Tinnitus

FAQ | Assessment & Diagnosis | Prevention & Management | Clinical Facilities | Research Avenues

Tinnitus FAQ

What is the normal process of hearing?

• A sound is created from changes in air pressure. The pressure changes create sound waves, which will travel through the ear canal to the Tympanic Membrane, or ear drum. The acoustic energy of the sound wave continues from the ear drum to the three small bones within your skull, or the ossicles. The Malleus, the Incus and the Stapes then transfer the energy to the Oval Window on the cochlea from the footplate of the Stapes. This transfer of energy causes the fluids within the cochlea of your inner ear to then move your hair cells. The hair cells will trigger a chemical change which ignites an electrical impulse to the VIII nerve, also known as the Auditory Nerve. The impulse is then directed through the Central Auditory Nervous System, or CANS, which will then process the acoustic information through a series of neural networks and allow you to comprehend the original sound.i
  • Endnotes:
    • NIDCD. (n.d.). Noise-Induced Hearing Loss: How can noise damage out hearing? Retrieved July 28, 2016, from https://www.nidcd.nih.gov/health/noise-induced-hearing-loss

What is tinnitus?

• Tinnitus pronounced as (TINN-a-tus or ti-NIGHT-us) (Latin origin: “to ring or tinkle”)1 is not a disease, but a symptom of a deeper auditory or neurological condition. It is one of the most common health complaints, with roughly 10%-15% of U.S. adults expressing that they suffer from hearing the internal noise.
• Tinnitus is as varied as the individuals who suffer from the condition. The noise can be experienced as a ringing, buzzing, hissing, clicking, roaring or even as music. The noise can vary in pitch, loudness and include one or both ears. The length and consistency of tinnitus can range from a one-time intermittent episode spanning to a daily continuous burden of the noise. Even though the noise may be heard in your ears, the cause of tinnitus can be damage to any structure(s) in the auditory pathway including the network of brain cells (or neural circuits) that process sound. ii
  • Endnote(s):
    • ASHA. (n.d.). Tinnitus. Retrieved July 28, 2016, from http://www.asha.org/public/hearing/Tinnitus/
    • ATA. (n.d.). Understanding the Facts. Retrieved July 28, 2016, from http://ata.org/understanding-facts
    • NIDCD. (n.d.). Tinnitus. Retrieved July 28, 2016, from https://www.nidcd.nih.gov/health/tinnitus

What are the different types of tinnitus?

• There are two primary categories of tinnitus:
  • Subjective tinnitus is a noise that can only be heard by the specific individual and not heard by others.
  • Objective tinnitus, such as pulsatile tinnitus, can be heard by others. It may be described as a rhythmic noise that can be heard internally and causes discomfort for the patient. Doctors can hear the noise by placing a stethoscope over the head and neck structures of the patient. iii
    • Endnotes:
      • ATA. (n.d.). Understanding the Facts. Retrieved July 28, 2016, from http://ata.org/understanding-facts
      • NIDCD. (n.d.). Tinnitus causes and types. Retrieved July 28, 2016, from https://www.nfd.org.nz/help-and-advice/hearing-conditions/tinnitus/tinnitus-causes-and-types/
      • NYU Langone. (n.d.). Types of Tinnitus. Retrieved July 28, 2016, from http://nyulangone.org/conditions/tinnitus-in-adults/types

What are some causes of tinnitus?

• Tinnitus can indicate damage to one or more delicate structures of the auditory system. There are multiple causes of tinnitus:
  • Ear and sinus infections
  • Earwax blockage
  • Exposure to loud noise
  • Aging
  • Diseases of the circulatory system
    • Such as Anemia and hypertension
  • Meniere’s disease
  • Certain types of brain tumors
    • Acoustic neuroma which is a noncancerous growth on the VIII nerve
  • Head injury
  • Ototoxic medications and drugs
    • There are over 200 types of medications that can negatively affect an individual’s auditory system. Starting or stopping these medications can lead to tinnitus among other auditory conditions.
• Health, environmental, and lifestyle conditions that may affect tinnitus:
  • Migraine headaches
  • Caffeine
  • Smoking
  • Hormonal changes in women
  • Thyroid abnormalities
  • Elevated levels of stress iv
    • Endnotes:
      • ASHA. (n.d.). Tinnitus. Retrieved July 28, 2016, from http://www.asha.org/public/hearing/Tinnitus/
      • ATA. (n.d.). Causes. Retrieved July 28, 2017, from http://ata.org/understanding-facts/causes
      • NIDCD. (n.d.). Tinnitus causes and types. Retrieved July 28, 2016, from https://www.nfd.org.nz/help-and-advice/hearing-conditions/tinnitus/tinnitus-causes-and-types/

Assessment & Diagnosis

What can I expect from an appointment for my tinnitus?

