Do you often find yourself complaining about the ‘voices’ in your head? Or the occasional buzzing, whistling or ringing in the ears that nobody else can hear? It isn’t something to ignore. You could be suffering from a hearing disorder called ‘Tinnitus’.

Tinnitus is an audiological and neurological condition, which can vary a lot among individuals. In general, there are three types of Tinnitus:

1. Subjective Tinnitus: This refers to the head or ear noises that are perceivable only to the specific patient. Subjective tinnitus is usually traceable to auditory and neurological reactions to hearing loss, but can also be caused by an array of other catalysts.
2. Objective Tinnitus: This refers to head or ear noises that are audible to other people, as well as the patient. These sounds are usually produced by internal functions in the body’s circulatory (blood flow) and somatic (musculoskeletal movement) systems. This type is very rare, representing less than 1% of total tinnitus cases.
3. Somatic Tinnitus: Somatic Tinnitus occurs when the sensory system in the body cause, worsen or influence Tinnitus in some way. Somatic signals are generated from muscle position sensors in the face, neck, head, trunk, arms, tongue, and the temporomandibular joint (TMJ). Somatic Tinnitus can be caused by muscle spasms, movements of the eyes (also called gaze-evoked Tinnitus), dental problems and TMJ dysfunction (lower jaw out of alignment with the skull).

In almost all cases, Tinnitus is a subjective noise. People describe hearing a variety of sounds: ringing, hissing, static, crickets, screeching, whooshing, roaring, pulsing, ocean waves, buzzing, dial tones, even music.

Why do they hear these sounds? To understand this, let’s take a look at what actually happens to a person with Tinnitus.

Understanding Tinnitus

Sound waves travel through the ear canal to the middle and inner ear, where hair cells in a part of the cochlea help transform sound waves into electrical signals. These signals then travel to the brain’s auditory cortex via the auditory nerve.

When hair cells are damaged, the causes of which we will understand later in the article, the circuits in the brain don’t receive the signals they are expecting. This stimulates abnormal activity in the neurons, which results in the illusion of sound, or Tinnitus.

As discussed above, a patient might experience varying sounds. Here are the three general ways of describing the perception of the Tinnitus sound.

The Many ‘Sounds’ Of Tinnitus

While a patient might experience varying sounds, there are three common perceptions of the Tinnitus sound:

1. Tonal Tinnitus:

Tonal Tinnitus, generally associated with Subjective Tinnitus, refers to the perception of near-continuous sound (or overlapping sounds) with well-defined frequencies. The perceived volume of the tinnitus often fluctuates.

2. Pulsatile Tinnitus:

Pulsatile Tinnitus is the perception of pulsing sounds, often in tune with the patient’s heartbeats. It is generally associated with Objective and Somatic Tinnitus.

3. Musical Tinnitus:

Musical Tinnitus refers to the perception of music or singing, sometimes the same tune, on a constant loop. Also called Musical Ear Syndrome, Musical Tinnitus is very rare.

If any of the above seem relatable, there is a good chance that you may be suffering from some form of Tinnitus. However, it should be noted that Tinnitus is rarely a disease in itself, but rather a symptom of some other underlying health condition. Let’s take a look at some of the commonly reported catalysts for Tinnitus.

What Tinnitus Might Be Hiding

Tinnitus alone may be not an indicator of the conditions mentioned below. It is ideal for a patient experiencing Tinnitus to consult a physician or an audiologist for a full examination to diagnose the underlying cause of the observed symptoms.

1. Hearing Loss:

Sensorineural hearing loss is commonly accompanied by Tinnitus. It is believed that Subjective Tinnitus cannot exist without some prior damage to the auditory system. The underlying hearing loss may be a result of:

• Presbycusis: Presbycusis refers to age-related hearing loss. This form of hearing loss tends to be bilateral (affecting both ears) and involves the sensory loss of high-frequency sounds. Presbycusis is the reasons why Tinnitus is highly prevalent among older people.
• Noise-induced Hearing Loss: Exposure to loud noises, either in single traumatic experience or over time, can damage the auditory system, and result in hearing loss, and sometimes, Tinnitus as well. Traumatic noise exposure could happen at work (loud machinery or equipment), at leisure (loud sporting events, concerts, recreational activities) and/or by accident (backfiring engine). Noise-induced hearing loss is sometimes unilateral (affecting one ear only).

The loss of certain sound frequencies leads to specific changes in how the brain processes sound. In short, as the brain receives less external stimuli around a specific frequency, it begins to adapt and change. Tinnitus could be the brain’s way of filling in the missing sound frequencies it no longer receives from the auditory system.

2. Obstructions In The Middle Ear:

Blockages in the ear canal can cause pressure to build up in the inner ear, affecting the operation of the eardrum. Objects directly touching the eardrum can irritate the organ and cause the perception of Tinnitus symptoms. Some of the common obstructions are mentioned below:

• Excessive earwax (also called Ceruminosis)
• Head congestion (caused by influenza or a common cold)
• Loose hair in the ear canal
• Dirt or foreign objects

In most cases, removal of the obstruction will alleviate the Tinnitus symptoms. In some cases, it is possible that the obstructions may have caused permanent damage leading to Chronic Tinnitus (Tinnitus that lasts for a period greater than 6 months).

