Have you ever heard the expression “ringing in the ears’‘?

Posted: November 12 2021

Maybe you’ve had the experience of sitting in a quiet room and hearing sounds such as ringing, buzzing, or even ‘whooshing’. That sound is called tinnitus [pronounced “tin-uh-tus” or “ti-night-us”] and it’s not uncommon. According to Stats Canada, an estimated 37% of adult Canadians experienced tinnitus between 2014 and 2015. For many people, tinnitus is just a part of their daily routine. For others, it can have a negative impact on their quality of life and ability to function. Persistent tinnitus may disrupt a person’s ability to concentrate, prevent them from relaxing, or even cause trouble sleeping. For these people, it’s important to have a better understanding of how tinnitus works in order to best manage it. So, what is tinnitus? And what can be done about it?

First of all, tinnitus is not a disease but a symptom. There are several different reasons why a person may experience bothersome tinnitus such as stress, lack of sleep, and hearing loss. In some cases, there may be an underlying medical condition that requires assessment by a physician. If a person experiences tinnitus that pulses with their heartbeat, the sensation of their body spinning or the room spinning around them, weakness of facial muscles, or significant depression/anxiety, it is important to seek medical attention as soon as possible. Now that that’s out of the way, why else may someone experience tinnitus? 

Most often, tinnitus occurs in tandem with hearing loss or after damage to the ears. You may have had the experience of attending a loud concert and noticed a more pronounced ringing in your ears afterward. While this type of damage isn’t always permanent, tinnitus and hearing loss are related - and it’s still a great idea to wear hearing protection at loud concerts! One theory is that tinnitus is a sort of “phantom sound” that occurs due to damage to the hearing system. This theory suggests that since the brain is no longer receiving as much sound, your auditory system “turns up the volume” so to speak, resulting in the perception of a sound that does not actually exist. Following this logic, for many tinnitus sufferers, simply introducing more sound back into their lives can greatly improve their symptoms. For those with hearing loss, this can be achieved by wearing a hearing aid. For those without hearing loss, they may consider introducing background sounds from a fan, sound generator, or soothing background music.

What about when introducing more sound isn’t enough? In these cases, step one is helping patients to understand their tinnitus. Like many sounds, tinnitus is related to the part of the brain that regulates our emotions. How a person reacts emotionally to tinnitus can have an effect on how it is perceived. For example, imagine that you are walking through a quiet forest when suddenly you hear a hissing sound - a venomous snake! Your brain quickly goes into fight or flight mode and, because you’ve labelled this sound as a threat, your brain actually pays more attention to the sound, making it seem amplified. Then, you look over and see someone letting the air out of their bicycle tire. You quickly realize that the sound was no reason to be alarmed and your brain starts to pay much less attention to it. As a result, the sound is much quieter and fades into the background. The way that individuals react to their tinnitus is similar to this analogy. Often, once patients understand the mechanism behind their tinnitus, they understand that it is a common phenomenon, and that it does not indicate there is anything wrong with them, they are much less bothered by their tinnitus. 

When sound therapy and a better understanding of tinnitus are not enough to improve quality of life, other interventions may be recommended. Several different types of tinnitus therapies exist, such as tinnitus retraining therapy, progressive tinnitus management, and cognitive behavioural therapy. While all of these interventions have some degree of evidence, cognitive behavioural therapy is viewed as the safest and most effective treatment, according to an analysis of literature by the British Tinnitus Society. If a consultation with an audiologist does not improve your tinnitus symptoms, they may refer you to a psychologist who performs cognitive behavioural therapy for patients with chronic pain. For both tinnitus and chronic pain, the focus of intervention is to shift the patient’s thinking away from negative thought patterns.

If you or someone you know suffers from tinnitus, please know that you are not alone and that there is hope! A hearing assessment and consultation with an audiologist is the first step toward improving tinnitus symptoms. Your audiologist will determine if your tinnitus requires medical intervention, or if amplification, lifestyle changes, or counselling can be utilized to manage your symptoms. In the majority of cases, tinnitus is not a threat and simply gaining peace of mind through a consultation with a hearing professional can greatly improve an individual’s tinnitus symptoms.

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