Understanding Tinnitus: The Ringing in Your Ears

• Managing Tinnitus

  • Sound Therapy
  • Hearing Aids
  • Media
  • Psychological Effects & Counseling
  • Tinnitus Retrainng Therapy (TRT)
  • Hyperacusis
  • Medications for Tinnitus
  • Neuromodulation
  • Self Care for tinnitus
  • What should i avoid if I have tinnitus?

• Resources and Support

• Stay Tuned Hearing Clinic

• FAQ – Frequently Asked Question

I want to get in early before you read on, to say that YOU ARE NOT ALONE! 

Many people deal with managing tinnitus and live a happy fulfilling life! 

You may feel at this moment that the ground has been taken from under your feet, but I assure you that things will get better. If not physiologically, then emotionally and mentally. It is a challenging thing to find out that you have tinnitus but there are a lot of people who have felt just as you do now and have gone on to live normal lives. I will speak more on this later on down the page, plus give some tips to help you along!

But, for now, let’s get into finding out about hearing loss and tinnitus.

So first off, I want to go into what is going on physically in the body.

I know, I know. It’s early and we are getting into the science behind it all, booorring! But it is a good idea to have an understanding of what is happening and how hearing works, and more importantly, how hearing is damaged on a physical level.

Ultimately, tinnitus may not start with your brain, but that is where it ends and produces the ringing in ears that we know as tinnitus (unless it is objective tinnitus as described below).  

The brain is a malleable and adaptive beast. If you have ever heard the term neuroplasticity, then you may know how the brain can adapt and reconfigure around trauma. The reconfiguration is usually quite a slow process. So it is with time, and some effort to some of the more mental management options suggested later on that you can encourage your brain’s neuroplasticity to reduce the impact of tinnitus based noise in the ears.

This is not a cure. This will not regenerate the damage that causes hearing loss and tinnitus but it will train your brain to perhaps take less notice, and if you are truly lucky (or work hard at it!) make it hardly noticeable. 

To understand how this process ends with the brain, we first need to understand how hearing works in the body…

5. Next, the force that is created by the bones on the cochlea window causes pressure waves through the fluid of the cochlea (that snail shell-looking thing in the picture over there). It is here that we come across the cochlea ‘hairs’ (stereocilia) which move from the pressure waves created by the inner ear bones on the cochlea oval window.

6. When the hairs move, they transmit ions causing a chemical reaction at the base of the hairs. Note: Only certain hairs will move that match the frequency of the sound being transmitted. The larger circled area of the cochlea for high pitches, the smaller top circled area for lower.

7. This chemical reaction at the base of the stereocilia then interacts with the auditory nerve to transmit electrical signals that travel along the auditory nerve straight to the brain. There the signals are interpreted by the auditory cortex as the sounds we are familiar with, such as a horn, a car, or a bird. 

OK, so you now have an understanding of how hearing works, and its delicate complexity. Now let’s get into how this relates to tinnitus, and how that process can be damaged to result in the condition.

Some of the above causes can be permanent, or they can be treated to cure your tinnitus. It is a good idea to contact your local physician and audiologist to try and find out what exactly may be causing the condition, the sooner, the better.

You may see or hear about the different types of tinnitus. I’ve shown already how broad and varying the symptoms can be, but there will be a few categories that you will come across in your research. Let’s go through a brief explanation of these types to better understand them.

As you may already be aware, it can be hard to explain tinnitus to someone who does not experience it, and it can even feel like people do not believe you. They may even look at you like you are talking about seeing ghosts that they cannot see, especially if you do not have the science and explanations of what is happening. We hope that the information here will help with this!

So, objective tinnitus is different. This is a type of tinnitus that others can also hear the sounds that you are hearing. This is because the sounds are being created by functions in the body close to the ear, which is picking it up and putting through a signal to the brain. The problem is, there are no sounds externally around you.

The most common reasons for this are movements in the jaw structure and muscles or sounds caused by blood flow. This may end up in broadening your medical investigation to head and neck specialists. 

As children develop their bodies go through change and this can result in some tinnitus. Usually, the type is called pulsatile tinnitus. It is important that if your child complains of tinnitus, you seek medical advice to reduce the risk of tinnitus as a long-term impairment.

The problem with finding symptoms for tinnitus is that tinnitus is actually a symptom itself. Tinnitus is usually the result of another medical condition, such as all the conditions we have already gone through above.

But if you are trying to figure out if the noise you can hear is tinnitus, we can go through some of the common themes of having this condition/symptom can manifest.

 If we have learned anything so far, it is that tinnitus comes in many varied forms. The one thing that is common throughout is the fact that there is a sound that is heard that is not present outside of your body, and in most cases not even within the body but a malfunction of the hearing process to get information to the brain.

