One of the most important aspects of my role as an Audiologist is to take a clear and concise case history in order to learn what concerns have brought my patients into my office. This history involves outlining symptoms/experiences such as perceived hearing loss, pain in the ears, noise exposure, vertigo etc. In these conversations the topic of tinnitus nearly always arises.
You’ve probably heard it pronounced or described (tin-NIGHT-us vs. TINN-a-tus) in different ways but I’d be willing to bet that at some point in your life you have been around an individual who experiences some degree of tinnitus. In short, Tinnitus can be classified as the perception of sound when in reality no external acoustic stimulus is present. It is a uniquely subjective phenomenon where one individual may perceive ringing, while another “hears” buzzing while another still may “hear” a low roar/rumble. The nature of an individual’s tinnitus is often tied to an underlying auditory deficit. You do not have to have hearing loss to experience tinnitus but very often they coincide with one another. Tinnitus can be both acute or chronic in nature and have many effects on an individual’s quality of life.
Tinnitus is very common. The U.S. Centers for Disease Control estimates that approximately 15% of the general public experiences some form of tinnitus. That’s nearly 50 million people! Of these 50 million around 20 million experience bothersome tinnitus and approximately 2 million people experience debilitating symptoms.
Because of the subjective nature of the perception tinnitus it can be difficult to objectively measure its severity as well as the impact it has on a patient’s everyday life. A tool Audiologists can use to help assess the impact of tinnitus is called the Tinnitus Handicap Inventory (THI) https://www.ata.org/sites/default/files/Tinnitus_Handicap_Inventory.pdf. The THI is a 25 question survey that helps to classify the impact Tinnitus has on a patient’s everyday life. I often use this tool in my daily clinical life in order to set fourth an appropriate and personalized treatment plan for my patients.
To date there is no cure for tinnitus. Rather, there are different treatment strategies to help relieve patients of their symptoms. The degree and severity of the tinnitus directs what course of treatment is most appropriate on a patient-to-patient basis. As I stated before hearing loss and tinnitus often coincide with one another. When a significant sensorineural hearing loss is present, I always recommend amplification as our starting point. It may sound counterintuitive but by treating hearing loss and further stimulating the auditory system hearing aids alone can often provide great relief for tinnitus. During the fitting process patients will regularly comment on how the severity of their ringing is greatly reduced immediately.
However, sometimes hearing aids alone do not provide immediate or sufficient tinnitus relief. In these circumstances I conduct a process called pitch matching. Pitch matching is the process of identifying the frequency and amplitude (i.e. pitch & volume) that most closely resembles a patient’s perceived tinnitus. This is done is a sound-proof and acoustically controlled environment. Once that information is collected, I can use that data to create a stimulus generated from an on ear device to further reduce the perception of tinnitus.
In the most significant and debilitating cases of tinnitus I implement Tinnitus Retraining Therapy (TRT). The end goal of TRT is habituation (the diminishing of a physiological or emotional response to a frequently repeated stimulus) to perceived tinnitus. TRT utilizes three vital therapeutic steps. First involves collecting an extensive case history, not only in regard to tinnitus but a full patient history and daily living habits. The second step is the fitting and programming of an appropriate ear device to help divert attention. Lastly psychological training is implemented to teach patients to successfully ignore tinnitus noise. This is achieved through stress management and deep relaxation exercises. The hope is to eliminate a patient’s anxiety over tinnitus so in no longer is perceived as a threat. This process can take time but when the work is put in by both the patient and clinician it can achieve life changing results.
Not all cases of tinnitus are this serious and can also involve a patient with no measurable hearing loss. In these situations, deep breathing exercise and simple noise generators can provide great relief. One of my favorite tools is the ReSound Relief app. This is a free smartphone app that helps patients to create a more comfortable distracting stimulus as well as teach relaxation strategies. Anecdotally patients have also told me cutting out excessive salt and alcohol from ones diet yielded great results.
In summation, do not lose hope! Millions of people are affected by tinnitus but there are a range of therapeutic interventions to help the most mild to severe cases. If your tinnitus ever drastically fluctuates in perception or sounds like a heartbeat it is important to report this information to your clinician. You can work together with your Audiologist to ensure further referral to primary care or an Ear Nose and Throat specialist is not warranted.