Tinnitus and Hyperacusis
What is tinnitus?
Tinnitus is a problem that affects about 10% to 15% of the population. It is often described as a ringing, buzzing or pulsating sound in the ear, but is defined as a phantom auditory sound (i.e. perceived sound in the absence of an external noise). Many people who suffer from tinnitus also experience tension in their head, neck and jaw, tiredness, irritability, poor concentration, anxiety and depression that can be severe. About 5% of the population reports severely intrusive tinnitus affecting day-to-day activities.
What causes tinnitus?
Most cases of chronic tinnitus are thought to be a result of damage to the microscopic nerve endings in the inner ear. However, current research now suggests that a more central region of the brain (i.e. dorsal cochlear nucleus) has been identified as a potential culprit especially when it is accompanied with a loss of hearing (i.e. auditory input reduction). Tinnitus is a symptom and not a disease and is often the result of an injury to the peripheral auditory system, hearing nerve and/or auditory centres in the brain. Wax buildup, eardrum perforation, ear infection, barotitis (i.e. ear blockage after a flight), noise exposure, advancing age, head injury, teeth grinding, intense period of stress, certain medications (i.e. aspirin in high doses) and medical conditions (i.e. otosclerosis or abnormal bone growth in the middle ear) are risk factors that have been associated with the onset of tinnitus.
What is hyperacusis?
Hyperacusis is a problem that affects about 5% of the population and 50% of patients with troublesome tinnitus. It is defined as a reduced tolerance to everyday environmental sounds. The decreased tolerance to sound is usually noticed with sudden high-pitched noises like alarms, bus brakes, silverware and dishes, children’s crying, and clapping.
What causes hyperacusis?
The most common causes of hyperacusis are hearing loss, noise trauma (i.e. airbag explosion, gun shot from firearm), head injury, adverse reaction to some medications or surgeries, chronic ear infections and posttraumatic stress disorder. Hyperacusis can come on suddenly or gradually.
What are the treatment options for tinnitus and hyperacusis?
Although there are no cures for tinnitus and hyperacusis, there are a number of therapeutic approaches that provide relief and help manage the condition. Audiological solutions include directive counselling, such as Tinnitus Retraining Therapy, in conjunction with sound therapy (i.e. table-top or ear level sound generators and/or hearing aids) to help individuals not only habituate to tinnitus but also improve sound tolerance.
What is Tinnitus Retraining Therapy?
Tinnitus Retraining Therapy (TRT) is a treatment program for tinnitus and hyperacusis using both directive counselling and sound therapy. Developed by Dr. P.J. Jastreboff in the mid-1980s,
TRT is used to retrain the subconscious part of the tinnitus sufferer’s brain to ignore the sound of tinnitus. For individuals who suffer from hyperacusis, TRT is used to retrain the auditory nerve through desensitization to once again tolerate normal environmental sounds. Treatment usually takes 18 to 24 months. If the protocol is followed carefully, some may see improvement by six months. Upon completion of the program, the tinnitus should no longer be bothersome, but if listened for, it will be heard. Continuity of care is essential for achieving results.
What are sound conditioners?
Many tinnitus sufferers find that head and ear noises are not as disruptive in the presence of some pleasing or neutral external sound. Sound conditioners such as in-the-ear maskers, hearing aids equipped with sound masking technology, or some combination of these solutions, can offer relief, particularly when you are struggling to fall asleep. Consult with your audiologist to find out what might be right for you.
Other approaches for tinnitus and hyperacusis relief
For some people living with tinnitus, relief may be found by lifestyle changes such as: limiting your intake of caffeine, cigarettes, alcohol and aspirin; eliminating salt from your diet; reducing stress; reducing exposure to loud sounds; and, addressing allergens in the environment.
For severe and debilitating tinnitus, some medications may provide relief by helping to reduce the effects of sleep loss, difficulties with concentration, fatigue, depression and anxiety which may contribute to the intensity of the tinnitus. These medications must be prescribed by a physician and their suitability and effectiveness will depend on overall health and other medical considerations. Lastly, some have found relief from tinnitus using alternative treatments such as acupuncture, chiropractic care, shiatsu massage, biofeedback, breath training, self-hypnosis, melatonin, gingko biloba, vitamin B12 injections and a personalized diet.
How CHS can help people with tinnitus and hyperacusis
CHS offers a number of services for people living with tinnitus and hyperacusis, including:
• Tinnitus Retraining Therapy (TRT) at our Toronto office
Frequently Asked Questions
What kind of audiological tests are performed? Will it hurt my ears? What if I’m not experiencing tinnitus symptoms when I am tested?
The audiological evaluation for bothersome tinnitus includes a hearing test and several other specific tests which allow your audiologist to evaluate whether you have tinnitus and/or hyperacusis (i.e. a sensitivity to certain sound frequencies) and to what degree. None of the tests are painful and whether or not you are experiencing tinnitus symptoms will not influence the test results.
I recently had audiological tests done. Do they have to be repeated?
If you are visiting a different audiologist from the one who did your original hearing test, the new audiologist will likely want to perform the tests again. Equipment calibrations may vary and an audiologist will want the most accurate and up-to-date information before discussing treatment options. At CHS, we will always perform our own series of tests if you are a new client.
What should I do if I am experiencing tinnitus symptoms?
If you are experiencing on-going sound sensations, there are a number of ways in which tinnitus can be identified and/or treated.
Family Doctor Assessment
Contact your family doctor to schedule a complete history and physical examination. The important details you will want to share with your doctor are:
• When did you first notice the tinnitus?
• What precipitating factors, if any, were involved (i.e. noise exposure, medication, infection, intense stress, etc.)?
• Description of the tinnitus (i.e. intermittent, pulsing, frequency, etc.) and the nature of the sound itself (i.e. ringing, buzzing, high-pitched squeal, etc.)
• How severe you feel the tinnitus is and what kind of impact it is having on your concentration and ability to sleep
Depending on the results of the examination, your doctor may refer you to an audiologist to have your hearing tested and to discuss potential treatment options. You may also be referred to an otolaryngologist (i.e. ear, nose and throat specialist) or other relevant specialties to rule out any potential underlying medical conditions.
If you choose to visit your audiologist for a hearing test, indicate that you are booking the test because of your experience with tinnitus and hyperacusis. After a full audiological examination, the audiologist will discuss the results with you as well as any treatment options that may be appropriate. All your test results will be sent to your family doctor on your request.
Your visit to the audiologist is also a good opportunity to ask questions about your tinnitus and hyperacusis and possible coping strategies.
Where can I find more information on tinnitus?
You can check out these websites: