Tinnitus Evaluation and Management

Tinnitus Evaluation and Management

Are you experiencing a ringing, buzzing, clicking, or hissing noise in you ear?  This condition is called tinnitus (Latin for “ringing”), and it has many potential causes. It may be soft or loud, high-pitched or low-pitched. You might hear it in either one or both ears. At FOCUS Audiology, we will help you find and treat the root cause of your tinnitus.  

Frequent causes of tinnitus:

Tinnitus is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound.  Tinnitus can result from a multitude of causes:

  • Earwax or ear canal obstruction
  • Ear and sinus infections
  • Diseases of the cardiovascular system
  • Noise-induced hearing loss
  • Stress and depression
  • Head injuries
  • Cranial nerve impingement 
  • Brain tumor
  • Hearing loss
  • Meniere’s disease
  • Thyroid abnormalities
  • Hormonal changes in women
  • Unusual bone growth of the middle or inner ear

A complete medical history and a comprehensive battery of tests will be performed by your audiologist and your ENT physician to discover the particular root cause of your specific tinnitus.

Why do I have this noise in my ears?

Although we hear tinnitus in our ears, its source is really in the networks of brain cells (neural circuits) that make sense of the sounds that our ears hear. A way to think about tinnitus is that it often begins in the ear, but it continues in the brain.

Scientists still haven’t agreed upon what happens in the brain to create the illusion of sound when there is none. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after a wound or broken bone has healed.

Tinnitus could be the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by turning up the sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise.

Tinnitus also could be the result of neural circuits thrown out of balance when damage in the inner ear changes signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of abnormal interactions between neural circuits. The neural circuits involved in hearing aren’t solely dedicated to processing sound. They also communicate with other parts of the brain, such as the limbic region, which regulates mood and emotion.

What should I do if I have tinnitus?

If your primary care physician cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You may be referred to an audiologist who use a variety of audiometric testing equipment to measure your hearing and evaluate your tinnitus.

What if the sounds in my ear do not go away?

Some people find their tinnitus doesn’t go away or it gets worse. In some cases it may become so severe that you find it difficult to hear, concentrate, or even sleep. Your audiologist and ENT will work with you to help find ways to reduce the severity of the noise and its impact on your life.

What Are my Treatment options?

Upon identifying the root cause of your tinnitus, you audiologist or ENT physician will explore options to treat the underlying condition.  This may include medications, surgical options, hearing aids, and/or sound therapy to re-train the brain and psychologically overcome the impact of tinnitus.  

In the event that you suffer from persistent tinnitus, tinnitus retraining therapy (TRT) habituates you to identify the tinnitus as a background noise so that you are no longer bothered by it.  TRT may be prescribed in conjuncture with medications that combat your underlying issue and psychotherapy to help you cope with the persistence of tinnitus.  There are currently no available medications that direct resolve tinnitus.

Though tinnitus does not have a cure yet, treatments that help many people cope better with the condition are available. Most doctors will offer a combination of the treatments below, depending on the severity of your tinnitus and the areas of your life it affects the most.

  • Hearing aids often are helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear. The better you hear, the less you may notice your tinnitus. Read the NIDCD fact sheet Hearing Aids for more information.
  • Counseling helps you learn how to live with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.
  • Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.
  • Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might be all you need to help you fall asleep.
  • Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.
  • Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits. Read the NIDCD fact sheet Cochlear Implants for more information.
  • Antidepressants and antianxiety drugs might be prescribed by your doctor to improve your mood and help you sleep.
  • Other medications may be available at drugstores and on the Internet as an alternative remedy for tinnitus, but none of these preparations has been proved effective in clinical trials.