Whether it involves a ringing, hissing, clicking, roaring, whining or whooshing tone, tinnitus is often described as the perception of sounds when there’s no external cause. It’s a phantom sound, in other words — very real to the person who’s experiencing it, but no one else can hear it.
For some people, it’s a temporary affliction (after attending a blaring concert or being exposed to other loud noises, say), and for others, it’s chronic or recurring; the sound is often high-pitched, and it can happen in one or both ears. It’s incredibly common, with about 1 in 5 people in the U.S. reporting bothersome tinnitus that negatively affects their quality of life or their ability to function, according to the American Academy of Otolaryngology — Head and Neck Surgery.
“Tinnitus is a perceptual phenomenon — it’s like pain: I can’t tell if you’re in pain or measure it, and the same is true with tinnitus,” says Dr. Quinton Gopen, an associate professor of head and neck surgery at the UCLA Medical Center. And while it’s not a disease in itself, depending on its severity, tinnitus can have profound effects on how a person feels and functions. A 2016 study by researchers at the University of California–Irvine and Harvard Medical School found that people with tinnitus were 2 ½ times more likely to have problems with anxiety or depression in the previous year than people who don’t have tinnitus. Not surprisingly, the condition can interfere with people’s ability to sleep. During the day, tinnitus can impair your cognitive function by affecting your ability to control your attention, according to a 2016 study in The International Journal of Audiology.
If the ringing or other tones are just in one ear or if the noises pulse like a heartbeat (what’s called pulsatile tinnitus) in one or both ears, see an ear, nose and throat doctor (a.k.a., an otolaryngologist) because these could be signs of a tumor on the acoustic nerve that’s usually benign or blood vessel abnormalities or vascular malformations. Imaging tests — such as an MRI or CT scan — can detect these problems, Gopen says.
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Who’s At Risk and Why
While tinnitus can start at any age, it becomes more common with each passing decade. That’s because, as people grow older, the hair cells in the inner ear tend to degenerate, which in turn makes auditory neurons hyperactive, explains Dr. Michael Benninger, chair of the Head and Neck Institute at the Cleveland Clinic. This hyperactivity causes them to respond as if they are being stimulated by sound even when they aren’t. Exposure to loud noises (say, from rock concerts or occupational exposure to roaring machinery) or having a strong family history of hearing loss puts you at risk for developing tinnitus at a younger age, Benninger says.
At any age, tinnitus can result from a variety of physiological problems. The most common cause is hearing loss, but having a severe ear infection, a disorder of the temporomandibular (jaw) joint, Meniere’s disease (a disorder of the inner ear) or other vestibular problems, an earwax blockage or migraines can also increase your risk. “Migraine is a disorder in which there is an enhanced sensory perception — where people are sensitive to sound, light, smell and motion — so sensory exaggeration may be one mechanism behind the link with tinnitus,” says Dr. Timothy Hain, a neurologist and otolaryngologist at Northwestern Memorial Hospital in Chicago.
Some medications can contribute to the condition, including high doses of aspirin and regular use of other non-steroidal anti-inflammatory drugs (such as ibuprofen), as well as certain antibiotics, chemotherapy drugs, diuretics and antidepressants. (Often the ringing goes away if the medication is discontinued, Hain says.) And once you have tinnitus, certain lifestyle factors — such as stress, sleep deprivation and excessive caffeine intake — can make it worse.
Complicating matters, “a lot of people with tinnitus are bothered by it at night and have trouble sleeping,” Gopen says. “Then when they’re sleep-deprived their tinnitus gets worse. It can be a pretty vicious cycle.”
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How to Find Relief
The first step is to see an otolaryngologist for an examination and to have your hearing checked by an audiologist to see if the tinnitus correlates with hearing loss. “In most cases, if you can improve the hearing, you can make the tinnitus better,” says Dr. J. Thomas Roland, Jr., chairman of the department of otolaryngology — head and neck surgery at the NYU Langone Medical Center.
Often tinnitus is intermittent “since background noise in the environment can buffer the sounds within your ears,” Benninger says. But if the ringing interferes with your sleep at night or your ability to function during the day, you can mask the unwanted sound by running a white-noise machine or a fan or using an app that’s designed to mask unwanted sounds. The Neuromonics Tinnitus Alleviator, a product that has approval from the Food and Drug Administration, can be used on any Apple device to both drown out the tinnitus and help retrain your brain to ignore the ringing sounds and become less reactive to them, Roland says.
If you have hearing loss along with tinnitus, a hearing aid can help both problems by giving you a more normal input of sounds, Gopen explains. If you’re completely deaf in one ear but have phantom noises in that ear, a cochlear implant can restore hearing and improve the tinnitus.
Some people experience a reduction in their tinnitus while taking supplements such as Ginkgo biloba or lipoflavinoids, but the medical research on their effectiveness is mixed. They do, however, fall into the “can’t hurt and might help” category so they’re worth discussing with your doctor, experts say. In addition, medications such as a tricyclic antidepressant (like amitriptyline) or a benzodiazepine (like clonazepam) can help, Hain says.
On the mind-body front, hypnotherapy and/or psychotherapy can help boost your ability to cope with tinnitus. These forms of therapy can be especially helpful for people who also have symptoms of depression or anxiety related to their tinnitus, Gopen says. By contrast, with an intervention called tinnitus retraining therapy, an audiologist can help you become less bothered by tinnitus on both a conscious level and a subconscious level by wearing a low-level sound-generating device for certain periods of time; the idea is that as the brain becomes habituated to the noise, it de-emphasizes the tinnitus, which has a desensitizing effect on the person.
More aggressive treatments are being investigated for those with intractable tinnitus that’s severely impairing their quality of life. On the less invasive end of the spectrum is repetitive transcranial magnetic stimulation, or rTMS, which uses magnetic pulses to stimulate the underlying brain tissue; rTMS has been found to be effective for treatment-resistant depression and it may reduce the perception and severity of tinnitus, as well. Then there’s deep brain stimulation, or DBS, which is already an accepted treatment for people with Parkinson’s, essential tremor and other medical conditions; research has found that DBS has helped people who have Parkinson’s and tinnitus gain a reduction in those unwanted sounds as a peripheral perk.
Thanks to new treatments on the horizon, experts say there’s no reason to suffer silently. “Tinnitus can be immensely disturbing to people, and the louder it is, the more disturbing it tends to be,” Hain says. It’s always worth seeing a doctor, experts say, because if there’s a physiological cause, it may be treatable; even if there isn’t, there may be ways to mitigate the noise in your head or enhance your ability to tolerate it.
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Tinnitus: the Sound From Inside Your Head originally appeared on usnews.com