 This sound may come as a persistent pitched ringing or a pulsating tone from the body’s pulse of blood flow to a whooshing like heavy wind. Maybe your sound only comes when you move your jaw. This is why investigation with a professional is necessary to investigate your particular symptoms for diagnosis and treatment or if treatment is not a possibility, then management.

That being said, let’s go through some of the more common symptoms and see what you can check off for your own experience.

Tinnitus can be a sign of an underlying condition, and therefore having your audiologist check you out for anything else that might be causing the issue can be a good idea and our suggestion. 

Many people already have tinnitus but don’t even know it because it is not of a level they notice in day-to-day life. It can be thought of as just something everyone has when things go silent.

So, when it gets to a level that becomes noticeable in your day-to-day activities, and especially if you find you are all of a sudden having other symptoms and conditions, we suggest seeking medical consultation.

Stay Tuned Hearing on the Mornington Peninsula can address any concerns you may have with a hearing test in their Mount Eliza clinic.

We have spoken about a lot of causes already, from trauma to medication and conditions. There are many causes, and not all of them are understood. This webpage is by no means an exhaustive documentation of them all, and consulting with your audiologist is always a good step in trying to find the cause of your tinnitus. But while we are here…

Let’s go through the more common causes that can put people at risk of developing tinnitus. These causes include: 

Exposure to loud noise is one of the most common causes of hearing loss and damage to the cochlea hair cells. 

Sound travels through the ear canal and vibrates the ear drum which then causes the waves within the cochlea. If these waves are too strong then there is a high risk of damage to the hair cells, or even the loss of complete frequencies if enough stereocilia are destroyed.

Ototoxicity means that something has the property of being toxic to the ear. Certain medications will have this warning as a side effect. Once experiencing the side effects of a drug, such as tinnitus, will result in a consultation to weigh the severity of the side effect against the severity and risk of the condition being treated. If the side effect of the drug outweighs its benefit, then the withdrawal of the drug may be warranted to remove the side effect such as tinnitus, or if the damage is already done, prevent further damage. 

Let’s go through a few of the common groups of drugs associated with tinnitus side effects:

• Antibiotics – Antibiotics in the aminoglycoside class such as gentamicin and tobramycin can cause ear disorders as part of their side effects. If you are suspicious of your medication’s side effects for tinnitus, then look for terms such as ototoxicity, ear disease, and cochleotoxicity in the documentation of the drug. If you do start having tinnitus symptoms, the best thing is to let the physician treating you know of the side effect right away.
• Diuretics – Loop and thiazide diuretics have this possible side effect.
• Quinine & Aspirin – Quinine is used to treat malaria and babesiosis and nonsteroidal anti-inflammatory drugs like Aspirin for pain, fever, or inflammation. When these are taken in high doses the result can be tinnitus, but usually stops after discontinuation of the drugs. 

Chemotherapeutic agents that include platinum have been found to have cochleotoxicity (ototoxicity). Cisplatin and carboplatin are two such agents that have this side effect. Factors in the severity of this side effect can depend on dosage, age of the patient, and duration of administering the medication. Basically, these drugs can damage the cochlea hairs we have gone over earlier, often resulting in stereocilia death.

So, yes. Chemotherapy medication can cause damage to the inner ear, and in turn cause tinnitus.

An inevitable factor for tinnitus is aging. It happens to us all, and as the body ages, stuff… well, breaks down. 

Being the most common cause of hearing loss, age-related hearing loss has its own name, presbycusis. With aging comes the degeneration of the cochlea and/or associated parts of the ear. The severity and onset of presbycusis can have many factors like genetics, and environmental exposure over your lifetime. So, with this degeneration comes the possibility of tinnitus.

Statistics predict that one out of three people aged 65 will experience presbycusis, and one out of two by age 75. The condition only comes second to arthritis in its prevalence amongst the aged population.

Have you ever heard about how adults are unable to hear certain pitches, yet younger children can? Well, this is part of aging and the effects of presbycusis, it starts within the higher pitch range the majority of the time.

Age-related hearing loss signs to look out for:

• Volume creep on T.V., Radio, and other media sources. Have you had people ask to turn something down in volume because it is too loud? 
• Not being quite sure of the direction of sounds as you hear them.
• Conversations on the phone becoming difficult.
• Not catching or understanding everything said in conversations. This may be more likely with women and children with higher-pitched voices.
• Sounds and speech around you become muffled.

If you have any concerns and would like to have your hearing checked it is a very easy process, and if you are a pensioner, it is fully subsidised with Stay Tuned Hearing. Check out our webpage for all the details related to the pensioners hearing services program provided by the Australian government.

Thinking about a hearing aid? Check out our guide to different types of hearing aids. Stay Tune Hearing can assist in all your hearing aid needs starting with assessment, then fitting and maintenance.  

