What is tinnitus?
Tinnitus is the symptom of hearing a sound where no sound is present and is very common. 18% of Australians experience tinnitus all the time with just about everybody experiencing it at some point. Tinnitus itself is not a disease but a symptom and can have a range of causes. It can be constant, loud and annoying to the point that it causes emotional stress, poor sleep, anxiety and depression.
What causes tinnitus?
Tinnitus remains a challenging condition to treat because in many cases we do not completely understand why it has occurred. The commonest association is with age related degeneration of the hearing system. Occasionally tinnitus on one side is the first sign of a benign tumour called an acoustic neuroma and this needs to be evaluated with an MRI scan. Tinnitus that is pulse-like may be caused by problems that make you hear your own pulse (such as a blocked middle ear) or occasionally by problems with a blood vessel. All patients with new tinnitus should have an audiogram and be evaluated by an ENT specialist to rule out serious causes.
How can tinnitus effect me?
- Health – anxiety, depress, sleep disturbance
- Personal life – relationship problems
- Social life – difficulty hearing in social settings, withdrawal from social activities
- Work life – decreased concentration and work performance
What treatments are available?
After a thorough assessment to rule out any serious cause, a number of treatment options for tinnitus are available.
Treatment of an ear conditions
Tinnitus can be caused by ear wax, a middle ear infection, Eustachian tube blockage or other treatable causes. An ENT specialist can help evaluate and treat these conditions. It is sometimes caused by a condition called otosclerosis that can also be treated successfully in some patients.
Tinnitus Retraining Therapy (TRT)
TRT is considered the most successful treatment for tinnitus. Our brain has an amazing ability to suppress familiar but unimportant noises, for example the noise of an air conditioner, ticking clock or a fan. The goal of TRT is to train the brain to suppress tinnitus in the same way, a process called habituation. There are two parts to TRT – counselling and auditory therapy.
Counselling involves identifying the fears and concerns created by tinnitus and a thorough explanation of why tinnitus is heard and how auditory therapy works.
Auditory therapy aims to enrich the environment by maximising the sound available. If there is hearing loss, hearing aids are recommended. Even a mild hearing loss can result in an increased effort to hear and increased awareness of tinnitus. Hearing aids increase environmental noises which reduce the awareness of internal noises.
If hearing is normal, a “white noise generator” can be used to stimulate auditory pathways to the brain and remove the brain’s ability to focus on the tinnitus. This reduces the contrast between the tinnitus and environmental sounds and facilitates habituation.
Cognitive Behavioural Therapy (CBT)
CBT identifies and attempts to reduce negative thought processes associated with tinnitus. These negative thoughts can generate much of the anxiety, fear, anger and distress that is associated with the symptom. Often these thoughts lead to a heightened awareness and focus on the tinnitus which can then increase the tinnitus. Patients are taught skills that can help them to reduce these thoughts. These include – distraction, creative visualisation, thought stopping and relaxation.
Hypnosis helps to induce a relaxed state where attention can be focused on directions given by the therapist. In this state people are more open to suggestions given to them. Hypnosis may assist with relaxation, changing thoughts regarding the tinnitus and improving sleep quality.
The Tinnitus Association of NSW contains further information as well as information about self-help groups.
The Hearing and Balance Centre at St Vincent’s Hospital, Darlinghurst, runs a clinic with audiologists and psychologists with a special interest in tinnitus.
Please note that Dr Roth does NOT offer tinnitus retraining therapy, cognitive behavioural therapy or hypnosis in his clinic. Please contact one of the two links above if you would like further information about these treatment options. Dr Roth provides evaluation for the cause of the tinnitus and can treat some causes.