3. Head And Neck Trauma:

Severe injuries to the head or neck can cause nerve, blood flow, and muscle issues result in the perception of Tinnitus. Tinnitus, related to head, neck or dental issues, is referred to as ‘Somatic Tinnitus’. Patients with head and neck trauma, generally experience greater variability in both sound, frequency, and location of their tinnitus.

4. Temporomandibular Joint Disorder (TMJ):

The Temporomandibular Joint is located in front of the ears, where the lower jaw connects to the skull. Damage to the muscles, ligaments, or cartilage in the TMJ can lead to tinnitus symptoms. The TMJ is adjacent to the auditory system and shares some ligaments and nerve connections with structures in the middle ear.

Generally, Tinnitus patients with a TMJ disorder will experience pain in the face and/or the jaw, limited ability to move the jaw, and regular popping sounds while chewing or eating.

5. Sinus Pressure and Barotrauma:

Nasal congestion from a severe cold, flu, or sinus infection can create abnormal pressure in the middle ear, impacting normal hearing and causing tinnitus symptoms.

Barotrauma, caused by exposure to extreme or rapid changes in air or water pressure, can damage the inner and middle ear. Some of the potential causes of barotrauma include:

• Diving/Snorkelling/Scuba
• Flying (only in the case of extreme, abnormal changes in elevation)
• Explosions or blasts

6. Traumatic Brain Injury (TBI):

Traumatic Brain Injury, also known as intracranial injury, occurs when an external force injures the brain. The causes include falls, vehicle collisions, violence, exposure to blasts or explosions, etc. It can damage the brain’s auditory processing areas, and generate symptoms of Tinnitus.

7. Ototoxic Drugs:

In many cases, Tinnitus is a side-effect of many prescription drugs. The Tinnitus symptoms are short-lived and usually recede once the patient stops taking the drugs. However, in the case of certain ototoxic drugs (having a toxic effect on the ear or its nerve supply) can cause more permanent Tinnitus symptoms. These drugs include:

• Non-Steroidal Anti-Inflammatory Drugs
• Certain antibiotics
• Certain cancer medications
• Water pills and diuretics
• Quinine-based medications

8. Ménière’s Disease:

Ménière’s Disease is a vestibular disorder in the inner ear, that can affect hearing and balance. Patients with this disease often experience bouts of mild-to-severe vertigo along with sporadic Tinnitus.

9. Hyperacusis:

Hyperacusis is an abnormal, extreme sensitivity to noise, including ordinary environmental sounds presented at normal volumes. Patients with hyperacusis experience physical pain (as against emotional annoyance) when exposed to sound.

10. Misophonia:

Misophonia is an abnormal, negative emotional reaction to selective sounds. Patients with misophonia may also have similar reactions to certain visual stimuli.

11. Depression and Anxiety:

Psychiatric issues can contribute to, and also be a consequence of Tinnitus. Tinnitus can create feelings of despair and anxiety among afflicted patients. At the same time, pre-existing behavioral conditions may make it more likely that the patient will experience tinnitus as a burdensome condition.

Tinnitus is also often reported to be a symptom of other diseases and medical conditions like Hypothyroidism, Hyperthyroidism, Anemia, High Blood Pressure, Lyme Disease, tumorous growths, etc.

As we have seen above, Tinnitus is a serious disorder and not one to be taken lightly. It is ideal to visit your physician or audiologist and ask for a thorough examination, and further treatment of the symptoms. Here are some common evaluation procedures and treatments for Tinnitus, and the underlying problems.

Evaluation And Treatment Of Tinnitus (Or Underlying Medical Conditions):

1. Physical Examination And Medical History:

The physician will give you a thorough physical examination, and run a few tests to check the source of the problem. He/She will ask you describe the noise you are hearing (pitch and sound quality, as well as if it is constant or periodic, steady or pulsatile), and the times and places where you hear it. Your medical history will be reviewed, to check for medications or supplements that typically result in Tinnitus as a side-effect.

2. Examination of Musculoskeletal Factors:

The physician may ask you to tighten muscles or move the jaw or neck in certain ways, to see if the sounds change. Musculoskeletal factors — jaw clenching, tooth grinding, prior injury, or muscle tension in the neck — sometimes make tinnitus more noticeable.

3. Hearing Loss Test:

Tinnitus that’s continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Tinnitus accompanied by hearing loss could be corrected with the help of hearing aids.

Pulsatile Tinnitus needs a medical evaluation, especially if the noise is frequent or constant. An MRI or CT imaging may be needed to check for a tumor or blood vessel abnormality.

4. Evaluation of general health:

Your general health can also affect the severity and impact of Tinnitus. It is a good idea to take stock of, and undertake treatment for disorders like depression, anxiety, insomnia, and pain with medications or psychotherapy.

If you are exposed to loud noises at work or at home, it is necessary to reduce the risk of hearing loss, or further hearing loss, by using protectors like earplugs or custom-fitted devices.

If Tinnitus has become a nightmare for you, get in touch with Centre For Hearing. We offer the most comprehensive diagnostic facilities and can help you find a solution to your hearing woes!

Don’t hesitate! Call us on +91 9811227492 today!