What is Tinnitus

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Tinnitus is a physical condition experienced as noises or ringing in the ears or head, when no such external physical noise is present. Tinnitus is not a disease in itself; it is a symptom of a fault in the auditory (hearing) system. Approximately 17 to 20% of Australians suffer from some degree of tinnitus, varying from mild to severe. It is common for tinnitus to fluctuate with stress or tiredness, but this has no harmful significance.

Types of sounds experienced with tinnitus:

There are many different sounds associated with tinnitus; some of the most common are:

  • Ringing
  • Buzzing
  • Whistling
  • Roaring
  • Humming

What causes tinnitus?

  • Among the more common causes of tinnitus are:
  • Exposure to loud sounds
  • Extreme stress or trauma
  • Degeneration (wear and tear) of the small bones in the middle ear
  • Ear problems, such as otosclerosis (fixation of the tiny stirrup bone in the middle ear)
  • Meniere's disease (swelling of a duct in the ear)
  • Some prescription and non-prescription drugs

Major preventable causes of tinnitus:

Exposure to loud noise – for example; noisy lawn mowers or chainsaws. People at high risk include industrial workers, farmers and transport workers. Rock concerts, boom boxes in cars and playing an i-pod loudly can also be hazardous.

Medications – for example, some prescription and non-prescription medications. If you have tinnitus, always check with your doctor whether the drug they are prescribing for you has a side effect of causing or exacerbating tinnitus.


What to do if you have tinnitus:

  • Seek a referral from your doctor to an audiometrist or audiologist.
  • Hearing aids may be appropriate and can reduce the perception of tinnitus by improving your hearing.
  • Avoid stress which is known to be one of the major contributing factors to exacerbating the degree and intensity of a patient's tinnitus.
  • Dietary exclusions of caffeine (tea, coffee, chocolate or cola drinks), alcohol, salt, quinine (tonic water), nicotine and marijuana.
  • Tinnitus Retraining Therapy (TRT) ask your doctor, audiometrist or audiologist for help with TRT.

Tinnitus Retraining Therapy

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How we hear - the conscious awareness of sound takes place near the surface of the brain, when a pattern of electrical activity travelling up the nerve of hearing from the ear reaches the auditory cortex.

Most of what we hear is a sequence of different sounds, like speech or music. In infancy, new sound experiences are stored in an information hungry, but relatively empty auditory cortex. Later on there is a continuous process of matching familiar memory patterns with those coming from the ears. Each time a pattern from the ears is matched with a pattern in the auditory memory we have the experience of evaluation. Another part of the brain close to this initial hearing centre is involved in the meaning of what we hear, and in interpreting the language. If it's a foreign language we can hear the sound but may not understand the meaning.

The meaning of sound – sound is of enormous importance in monitoring our environment. The ability of animals to develop extremely acute hearing, by which they could detect the very small sounds of an attacker a long way off, contributes to the survival of that species. These warning signals produce acute anxiety, prompting appropriate action to avoid attack, the so-called survival reflex.

Humans respond in the same way to the sound of a motorcar horn, by automatically putting our foot back on the pavement or sidewalk. Some sounds can be identified as warning signals, while others can evoke a feeling of security or pleasure. We have this experience every day with sounds that alarm us or sounds that soothe us such as music, or the sounds of nature. Many sounds naturally evoke strong emotions of one sort or another.

Conditioned responses – when a sound has a special or critical meaning, like a baby waking at night, or the creaking of a floorboard, or the sound of our first name, we respond to it in an automatic manner. This happens after a short learning period, but the responses can remain as strong as ever throughout life. During sleep, the conscious part of the brain is “shut down” so we don't hear, see or feel anything; however, the mother still wakes to the baby stirring even though she has just slept through a thunderstorm. This shows that if any pattern of sound is of a great significant meaning it may be detected by subconscious filters in the hearing pathways, between ear and brain (auditory cortex).

In situations of danger, or perceived threat the familiar “fight or flight” is triggered. This involves high levels of automatic function; tense muscles, raised heart and breathing rates, sweating, and are the complete opposite to the state of relaxation. Most of our day-to-day activity consists of a series of conditioned or learned responses, executed to order, like reading, writing, playing an instrument or driving the car.

So each and every sound we hear and learn the meaning of has an “emotional label” attached to it, which may change from time to time to how we feel in ourselves and the context in which we hear it.

The meaning of tinnitus sounds – in 1953 Heller and Bergman performed a simple and classic experiment. They placed 80 tinnitus free individuals (university members) in a sound proofed room for 5 minutes each, asking them to report on any sounds that might be heard. The subjects thought they might be undergoing a hearing test, but actually experienced 5 minutes of total silence. 93% reported hearing buzzing, pulsing, whistling sounds in the head or ears identical to those reported by tinnitus sufferers. This simple experiment shows almost anyone can detect background electrical activity present in every living nerve cell in the hearing pathways as a sound. Studies have shown that about 85% of tinnitus sufferers do not find it intrusive, disturbing or anxiety provoking (something the other 15% of tinnitus sufferers find very hard to believe!). The reasons for this are not so much because the quality or loudness of the tinnitus is different; in fact we have found that tinnitus is of a very similar type of sound in those who are bothered by it and those who are not.

