sounds
3. Stress and anxiety
4. Ear infections
5. Ear wax build up (cerumen impaction)
6. Menier’s disease (increased fluid in the inner ear)
7. Glue ear (otitis media with effusion)
8. Otosclerosis (stiffening of bones in the middle ear)
9. Perforated ear drum
10. Head and neck trauma
11. Temporomandibular joint disorder (disease of the hinge of the jaw)
12. Sinus pressure
13. Barometric trauma (diving, snorkelling, flying)
14. Certain medications
15. Others (cardiovascular problems, neurologic disease, genetic and inherited ear disorders, metabolic conditions, autoimmune disease and tumours specifically acoustic neuroma)
The most common form is a high pitched tone described as ringing. Other symptoms can include a pulsation that is rushing or humming and varies in intensity with exercise or changing of body position or even in-beat with the patient’s heart beat. A clicking sound may indicates a nerve or muscle abnormality.
A visit to the ENT doctor or the audiologist is warranted. A full history and physical examination of the ear will be performed. A hearing test might be ordered for. Other tests like brain imaging via MRI or CT Scan might be helpful, depending on the history and physical examination.
What are the treatment options for tinnitus?
There is currently no scientifically proven cure for most cases of chronic tinnitus.
The main aim for all currently-available tinnitus treatment options is to lower the perceived burden of tinnitus, allowing the patient to live a more comfortable, unencumbered, and content life.
Manage the underlying cause:
• Hearing loss-if tinnitus is accompanied by hearing loss, then correcting it might be helpful.
• Depression-depression is common in patients with tinnitus and safe and effective treatment options are available for major depressive episodes.
• Insomnia-difficulty sleeping due to tinnitus might be treated by medications or behavioural means.
Behavioural therapies help living with longstanding tinnitus.
• Tinnitus retraining therapy (TRT)- This involves retraining the subconscious part of the auditory system to accept the sounds associated with tinnitus as normal, natural sounds rather than annoying sounds. The goal is for the person to become unaware of their tinnitus unless they consciously choose to focus on it.
• Masking-using a real external sound to counteract the perception of and reaction to tinnitus.
• Biofeedback and stress reduction-biofeedback is a relaxation technique that helps you control your inner body functions like heart beat or breathing rate. It helps to manage tinnitus-related stress by changing your reaction to it.
• Cognitive behavioural therapy (CBT)-you learn to control your emotional response and therefore dissociate tinnitus from painful negative behavioural responses. It involves using coping strategies, distraction skills, and relaxation techniques.
Other therapies have been studied although none have been found to be more reliable than placebo.
• Vitamins and minerals-B vitamins, Zinc and Copper
• Herbal medications-e.g ginkgo biloba
• Exercise-30 minutes for 3 days in a week.
What is the prognosis of tinnitus?
The impact of tinnitus on daily life not only depends on the perceived sound but on the reaction to the sound. Most long term tinnitus is unlikely to go away. However, with coping strategies, it might become less bothersome.
How does tinnitus affect my general wellbeing?
The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.
1. Hesse, Gerhard. “Evidence and evidence gaps in tinnitus therapy.” GMS current topics in otorhinolaryngology, head and neck surgery 15 (2016).
2. Frank, Wilhelm, Brigitte Konta, and Gerda Seiler. “Therapy of unspecific tinnitus without organic cause.” GMS health technology assessment 2 (2006).
3. American tinnitus association
4. British tinnitus association
5. Jackler and Brackman Neurotology