Tinnitus can be a symptom of Meniere’s disease, along with episodes of vertigo, and hearing loss. This condition usually starts with one ear but can over time affect the other ear. This is a fluctuating tinnitus that may happen in periods of approximately 20 minutes or so along with the other symptoms. 

If you experience fluctuations of these symptoms, often preceding a headache and a full ear feeling, you may want to check with a physician on the possibility of this disease. You may also have to deal with secondary symptoms from vertigo such as nausea, vomiting, and sweating.

Yes, I’m going to say it, even if you’re sitting there thinking, “It’s too late for that!”

Prevention is always the best treatment! There I said it, but this is true to prevent further damage. You may think things cannot get worse, but yes, they can and if you don’t take notice and continue with what caused the problem in the first place, it will.

Wear earplugs if you work at a place with loud sounds/noise as you work. You may start to notice those signs your business has for its workers to wear protective equipment, which usually includes earplugs. They don’t have those signs there for no reason, they know that there is sound above the range where it can cause damage and they don’t want liability.

You need to actively protect your hearing because no one else will.

As I mentioned at the very start of this webpage, this can be a difficult time to navigate through emotionally. Especially if the damage that has been done to your hearing is not something that can be reversed.

Your first instinct will be to search the internet for those that suffer from tinnitus, so you can see how bad the situation is, and if there is hope. This can be a double-edged sword.

On the one hand, you will find people who are suffering or have suffered these first weeks or months just as you are now. You will find some solace in their stories and the ways that they have gotten through their struggles. But, on the other hand, it can be easy to fall into the despair of the many also coming there to look for a cure for tinnitus they might not find. So keep this in mind while you find these stories and if it starts to become too much, take a rest from looking things up a while.

In the first few weeks of having tinnitus, it can be hard. But know that it is very possible to lead a full and rewarding life! 

The best thing that you can do when you first experience tinnitus, is to become educated about it, and well you are here reading this, so good job! Next is to have professional help by seeking out an audiologist who can assess your tinnitus and any underlying conditions and advise on ways to manage the symptom. 

In the end, it will be up to you to decide what works, and what does not in managing your tinnitus.

Here are a few of the suggestions you may encounter:

Just think of all the sounds that you encounter in your daily life that you take no notice of, that fan you have running, the din of chatter in the office, and traffic outside your house. These sounds can be noticeable once introduced to them, but they soon go into background sounds your brain deems them not important. This is the goal for your tinnitus!

This may not be something that you don’t find so easy to start with, especially if you have only recently been diagnosed with tinnitus. But once tinnitus is no longer a mystery, and you are aware of the causes, symptoms, and treatments you can start the management journey. 

I have come across patients who have had tinnitus for many years to one day say that it is gone. It can be a mystery why this can sometimes happen, but it is possible that just coming to terms with the condition and with it becoming such a constant presence the brain decides that it is not important to inform you any longer and shuts it out from your consciousness. The brain is a malleable thing, and it is possible for neuronal paths can shift over time to compensate for changes in the body. 

Close to 80% of people who experience tinnitus also suffer moderate to severe hearing loss. So, it makes sense that manufacturers of hearing aids have sought to utilise the technology available in modern hearing devices. With the advanced technology of Wi-Fi and Bluetooth, it is not uncommon to have hearing aids be able to provide relief to tinnitus symptoms by helping mask the ringing in your ears with ambient white noise, meditation audio, and other customisable sounds to make tinnitus less noticeable.

Stay Tuned Hearing is an independent audiologist providing hearing aids of major brands that have the latest options for tinnitus management. If you are interested in a new hearing aid with this functionality, please call us on 03 9708 8626 to make an appointment today so that we can assess your condition and advise on providing you some relief.

Maybe you are a documentary buff or have a hobby and can watch media about that topic all day long. Use what you love to distract your brain and muffle out the noise in your head. 

Now, this is not to say you want to drown out the noise with dangerously high volume as this will only exacerbate the problem. But a healthy volume that can allow you to hear the media and also challenge your attention from tinnitus is a good option.

Try and take notice of what you are doing in those moments throughout the day when you have not even noticed your tinnitus. What were you doing; what subject did you delve into and what media did you use?

Here are a few suggestions to try out:

• Audible Books – Most audible book services will allow you to test out the app with a free book, why not give it a try and find something you are interested in? If tinnitus is keeping you up at night, play the book on your phone and lay it on the bed to listen to.
• ASMR – Autonomous Sensory Meridian Response (ASMR) is not as strange as you may first think. Many people experience this effect when listening to certain triggers and types of ASMR. There are a lot of different types, from soft-spoken book reading to scratches on a microphone to visual movements on screen. This can be great for tinnitus distraction as it can have a visual component too as you watch. 
• Video – Much like ASMR, but the video can be of anything. Maybe a film that makes you feel calm, or a YouTuber that you share a hobby with.
• Documentaries – Who can resist the tone of David Attenborough explaining the mysteries of nature?! 
• Ambient Soundscapes – Listen to the rainfall, or crickets … cricket, or maybe a storm roll in, ambient sounds can be relaxing and mask your tinnitus.
• Music – Music may be what got you here, but it’s what you love. This can be a great way to mask tinnitus with your favorite bands (Just as safe levels!).

