- Objective – can be detected by an observer e.g. vascular/muscular sources. These usually cause a pulsing (with the heartbeat) or clicking type noise.
- Subjective – not audible to an observer (this is the commoner type of tinnitus). This usually causes a more sustained type of sound e.g. a hiss, ringing, or steam.
In many cases except for some inner ear hearing loss, no clear cause for the tinnitus is evident. Some patients have had past noise damage which may have contributed to the problem. In some cases, a clear cause can be identified and sometimes corrected. This includes impacted ear wax or problems with the eardrum or bones in the middle ear. In the majority of cases, no serious abnormality is found. On rare occasions, more serious problems such as an acoustic neuroma (a benign swelling on the nerve to the ear) or a vascular problem may be causing tinnitus. These are rare but benefit from being diagnosed early and in some cases require treatment.
The investigations for tinnitus include a hearing test. Further investigations depend on the story, examination, and hearing test results. These may include an MRI scan.
If you have tinnitus please discuss with your GP who may consider referring you to your local ENT or audiology department/specialist.
The management of tinnitus depends on the cause (if any) and the amount of trouble it is causing. If no obvious correctable cause is found, some patients find simple re-assurance sufficient. Others will require more help to cope.
Certain general measures help. These including:
- Reducing/ giving up caffeine (tea, coffee some fizzy drinks)
- Reducing sources of stress if possible
- Make sure you get enough sleep
- Prevent excess hunger/thirst
- Many of the lifestyle advice measures for migraine treatment can also help with tinnitus. See here.
In most people with tinnitus, background noise can help reduce awareness of tinnitus. This principle can be used to help cope better with tinnitus. Simply playing the radio or TV in the background can be helpful. Certain types of noise seem better at reducing the awareness of tinnitus. These include white noise which is hissing type noise. One would assume listening to a noise that is similar to tinnitus should not help. In practice, however, this principle of “sound therapy” is used by some patients to successfully reduce the effects of tinnitus. Devices can be purchased which generate various types of noise which experience has shown can be helpful (see here). These devices can be placed near the bed to help sleep. Smartphones can also be used in conjunction with “Tinnitus” apps to generate various helpful noises as well as other helpful advice. Some tinnitus apps are ReSound Tinnitus Relief, Tinnitus Pro, Hear&Tinnitus, Tinnitus. Some of these apps can also do more complex sound manipulation of music which they claim may help tinnitus. These noise generators can be used in conjunction with a pillow speaker (these can be purchased from Amazon or the British Tinnitus Associate shop). This can be placed underneath your pillow and provides noise to the ear even if on a pillow. They reduce the disturbance of your partner. Bose makes a device that can be worn in the ear (sleepbuds) that generate noise to help sleep for patients with tinnitus.
The audiology department can provide personal sound generators which can be worn in a similar fashion to a hearing aid.
A proportion of patients with tinnitus finds everyday sounds uncomfortable or unbearable (hyperacusis). In this group sound therapy is more difficult but can still be used to help the patient to gradually habituate to noise and tinnitus.
Patients with tinnitus who have significant hearing loss generally find a hearing aid can help reduce awareness of tinnitus. Some hearing aids can also act as noise generators.
Learning to relax via relaxation techniques or meditation can help reduce the anxiety of tinnitus. There are many self-help books, CDs, DVD’s and websites for this. Smartphone apps are another way to relax or meditate. Some app and relaxation methods use the principles of mindfulness meditation. These apps include Buddhify2, Headspace, Breath, Tinnitus Relief by Helena, etc. I do not specifically endorse one app over another.
Understanding the mechanisms of tinnitus and learning to cope with it is key to reducing the annoyance and effect of tinnitus. Professionals can help tinnitus patients with formal tinnitus counseling. Other psychological methods include cognitive behaviour therapy and tinnitus retraining therapy.
Many patients want to know if there are any drugs that can help tinnitus. There is no proven safe effective drug therapy at present. Some patients with recent-onset tinnitus may benefit from benzodiazepines (e.g valium). Although helpful for some they are addictive and should not be used for more than a few days. Patients who are very anxious or depressed may benefit from treatment for these problems which may include cognitive behaviour therapy or medications including antidepressants.
Further information can be obtained from these sites:
Most audiology centres in NHS hospitals will provide treatment for tinnitus. These can be accessed via an ENT department referral. Your GP can refer you to a local ENT department /specialist who in turn can refer you to the audiology centre for further assessment or treatment if appropriate.
Private clinics also provide help (e.g. here) but it is advised you discuss the issue first with a GP and if required with an ENT specialist.
Certain usually rare, types of tinnitus can be improved with medications or surgery. I am not referring to obvious causes such as ear wax or middle ear congestion / middle hearing loss. These include:
- Middle ear myoclonus. This is a tapping scratching sound due to twitching muscle in the middle ear. The tendon to the muscle can be cut which can improve the problem.
- Typewriter tinnitus. The cause is not known. This type of Tinnitus is described as a rapid tapping noise. The medication carbamazepine can help.
- Vascular tinnitus. A wooshing pulsatile noise which is in time with the pulse. The vascular problem may be correctable e.g with correction of sigmoid sinus diverticulum or occlusion of an AVM.
- Pulsatile noise due to an unusual type of migraine or Meniere’s disease. Treatment for migraine or managers may be of help. See the page on migraine treatment and Meneire’s disease.
This is a condition in which patients are sensitive to sounds at a volumn which ordinarily would not cause problems for most people. The cause as with tinnitus is unclear.
Treatment options include sound desensitisation therapy via an audiology centre. There is some evidence that migraine preventative treatment can help some patients. This included lifestyle measures, dietary modifications, and medications (nortriptyline, verapamil, and topiramate). See here.
Mr. Rejali and Mercia Health have no relationship/link, financial or otherwise to any of the external websites/organisations listed above.