Tinnitus: Ringing in your ears

Tinnitus is the perception of sound in the ears or head that is not caused by an external sound source. Those living with the condition may experience a buzzing or ringing in one ear or both, or the sound may appear to be generally in the head region. It’s not an illness or a disease in itself, but it is often a symptom of a problem within the ear or the hearing pathways to the brain.

There are four different types of tinnitus: subjective, neurological, somatic and objective, with each having a different root cause. Subjective tinnitus is the most common form of the condition and develops following exposure to excessive noise. Neurological tinnitus develops due to a disorder affecting the brain’s ability to process sound. Somatic tinnitus is linked to the sensory system, while objective tinnitus is triggered by vascular deformities or involuntary muscle movement.

Tinnitus is often described as a ‘ringing in the ears’, but what people with this condition hear is highly variable. Some people hear hissing, whooshing, roaring, whistling or clicking. It can be intermittent or constant, single or multiple tones or more noise-like. The most common description of noise-induced tinnitus is a high pitched tone or noise.

The volume or loudness of the sounds heard varies between individuals and can range from very quiet to disturbingly loud. Although some people say that it comes and goes or as a tone that changes pitch throughout the day, for most, it is a steady, unchanging noise that is present during every waking minute.

Considering the symptoms different types of tinnitus can be distinguished:

• Pulsatile Tinnitus
• Tinnitus at night
• Tinnitus in the morning
• Tinnitus during pregnancy

Tinnitus typically develops after the inner ear is damaged or impaired somehow. Some potential causes of tinnitus include:

• Exposure to loud noises like loud music during concerts or festivals
• Ear infections.
• Hearing loss.
• Head or neck injuries/problems
• A buildup of earwax.
• A build-up of fluid behind the eardrum.
• Some medications (e.g. very rare side effect of Covid-19 vaccine)

Tinnitus has also been linked to various illnesses, injuries and health conditions. Some of these conditions include:

• Meniere's disease.
• Dysfunction of the eustachian tube.
• Otosclerosis.
• Temporomandibular joint (TMJ) disorders.
• Head and neck tumours.
• Vasculitis.

Tinnitus can develop gradually over time or occur suddenly. Symptoms can also suddenly appear, causing people to question why they have a ringing in their ears.

Although anyone can experience tinnitus, several risk factors may increase your chances of developing the condition. Common risk factors of tinnitus include:

• Age. As we get older, hearing loss becomes more common as our hearing sensitivity declines. Those living with hearing loss are typically at a higher risk of developing tinnitus.
• Exposure to loud noises. Regular and repeated exposure to high levels of noise puts us at greater risk of tinnitus. While this often includes workplace noise, such as machinery and other loud equipment, listening to loud music using headphones, attending concerts, and noisy hobbies can also impact hearing health.
• Tobacco use. Smoking has been found to increase the risk of developing tinnitus.
• Alcohol consumption. Consuming alcohol may also lead to a higher risk of tinnitus.
• Some health issues. A variety of common health issues, such as anemia, high blood pressure, low blood pressure, diabetes and circulatory problems, have been associated as risk factors for tinnitus.

Tinnitus can often be diagnosed by an audiologist or hearing health professional based on the symptoms a patient describes. This being said, however, further investigation may be required to identify and treat the cause of the condition if an underlying health issue is thought to be present.

Several different tests are used to help diagnose tinnitus and its causes, including:

• Hearing tests. A series of tests will be conducted by an audiologist to examine the state of your hearing and to determine if you are living with any degree of hearing loss. Testing may also be used to determine what type of hearing loss has developed.
• Imaging tests. If relevant to the suspected cause of your symptoms, imaging tests, such as an MRI or CT scan may be recommended.
• Movement tests. For some people, movement of the jaw, neck, eyes, arms or legs may worsen the symptoms they experience. Your doctor may ask you to move different parts of your body to help rule out certain health conditions.
• Blood tests. If your doctor believes that the symptoms you are experiencing may be caused by an underlying health issue, they may recommend that you undertake a blood test or two. This may be used to rule out conditions such as vitamin deficiencies, thyroid issues and anemia.

While testing can help find the root cause of tinnitus in some patients, for others, a definite cause may never be found. If this is the case for you, your hearing health professional can provide some practical tips to help you manage your symptoms.

1. Seek Help
   Make an appointment. Amplifon offers a free test to determine if you have hearing loss. If you do, you will undergo a full diagnostic hearing test with an audiologist or audiometrist to find the right solution for you. 
   
   
2. Reduce Exposure to Loud Noise
   Protect your ears with earplugs or earmuffs. High-risk groups include industrial workers, farmers and war veterans.
   
   
3. Hearing Aids 
   Hearing aids may assist with tinnitus by helping to overcome any underlying hearing loss.
   
   
4. Relaxation and Meditation
   If you relax more, you stress less. The intention of relaxation and meditation is to teach yourself to take the focus away from the symptoms of tinnitus, turning your attention to what you enjoy.
   
   
5. Diet
   Ease up on caffeine and alcohol as they can temporarily increase tinnitus for some people.
   
   
6. Exercise
   Regular exercise helps the body achieve a higher level of well-being and, in most cases, helps people to ignore and better cope with their tinnitus. 
   
   
7. Quit Smoking
   Smoking narrows the blood vessels that supply vital oxygen to your ears and the sensory cells.

Approximately 1 in 3 people in Australia will suffer from tinnitus at some point in their life, and about 1 in 6 have constant tinnitus symptoms.

About 90 per cent of cases of tinnitus occur with an underlying hearing loss. The World Health Organisation (WHO) now lists tinnitus as a distinct disorder and states that noise exposure is a significant cause of permanent hearing loss worldwide. Recent research confirms that it is the second most common form of hearing loss after age-related hearing loss. Prevalence increases with age, but experiences of it are prevalent in all age groups, especially following exposure to loud noise. 

Close to half of those who live with tinnitus find it moderately or severely distressing. You may suffer debilitating symptoms such as anxiety, depression or sleep disturbances. It can be confusing and even frightening when it occurs for the first time, but it is rarely a symptom of a serious disorder. If it lasts for longer than a week or affects your concentration, sleep or anxiety levels, book an appointment with your GP or with your local Amplifon audiologist or audiometrist.

Although not all cases of tinnitus can be prevented, some behaviours may help lessen your risk of developing the condition. Some preventative measures include:

• Using hearing protection at work and when exposed to high noise levels.
• Limiting the amount of time you listen to music at high volumes using headphones.
• Reducing the amount of caffeine, alcohol and nicotine you consume.
• Taking steps to care for your cardiovascular health, including exercising and eating well.

Tinnitus is not a disease or a cause of hearing loss. It is a symptom that something is wrong somewhere in the auditory system, including the cochlea of the inner ear, the auditory nerve and the areas of the brain that process sound. In about 90% of cases, it accompanies hearing loss and an individual can experience both hearing loss and tinnitus from noise damage, but the two do not always occur together. It is possible to have no measurable hearing loss but suffer from the condition.

Hearing aids can help manage tinnitus as they assist in overcoming any underlying hearing loss. By reducing the amount of attention your brain is paying to the ringing in your ears, in most cases, hearing aids can provide some tinnitus relief. Additionally, many modern hearing aids are equipped with integrated tinnitus noisers, which generate soothing sounds that can further mask the tinnitus noise, enhancing overall relief and improving quality of life.