• A team of health care professionals may take part in the assessment, diagnosis, and treatment of your tinnitus. These professionals can include, but are not limited to:
  • Certified Audiologists
    • Professionals who hold licensure and certification from the state and governing body to ensure they uphold the standards of the profession
  • Otolaryngologists
    • Also known as ENT’s or Ear, Nose, and Throat doctors
  • Primary Care Physician
    • May refer you to the other specialists
• Your appointment will start by obtaining a comprehensive health form to tell your provider about your past and current medical history, any medications you have and/or continue to use, and your aural health and risk factors, such as occupation and family history.
• Diagnostic Testing
  • Footnote: http://www.ata.org/understanding-facts/measuring-tinnitus
• There are a number of questionnaires that can also be used for the initial evaluation and later management options for your tinnitus. Some questions that may be asked about your tinnitus include:
  • Ear specificity
    • Is the noise bilateral or unilateral? If it is only one ear, which ear is it?
  • Is the noise continuous or irregular?
  • Describe the noise. Is it a hissing, buzzing, ringing, music, heartbeat, etc.?
  • What is the pitch of your tinnitus? Does it ever change?
  • How loud or soft is the tinnitus? Does it ever change?
  • Does anything make the tinnitus better or worse? Do you know any triggers for the tinnitus?
  • Are you able to ignore the tinnitus or is it highly bothersome?
• The diagnosis of tinnitus is geared toward finding the underlying cause. An aural examination will most likely take place. This exam can include an otoscopy to check for ear wax and audiometric testing to ensure there is no underlying hearing loss. If abnormal results are found, further testing and referrals for items such as CT scans may follow.
• After a comprehensive assessment occurs and a diagnosis is given, there will be a discussion of management and treatment options. v
• Note: If the health care provider you are seeking treatment from says there are no options to help you manage your tinnitus, seek help from another professional. Your provider should want to help deliver the products, treatments, services, and practices that can help reduce the severity of your tinnitus and allow you to live a more comfortable and productive life. 2

vATA. (n.d.). Patient Roadmap. Retrieved July 28, 2016, from http://www.ata.or/managing-your-tinnitus/patient-roadmap

2 ASHA. (n.d.). Tinnitus Management. Retrieved July 28, 2016, from http://www.asha.org/public/hearing/tinnitus-management/
NYU Langone. (n.d.). Tinnitus in Adults. Retrieved July 28, 2016, from http://nyulangone.org/conditions/tinnitus-in-adults

Prevention & Management

How can I try to prevent tinnitus?

• Prevention strategies for tinnitus focus on decreasing one's risk of a hearing loss. It is important to note that if one already suffers from tinnitus, prevention steps will not reverse your symptoms. Instead, these steps should be taken to help prevent your tinnitus and any other auditory functions from worsening.
• A basic overview of what constitutes as an unhealthy auditory environment is one which exposes the listener to any one-time or long-term exposure to noise at 85 dB and above. One suggestion to determine if your environment is too loud is through the use of mobile applications. Many of the applications will measure the sounds in decibels.
• Here is a list of average dB ratings for familiar sounds:
  • • Humming of refrigerator
      • 45 dB
    • Normal conversation
      • 60 dB
    • Noise from heavy city traffic
      • 85 dB
    • Motorcycles
      • 95 dB
    • MP3 at max volume
      • 105 dB
    • Sirens
      • 120 dB
    • Firecrackers
      • 150 dB3
• Overall, the louder the noise, the shorter the distance between the source of the noise and the listener and the longer the duration of exposure to the noise, the greater the impact on one's hearing.
• Strategies such as turning down the volume of music or decreasing the emittance of noise from loud machinery can help preserve one's hearing. The use of hearing protection devices like earmuffs, ear plugs, canal caps, and other sound mufflers should be used to limit one's exposure to loud noises if withdrawal from the noisy environment is an unavailable option.vi

How can tinnitus be managed?