Found something not listed here that works for you? Let us know in the comments!

Tinnitus retraining therapy is training that a professional can guide you through to achieve habituation for your tinnitus. Much like already described, we want to train the brain to not pay unwanted attention to sounds like the noises in your ears and become diminished. 

This kind of therapy has a close connection to cognitive behavioral therapy (CBT) which is a more commonly known and popular process to deal with these types of issues.

Hyperacusis is an increased sensitivity to sound, along with a low tolerance for noise in your environment.

Tinnitus and hyperacusis can sometimes go hand in hand. As you become more aware of the sounds around you and how this affects your perception of tinnitus it may make tinnitus more noticeable. 

This is not such a bad thing; you are just becoming aware of the volume you are exposing your ears to and wanting to monitor it so as not to make your tinnitus worse. This can result in sensitivity to volume that may result in tinnitus episodes. But protecting your ears is a natural reaction after you have been diagnosed and fear to cause or worsen tinnitus. 

Unfortunately, there are no proven medications effective for tinnitus directly. 

There can be medication for underlying conditions found during your diagnosis of tinnitus linked to a medical cause other than irreversible hearing loss damage.

You may still find a lot of Alternative Medicine options on the internet, or testimonials from (supposed) sufferers in what they have used. Approach these ideas with caution and consider that they are not medicine, but an alternative to medicine.

People with tinnitus can become desperate to alleviate their ringing or other noise, and when there are desperate people, there are also those who would take advantage of that desperation. So, if you hear about an alternative to medicine that will cure tinnitus, it is a sign of something too good to be true.

Something still being tested and trialed is Neuromodulation. 

Neuromodulation for tinnitus is when an external source of magnetic, or other method, creates stimulation for neurotransmitters to send signals to the auditory cortex of the brain. 

With the results very mixed and without any substantial evidence to show definitively that neuromodulation is a success, there is still a lot of research to be done in the area. There have been some promising results for some, and it is something to keep an eye on to see how things proceed in the future. 

Here is a video on the subject: What is Neuromodulation and how does it help tinnitus?

Here are some studies to read if you want to go deeper: 

Effects of Non-Invasive Neuromodulation of the Vagus Nerve for Management of Tinnitus: A Systematic Review with Meta-Analysis

State of the art: non-invasive electrical stimulation for the treatment of chronic tinnitus

Dual-site transcranial direct current stimulation to treat tinnitus: a randomized controlled trial

Meditation or some other form of relaxation can help alleviate symptoms of tinnitus. This could be perhaps as easy as a relaxed walk in the park or around the block to get your mind off things.

Don’t be hard on yourself and focus too much on fixing your tinnitus. This could end up doing the exact opposite of what you are trying to achieve and feeding the symptom with constant attention. 

If you do not feel you are getting results fast enough, remember that this is a long-term thing and there will not be any shortcuts. Getting angry, or sad can be normal, but don’t let it consume your thoughts and emotions. 

Instead, try to go out and get a new hobby or focus more on the hobby you already have. 

Activity – Keep active. Even small things to get out of the house can help with your mental health and in response help with your tinnitus.

• Loud prolonged noise exposure! – I mean, it’s probably how we ended up here, and it can be how your tinnitus can get worse. Be aware of the media device noise levels you are exposing yourself to through your headphones. Don’t forget that headphones can be deceptive due to the concentration of the noise. It’s advised when able to keep the volume well below recommended limits to be safest when you can.
• Smoking – Smoking can affect the narrowing of blood vessels and affect blood pressure. Many studies have found a correlation between smoking and tinnitus, but the causational link is still unknown. 
• Diet – Some foods can have a temporary effect on your tinnitus. This could be caffeine that may increase your anxiety for example. Basically, foods and drinks (including alcohol) that elevate blood pressure can be ones to monitor.
• Stress – Easier said than done, I know. But stress, tinnitus, and anxiety are not a good mix. Try and remove some of the more stressful things in your life and even reach out to a professional for help with your mental health and ways to manage stress. 

At Stay Tuned Hearing your wellbeing is our highest priority, so let our Audiologist bring you some peace of mind if you are suffering from tinnitus. We’d love to hear from you and help you on your journey to recovery.

If you would like to book an appointment at our Mount Eliza Clinic or book a home visit, please follow this link to see the ways you can contact us.

Robin brings with him over 20 years of experience in audiology education, so you can be rest assured that you are in capable hands.