Ringing in the ears – tinnitus

Quite commonly, many people admit to hearing noises in their ears or head; noises that no one else can hear and that are not associated with any outside sounds. This experience is known as subjective tinnitus. There are many descriptions of tinnitus sounds, most commonly described as hissing, ringing, humming, the sound of escaping steam, buzzing, roaring, the sound of fluorescent lights, static, whistling, whooshing, or crickets. Not only do many people experience tinnitus constantly or intermittently for short periods of time, but additionally, it is actually possible to induce tinnitus in almost any person by keeping him/her in very quiet place for some time. Indeed, the experiment performed by Heller and Bergman in 1953 (repeated by others 50 years later) showed that 93% of participants (80 subjects with normal hearing and no tinnitus) described experiencing temporary tinnitus-like sounds after only 5 minutes in silence (in a sound proof room). Tinnitus is not a disease, it is an experience associated with the perception of sound generated by the auditory system as a compensatory mechanism. Some refer to tinnitus as “the music of the auditory part of the brain”.

People of all ages, with hearing ranging from “perfect” to deaf, may all experience tinnitus. Even though people with hearing loss may or may not have tinnitus, tinnitus is more prevalent in individuals with some degree of hearing loss. It is estimated, that 1 in 10 Americans have tinnitus, 8-12 million Americans express concern about it, and about 2 million are debilitated by tinnitus. It is not unusual for people who suffer because of tinnitus and need help due to hearing loss, experience decreased sound tolerance as well, a problem which requires attention. Decrease sound tolerance is present when a subject exhibits negative reactions (e.g., discomfort, annoyance, pain) as a result of exposure to sound that would not evoke the same reactions in the average listener

It is difficult to identify the exact cause of tinnitus in many patients, but the most common causes include noise exposure, head and neck trauma, and side effects of ototoxic medications. Occasionally, it may be due to wax accumulation, a simple problem to correct. Additionally, tinnitus can be a symptom of various medical disorders; thus, when the medical problem is properly addressed, the tinnitus may resolve. Therefore, it is important to consider a visit with an otolaryngologist (ENT doctor) to exclude medically treatable disorders.

Epidemiological studies have shown that 85% of individuals who experience tinnitus are not bothered by it and find it to be a non intrusive experience. The type and loudness of the sound is very similar in both people who are not bothered by tinnitus and those who suffer because of it. So the obvious question is what is a difference between these people? Why are some people annoyed and distressed by tinnitus, have problems sleeping and concentrating, suffer from anxiety, and, thus, seek help for their tinnitus. To understand the answer to this question, it is important to note, that the problems described by people affected negatively by tinnitus are not strictly related to the tinnitus sound, but rather both to emotional response and the response of the autonomic nervous systems (manifested as annoyance, frustration, distress, anxiety, depression, problems with concentration or sleep) induced by tinnitus.

The difference between people who do not have a problem with tinnitus and those who suffer from it depends on whether they initially created positive, neutral, or negative associations with tinnitus when they noticed it for the first time. For example there is a region in rural India where people believe that tinnitus is the voice of god talking directly to them. Consequently, people with tinnitus feel very special and blessed and, consequently, they do not have any problems with tinnitus. In fact, they feel privileged to have tinnitus! Another example is from my own family.

Many years ago, when I started treating tinnitus patients, I became aware that my father had tinnitus. Sometimes, even as snow fell outside the window, he would say “Wow, my cicadas are very loud today”. So I asked him “Would you like me to help you with it?” With a surprised smile on his face, he asked “Why? I love my cicadas, I listen to them when I cannot sleep at night and the sound helps me fall asleep.” At first this did not make sense to me. For years, I had heard complaints from so many people who suffered from tinnitus about the “noise of the cicadas” which destroy their lives! My father then explained to me why, not only did he not have a problem with hearing the cicadas, but he actually liked his cicadas! He described to me vacations on the border of Adriatic Sea and camping in an olive orchard when he was young. There he heard a choir of cicadas for the very first time. He said “I was so relaxed and happy. It was one of the best times in my life, so now tinnitus brings back this happy memory to me.”

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  1. Very interesting article. Its quite true, different persons encounter tinnitus through different factors and circumstances, there are many different specific things that may cause tinnitus.

  2. Hi Doctor! Thanks for sharing your views with us. My question is, whether or not the subjective tinnitus is curable? I am suffering from it, went through several treatments but the disease doesn’t seems to leave my body

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