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Tinnitus is the perception of sound in the ears or head that is not caused by an external source. People often describe it as a ringing, buzzing, humming, hissing, or clicking noise. It can be constant or intermittent, soft or loud, and heard in one ear or both. For some, it is a mild annoyance. For others, it can be profoundly disruptive, impacting sleep, concentration, emotional well-being, and even contributing to anxiety and depression.
Tinnitus is not a disease but a symptom of an underlying issue in the auditory system. It affects up to 15-20% of the population at some point, and while it is more common in older adults, it can affect people of all ages, including children.
Causes of Tinnitus
There is no single cause of tinnitus. It can result from a wide range of conditions and events that affect the auditory system. Some of the most common causes include:
1. Hearing Loss:
The most common cause of tinnitus is hearing loss, particularly age-related hearing loss (presbycusis) and noise-induced hearing loss. The delicate hair cells in the cochlea (inner ear) can become damaged or die, disrupting the way processing of sound signals in the brain, in response to a lack of input from the ear, can create phantom sounds—what we perceive as tinnitus.
2. Noise Exposure:
Long-term exposure to loud noise—whether from industrial environments, live music, or even headphone use—can damage the auditory system. In Australia, noise-induced hearing damage is a growing concern among younger populations.
3. Earwax Blockage:
A build-up of cerumen (earwax) can block the ear canal and affect the way sound is conducted, leading to temporary tinnitus. Removing the wax often alleviates the symptom.
4. Ear and Sinus Infections:
Inflammation or fluid in the middle ear can trigger temporary tinnitus, especially in children.
5. Ototoxic Medications:
Certain medications, particularly high doses of aspirin, chemotherapy agents, antibiotics like gentamicin, and diuretics, are known to damage the inner ear and cause tinnitus.
6. TMJ Disorders and Neck Problems:
Jaw joint disorders and cervical spine issues can lead to somatosensory tinnitus, where head or neck movement seems to influence the volume or pitch of the tinnitus.
7. Vascular Conditions:
In rare cases, tinnitus may be pulsatile, matching the rhythm of the heartbeat. This can be due to abnormal blood flow in nearby vessels, often indicating vascular problems that require medical investigation.
8. Neurological Conditions:
Multiple sclerosis, vestibular schwannomas (also known as acoustic neuromas), and other neurological issues can also be linked to tinnitus.
9. Stress and Mental Health:
While not a direct cause, chronic stress and anxiety can exacerbate the perception of tinnitus. It becomes a vicious cycle: the more anxious a person feels, the more they focus on the tinnitus, which in turn makes it seem louder or more intrusive.
Symptoms and Experience
Tinnitus is highly individual. Some of the ways people describe their experience include:
- Ringing or buzzing in one or both ears
- Clicking or tapping sounds
- Whooshing or ocean-like sounds
- Pulsing in rhythm with their heartbeat (pulsatile tinnitus)
- Sudden spikes in volume during periods of fatigue or stress
- Fluctuation in intensity depending on the environment (e.g., worse in silence)
For many, tinnitus is more noticeable at night or in quiet settings, when there are no other sounds to mask it. This is why it can disrupt sleep or become emotionally distressing over time.
Diagnosis and Assessment
Diagnosis typically begins with a comprehensive hearing test performed by an audiologist. At The Audiology Place, we take a full case history and assess your hearing, often including:
- Pure tone audiometry to assess hearing thresholds
- Speech testing, especially in noise
- Tympanometry to assess middle ear function
- Otoacoustic emissions (OAEs) to evaluate cochlear health
- Questionnaires to understand how tinnitus is impacting daily life (e.g., the Tinnitus Handicap Inventory)
If there are red flags, such as sudden hearing loss, pulsatile tinnitus, or balance issues, a GP or ENT specialist may need to investigate further.
Treatment Options
There is currently no universal cure for tinnitus, but there are many ways to manage it effectively. Treatment is highly individual and depends on the cause and impact of the tinnitus.
1. Hearing Aids:
For many people with hearing loss, properly fitted hearing aids reduce tinnitus perception. Amplifying ambient sound helps mask the tinnitus and reduces the brain’s need to generate phantom sound. Modern hearing aids often include built-in tinnitus masking programs—soft, soothing sounds like white noise or nature sounds that reduce the contrast between silence and tinnitus.
2. Sound Therapy:
This involves using external sounds to reduce the perception of tinnitus. It can be as simple as using a fan or white noise machine at night, or more structured approaches like tinnitus-specific apps and sound generators. Some people benefit from listening to pink noise, ocean waves, or music engineered for tinnitus relief.
3. Cognitive Behavioural Therapy (CBT):
CBT is one of the most evidence-based psychological approaches for managing tinnitus distress. It doesn’t remove the sound but helps reframe your relationship with it, lessening anxiety and reducing the emotional burden. The goal is to help tinnitus become less intrusive and more manageable.
4. Tinnitus Retraining Therapy (TRT):
TRT combines counselling with sound therapy. It is based on neuroplasticity and the idea that the brain can learn to ignore the tinnitus signal over time. This technique may take months but can result in long-term habituation.
5. Mindfulness and Stress Reduction:
Because stress amplifies tinnitus, stress-reducing practices like mindfulness meditation, yoga, and breathing exercises can be powerful tools. These help regulate the nervous system and reduce the emotional response to tinnitus.
6. Medical Management:
If tinnitus is due to an underlying condition—like an ear infection, jaw disorder, or vascular anomaly—treating that condition can often reduce or eliminate the tinnitus. In some cases, a referral for surgical or pharmacological treatment is needed.
7. Auditory Processing Training and Neuromodulation:
For complex cases, especially where Auditory Processing Disorder (APD) is present, targeted auditory training may be helpful. Newer methods like bi-sensory stimulation (combining sound with touch or electrical stimulation) are being trialled to retrain how the brain processes sound.
Latest Thinking and Research
The field of tinnitus research has evolved rapidly in recent years, with several promising areas:
- Brain Imaging and Neural Pathways:
We now understand that tinnitus involves not just the auditory cortex but also areas of the brain responsible for emotion and attention. This supports the effectiveness of multidisciplinary approaches like CBT and neuromodulation. - rTMS (repetitive transcranial magnetic stimulation):
This is a non-invasive method that uses magnetic fields to modulate brain activity. Studies have shown that targeting auditory regions of the brain may reduce tinnitus severity in some people. It’s not widely available yet but is being explored in clinical trials. - Bimodal Stimulation Devices:
Devices such as the Lenire® system in Europe use a combination of sound and tongue stimulation to retrain brain pathways. Early trials are promising, showing reductions in tinnitus volume and distress. - Gene and Nerve Regeneration Research:
There is ongoing research into regenerating damaged auditory nerve fibres or cochlear hair cells, which could one day address the root cause of hearing loss-related tinnitus. While still in its infancy, this could pave the way for curative treatments. - Biomarker Identification:
One of the challenges in treating tinnitus is that it’s subjective. Scientists are working to identify biomarkers—measurable indicators of tinnitus in the brain or blood—which would make diagnosis and tracking treatment success more objective.
Final Thoughts
Tinnitus can be deeply frustrating and sometimes overwhelming—but it is also manageable. The key is a thorough assessment to identify any underlying causes, combined with a personalised treatment plan that may include hearing aids, counselling, sound therapy, and stress management. At The Audiology Place, we approach tinnitus holistically, recognising that while the sound may be in the ears, its impact is felt across the whole person.
Don’t suffer in silence if you or a loved one is experiencing tinnitus. There are options, and with the right support, it can become a sound you can live with, rather than one that controls your life.
