Most people have heard of tinnitus, the name for hearing noises that are not caused by sounds coming from the outside world. But where do these sounds come from and what can actually be done about them? Mr Nitesh Patel, Consultant ENT Surgeon and Tinnitus specialist at The Holly, explains.
- Tinnitus is actually a symptom – not a disease
If you have experienced sound which has not come from an external source, you have experienced tinnitus. The type of sound can vary widely and is often described as ringing, whooshing, humming or buzzing. However, the sound can also be rhythmic or even musical. The sound may be heard in one ear, both ears or be difficult to localise and seem to be generally within the head.
- Tinnitus is common
People of all ages including children can experience tinnitus. Up to 30 per cent of people will experience tinnitus at some point in their lives – one in three people – which is a lot when you think about it.
While it’s generally more common in older people with hearing loss younger people are increasingly presenting with tinnitus. This challenges the old view that tinnitus is simply due to hearing loss.
The field of neuroscience is rapidly developing and revealing that there are wider changes in brain network activity and central monitoring of multisensory data in tinnitus and other related functional neurological disorders. The steep rise in tinnitus cases during the Covid-19 pandemic, even in people who have not suffered with Covid-19 or have hearing loss, highlights the wider impact that stress and poor sleep quality can have on our multisensory monitoring systems which can maladapt when faced with significant adversities.
- Most cases of tinnitus are generated by nerve signals in the brain
Tinnitus that occurs without an active disorder affecting the hearing system is called primary tinnitus. This type of tinnitus is generated by electrical signals (nerve impulses) in the brain. The brain adapts to experience and responds to stress. Stressful experiences related to a physical illness, physical injury or emotional trauma can cause brain hyperactivity and trigger tinnitus.
Secondary tinnitus is much less common and occurs with an active or acute ear disorder such as an ear infection, ear injury, or swelling affecting the hearing system. Rarely, it can be due to hearing actual sounds within the head associated with jaw or muscle movements or circulating blood (the technical name for this is pulsatile tinnitus).
The type of tinnitus a person has can be diagnosed through a focused history, clinical examination and where appropriate, specific investigations such as audiology tests and radiology scans.
- Emotions drive tinnitus perception
The brain is organised into intrinsic connectivity networks, and overactivity in one part of the brain can stimulate another. Tinnitus is generally worse when focusing attention on the sound or when going through stress. Learning to focus attention away from the sound, improving sleep quality and practising mindfulness and relaxation techniques can significantly help reduce the emotional drive of tinnitus.
Unfortunately, due to unregulated material widely available on the Internet, some people are misinformed about tinnitus and this can lead to significant health anxiety. Simply talking to a health professional with experience of managing tinnitus and being provided with proper information can significantly allay such health anxiety and reduce the emotional drive of tinnitus.
- There are treatment options for tinnitus
Secondary tinnitus associated with an active ear disorder often improves after specific treatment for that ear disorder. For example, removal of obstructing ear canal wax, treatment of an active ear infection or surgery for a treatable cause of hearing loss.
It is important to understand that primary tinnitus is not harmful, and as it is not a specific disease does not need a specific cure. However, bothersome persistent primary tinnitus can significantly impact quality of life – and there are treatments methods available to help reduce and control the brain nerve signals that generate the tinnitus. These include various audiological and psychological therapies. If you experience bothersome persistent tinnitus you should seek appropriate medical help, and you can always see our specialist team at The Holly for expert advice.