• Currently, there is no known cure for tinnitus. However, there are several ways to manage tinnitus and help increase one's quality of life. Each individual tinnitus patient will have to customize their treatment/management techniques with the help of a hearing health care professional. Many times, using a collection of techniques may lead to a decrease in the effect of the tinnitus.
• Here are some of the management tools and techniques:
  While extensive, this list is not exhaustive. For more information about management and treatment methods, speak with your health care provider.
  • Sound Therapy devices/Tinnitus masking devices
    • Any device that emits noise to help relieve the patient of negative emotions associated to their tinnitus. They can be tabletop or personal wear devices such as devices similar to hearing aids or hearing aids themselves. These devices are used to provide a steady background noise to decrease the effects of tinnitus.
  • Hearing aids
    • The purpose of the personal electronic device is to increase the degree of acoustic information the individual receives when there is a significant loss to one's ability to process sound.
    • The devices can be combined to have programmable sound therapies.
  • Modified-sound/Notched-music devices
    • These devices are more individual than more mainstream sound devices and tinnitus maskers. They are medical-grade and used less consistently than other sound generators/devices.
  • Self-help groups
    • The ATA can direct you to a local tinnitus group. These self-help groups offer support and a welcoming environment to help you accommodate with your tinnitus. vii
      • Use of low-level background sounds (e.g., music, waterfall, raindrops, ocean waves, etc.)
      • Apps for portable media players
      • Habituation therapies (e.g., Tinnitus Retraining Therapy)
      • Relaxation therapy
      • Experimental therapies
      • Acoustic neural stimulation
      • Drug therapies
        • The use of antidepressants and antianxiety drugs
      • TMJ treatments
      • Lifestyle changes
        • Reduction of stress

Clinical Facilities

I believe I suffer from tinnitus. What are the next steps?

• • The American Tinnitus Association (ATA) has created a patient map on how to seek treatment for one’s tinnitus.4
  • As described in the figure, first and foremost, stay calm and take care of your personal health. In a study completed by Schaaf et al (2014), it was concluded – through the comparison of stress levels to individuals suffering from psoriasis within a hospital setting – that stress is a factor of tinnitus. (Schaaf, Flohre, Hesse, & Gieler, 2014). 5
  • Next, contact your primary care physician or hearing health care professional, such as an ENT or Certified Audiologist.
  • Ensure to create a support system of not only those involved with the medical treatment and management for your tinnitus, but also family, friends, and possible support groups. Having such a collection of individuals and teams can lead to improved emotional and social components to one’s quality of life.
  • Lastly, do not become discouraged by those who claim there is no hope for relief from your tinnitus. There are methods to help alleviate your symptoms.viii
    • Endnote:
      • ATA. (n.d.). Patient Roadmap. Retrieved July 28, 2016, from http://www.ata.org/managing-your-tinnitus/patient-roadmap
  • Find a facility to provide Clinical Hearing Services near you. Here is a list of providers to help with a number of clinical hearing services at and around Hofstra University.

Research Avenues

• While many of the clinical services provided can help alleviate tinnitus, management is no cure.6 Government and private agencies, universities, and hospitals are but a few avenues for research being conducted on tinnitus. The research can range from the improvement of the tools and techniques for assessment, diagnosis, and management to the development of educational resources for tinnitus. Others are working not only to alleviate and educate the public about tinnitus, but for a cure.
• Clinical Trials vs. Clinical Research
  • It is important to note that while you are viewing and considering opportunities to become involved in research, Clinical Trials and Clinical Research differ. As stated on the NICHD website, a clinical trial is a subset of clinical research. Clinical trials do not guarantee relief, but instead allow participants to further the research from a pre-proposed plan. Clinical research is the all-encompassing group which includes all behavioral and biomedical research conducted on humans or on materials from humans.ix
  • Here are a number of resources leading to the discussion and distribution of past, current, and future research for the assessment, diagnosis, management, and treatment for tinnitus.
    • ATA
      • http://www.ata.org/research-toward-cure/research-program/roadmap-cure
      • http://www.ata.org/research-toward-cure/research-program
    • NIDCD
      • https://www.nidcd.nih.gov/clinical-studies
    • Hearing Health Foundation
      • http://hearinghealthfoundation.org/researching-hearing-loss
    • CenterWatch
      • https://www.centerwatch.com/clinical-trials/listings/condition/897/tinnitus
        • CenterWatch is an online resource to help individuals search, assess their eligibility, and sign up to participate in clinical trials. The link above will bring you directly to the page for tinnitus research. If you would like to participate in other research, just type the keyword into the search bar in the right-hand corner.
    • ClinicalTrials.gov
      • Website
        • Click on ‘find studies’ and type in a keyword in the search bar titled “search for studies.” Click on the tab “On Map.” Click on the portion of the map for the United States and then New York. A list of studies in the state will appear.
        • If you would like to participate in a study, click on the box at the top of the list that says “Include only open studies.” A list of open studies will appear and you can read through the studies purpose, participant criteria, contacts, and locations among other information.
    • Past research
      • Tinnitus
        • Progressive Tinnitus Management
          • http://www.research.va.gov/currents/0116-1.cfm
          • http://www.ncrar.research.va.gov/Education/Documents/TinnitusDocuments/
        • NIHL/MIHL