Understanding Tinnitus
What is tinnitus?
Tinnitus is a condition where internal sounds are perceived without any external source, making it impossible for others to hear. This hearing disorder affects many individuals, with an estimated 10 to 25% of adults and children experiencing it. In most cases, tinnitus is accompanied by hearing loss to some degree, and it can manifest as various sounds such as ringing, buzzing, or roaring, among others.
While tinnitus can improve for some people over time, it can also worsen and become chronic, lasting over three months. The cause of tinnitus remains perplexing, although medical research suggests that the condition rarely indicates a severe medical problem and does not typically interfere with daily activities. However, it might cause anxiety, depression, and affect mood, sleep, and concentration. While tinnitus cannot be cured, sound therapy devices such as hearing aids, behavioral therapies, and medication can help to manage and reduce symptoms.
What are the symptoms?
Tinnitus is a condition with varying symptoms that can differ between people. Some may perceive noise in one, two, or all sections of their head which can be a ringing, buzzing, humming, hissing or a squeal. It might change in volume and pitch and appear intermittently or constantly. Certain body movements such as neck-turning, eye movement, or touching can also cause altered perception of the sound called somatosensory tinnitus.
The sounds of tinnitus are usually subjective, meaning only the person experiencing it can hear them. However, sometimes the sounds can be heard with a stethoscope making it objective tinnitus. Objective tinnitus has a known cause and can be treated.
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What are the causes?
- Tinnitus is a medical condition whose root cause is not yet fully understood. That said, it has been observed that certain factors are associated with its occurrence. Exposure to loud noise, such as those in the workplace or during entertainment events like concerts, is the most common cause of tinnitus. In many cases, military veterans get tinnitus as a service-related disability following exposure to loud noises resulting from activities such as gunfire, machinery, and bomb blasts. Though there’s a strong association between tinnitus and hearing loss due to aging and exposure to loud noise, some individuals with hearing loss don’t develop tinnitus.
- Tinnitus can be caused by medications, especially when taken in high doses. Notable ones include some antibiotics, anti-cancer drugs, non-steroidal anti-inflammatory drugs, antimalaria meds, and antidepressants. Blocked ear canals due to earwax or infections can also cause tinnitus, as can head and neck injuries that damage the ear structure or the corresponding nerves and brain parts involved in sound processing.
- Less common risk factors for tinnitus include Ménière’s disease, which causes an imbalance in the inner ear and hence affects hearing, a clenched jaw that can damage surrounding tissues, vestibular schwannoma, which is a non-malignant tumor on the nerve connecting the inner ear to the brain, high blood pressure, atherosclerosis, or malformations of blood vessels that can affect blood flow, and certain conditions such as diabetes, migraines, thyroid disorders, anemia, and autoimmune disorders like lupus and multiple sclerosis. In some cases, tinnitus may occur for no discernible reason.
What research is being conducted?
Various research centers, including the National Institutes of Health (NIH) and those financed by NIDCD, are studying tinnitus and devising novel treatment strategies. In light of the condition arising from alterations in brain neural networks, researchers are presently investigating the efficacy of magnetic or electrical brain stimulation as a potential treatment.
- Currently, several research initiatives are in progress regarding managing tinnitus. Researchers are exploring different treatments such as cochlear implants that can restore functional hearing in individuals experiencing severe to profound hearing loss and non-invasive electrical stimulation that suppresses tinnitus without causing damage to acoustic hearing. Acoustic stimulation combined with electric stimulation to the tongue, head, or neck is also being researched as a long-term relief measure for people with tinnitus.
- Preliminary trials on repetitive transcranial magnetic stimulation (rTMS) showed mixed results. However, researchers are now identifying the ideal coil placement and frequency of patient visits for effective treatment. Deep brain stimulation (DBS) is also being employed for individuals with movement disorders or neuropsychiatric conditions that have reported decreased tinnitus symptoms. Although DBS has shown promising results, invasive surgery is necessary, and more research is necessary to determine whether this method should be routinely used solely for tinnitus management.
- Medications are also being developed to treat tinnitus, and second-generation versions of a drug that reduces tinnitus in mice are being explored. Genetic associations are being researched to predict, prevent, screen, and treat hearing impairment and tinnitus associated with aging. Additionally, brain imaging technology and smartphone applications are being employed to better understand the various types of tinnitus.