The main differences are that those who find tinnitus troublesome evaluate and perceive it as a threat, or an annoyance, rather than something of little or no consequence. It may also emerge for the first time when something else unpleasant or frightening is happening to us. In these situations, tinnitus is classified as a warning signal, relating either to a bad experience or to negative thoughts about its meaning or outcome. Just as the animal alerted to danger by the sound of a predator focuses solely on that sound to survive, so do those who consider that tinnitus is a threat or warning signal and are unable to do anything but listen to it.

Tinnitus as a new experience – when tinnitus first emerges it is a new signal; there are no memory patterns, and no means of categorizing it. Any new experience produces an “orienting response” where we are forced to pay attention, until the signal is classified and understood.

Tinnitus as a threat – for many sufferers, tinnitus is quiet threatening. Some people fear that tinnitus means they have some kind of serious illness and others are convinced that the experience of tinnitus means permanent damage to the ear. There are patients who worry about the possibility that it heralds a brain tumor, blood clot, will damage their hearing, or some serious mental illness (“it will drive me mad!”). Many people fear that the tinnitus will get louder, continue forever, cannot be cured and even the concept that the tinnitus is invading one's “right to silence” and this constitutes a threat.

Fear, anger and guilt are very powerful emotions, which are intended to enhance, survival-style, conditioned reflex activity, and consequently greatly increase attention on the tinnitus. In our experience, tinnitus improves when the patient overcomes these feelings and stops dwelling on thoughts of injustice.

Tinnitus as a phobic state – in some patient's extreme fear of tinnitus in a phobic state developing, very similar to that of the fear of spiders, frogs, small spaces, flying, etc. In any phobic state a slow process of “desensitization” has to be used, confronting the feared object, learning first to tolerate it, and then to accept it as a normal phenomenon that does not in any way threatens. Many aspects of tinnitus retraining are common to these techniques.

Tinnitus Retraining Therapy (TRT) – successful tinnitus management is a result of retraining and relearning. Once the tinnitus loses its sinister meaning, however loud it has been or however unpleasant it may seen, it DOES begin to diminish and in many cases may not be heard for long periods of time.

Retraining the subconscious auditory system to accept tinnitus as something that occurs naturally and not as a threat or warning may take time and involves reprogramming or resetting the networks which are selectively picking up “the music of the brain” in the auditory system. Tinnitus retraining first involves learning about what is actually causing this tinnitus. As a result of this and other therapy including sound therapy, the strength of the reaction against tinnitus gradually reduces. This reaction controls the disposition of subconscious filters which are constantly looking for threats. With strong reactions the filters are constantly monitoring the tinnitus, without a reaction habituation occurs, as it does to every meaningless sound that is constantly present. Firstly the disappearance of the reaction means that sufferers no longer feel bad, or distracted, and normal life activities can be resumed – sleep, recreation and work, as before. Secondly as the auditory filters are no longer monitoring the tinnitus it is heard less often and less loud. As a result it can become a friend instead of an enemy.

Habituation of reaction and perception – the presence of any continuous stimulus (e.g, moving to live by a busy road from the quiet of the country) usually results in a process called habituations, whereby the individual responds less and less to the stimulus as long as it does not have any special negative meaning. What happens here is the signal is no longer detected, and cortical neurons are unresponsive. With tinnitus this means that it is no longer heard, even if it is listened for. However, maintaining these habituations is easier if tinnitus is heard from time to time as it will renew your beliefs that tinnitus is “your friend”, and guards against relapse. TRT's goal is to get rid of tinnitus reaction – NOT tinnitus perception.

Silence may not be golden – most tinnitus is first heard at night in a well soundproofed bedroom, or a quiet living room. Everyone, especially tinnitus patients should avoid extreme silence, and retraining programs will always sue sound enrichment. Make sure there is always a pleasant, non intrusive background sound (like a large slow fan, or an open window, and purchase a device for generating nature sounds). Choosing what is right for you may take some time. Nature sounds are always the best, as they are already habituated, and usually produce feelings of relaxation, calm and well-being.


What else can I do about Tinnitus?

Herbs – Ginkgo (Ginkgo biloba) is a herb that improves blood circulation to parts of the brain that affect the inner ears and it is found to be very effective in treating tinnitus, as well as associated problems of depression and poor concentration. Use it in combination with brahmi, another herb that improves peripheral circulation. Black Cohosh (Cimicifuga racemosa) and California poppy (Escholzia californica) are both useful as mild nervines for over stimulated ears, thanks to their sedative and anti-inflammatory effects.

Diet and Nutrition – eliminate toxins is successful in treating tinnitus by putting patients on an elimination diet, where common allergens like wheat and dairy are avoided, then gradually reintroduced. You can have a hair analysis test run to check for heavy metals, especially mercury. Mercury can be removed with a combination of vitamins C and E, n-acetyl-cysteine, and lipoic acid. Think zinc ! A Japanese study found zinc useful in treating tinnitus. Researches gave zinc to patients and, after two weeks, their symptoms had improved. Another study in Otology & Neurotology found that 50mg of zinc daily gave tinnitus sufferers significant relief. Zinc deficiency is linked with many neurological disorders.

Avoid irritants like caffeine, alcohol, nicotine, and asprin which can all make ringing in the ears worse. Give the artificial sweetener aspartame a wide berth, as it irritates nerves. Excess dietary fat may contribute to the problem by slowing micro-circulation to the ears. Cut down on salt as it causes the body to retain fluid, which may swell the functional organs of the ear. Processed foods often contain large amounts of salt, so read labels. Exercise regularly to improve circulation and to ease symptoms.


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