Tinnitus

What is it?

Tinnitus is a perception of sound where there is no external source of a corresponding sound.

So put simply, tinnitus is any sound you hear, which is not being created by something outside of your ears.

Everyone who gets tinnitus experiences it differently.  It may be a buzzing, humming or rushing noise, or possibly a ringing, chirping or whistling noise, and even in some cases a musical sound, or choral singing.

It may appear in one ear, both ears, or just seem to be in the middle of your head and it could be either temporary or permanent.  In most cases it will appear as a constant steady sound but occasionally it may fluctuate or pulse.   It may appear louder at certain times than others depending on how much external sound is around you, which is why most people report it being most noticeable at bedtime or first thing in the morning.

What causes it?

Should I be worried?

Hearingcare professionals have guidelines to refer you to your GP or a tinnitus specialist if  your tinnitus matches certain criteria and there is no obvious cause.   You should seek advice if you haven't previously consulted your GP or other ENT specialist and your tinnitus matches any of the following criteria:

In many cases the cause of tinnitus will be idiopathic (unknown cause).  A blocked ear due to earwax or infection may cause temporary tinnitus which clears when the ear is treated.   Tinnitus caused by exposure to noises such as loud machinery or music may be temporary, but could also become permanent with repeated exposure, so it's important to wear hearing protection as much as is possible in these situations to reduce the risks of damage to your hearing which may make your tinnitus appear louder. A  hearing loss doesn't cause tinnitus but if your brain cannot hear the sounds created outside of your ears, it is more able to focus on the tinnitus  sounds inside your head.   So if you have tinnitus and also have a hearing loss, treating the hearing loss won't cure your tinnitus but should make you less aware of the tinnitus when you wear the hearing aids.

In some people tinnitus may be a side effect of ototoxic medication they may be taking or have recently been prescribed.  If you think this is the case you should speak to your GP or a pharmacist to see if there are alternative medications you could take.

Unilateral tinnitus

Unilateral tinnitus only appears in one ear, and always the same ear.   This could be caused by an infection or earwax blockage, or it could be a symptom of a one sided hearing loss.  We can check these things and refer you for further investigation if required.

Pulsatile or fluctuating tinnitus

Pulsatile tinnitus is where the tinnitus appears to fluctuate or pulse rhythmically, usually with your heartbeat.   This may indicate changes in blood flow in the vessels near your ears.   There may be an underlying cause for this which you should speak to your GP about, as treating the cause may help alleviate some or all of the tinnitus.

Distressing tinnitus

Distressing tinnitus would either stop you falling asleep at night, or wake you up during the night.  Poor or disturbed sleep is recognised as being a contributor to other physical or mental health issues.   If you are experiencing distressing tinnitus you should speak to your GP to see if there is an underlying cause that may require medication or more specialised treatment.   

Changes to pre-existing tinnitus

If you already have tinnitus that develops a permanent change in either:

• frequency - the tinnitus changes pitch or tone

• intensity - the volume of the tinnitus increases 

then you should consult your GP or other ENT specialist about the change, even if you have already consulted them about the pre existing tinnitus.

What if my tinnitus bothers me?

Hyperacusis

Hyperacusis is an oversensitivity to normal everyday sounds, or a reduction or alteration in sound tolerance.  Sounds which most people find comfortable can become uncomfortably loud or even be intrusive or possibly painful to a hyperacusis sufferer.

There is no reliable evidence as to how many people are affected by hyperacusis and it affects each individual differently, with some using coping strategies but others withdrawing from situations that are likely to cause discomfort.

Hyperacusis is common with tinnitus sufferers and is often found in people with ASD (autism spectrum disorder), however having one condition doesn't automatically mean you'll have both.

Hyperacusis would usually be diagnosed by an ear, nose and throat (ENT) specialist so if you think you may have this condition you should speak to your GP for referral to ENT

Types of Tinnitus

Most people with tinnitus will usually experience it in both ears to a similar level, or it seems to be in the middle of the head.  It is estimated that 1 in 3 people experience tinnitus at some stage in life, sometimes even as a child.  For most people tinnitus tends to be temporary and it comes and goes but can be triggered by unprotected noise exposure or even periods of increased stress.   Many people aren't bothered by their tinnitus and have developed skills to help them deal with it, but if your tinnitus is bothersome please read the section headed 'What if my tinnitus bothers me'?

Tinnitus - general

Pulsatile tinnitus

Musical tinnitus is where a person hears a tune or song rather than a ringing or rushing noise.   The person seems to perceive the tune or song at the same pitch as when they first heard it, so even if the person has developed a hearing loss, they still hear the song or tune as they originally did.   There doesn't appear to be any underlying cause that has been identified but there are often emotive links to the tunes heard, such as those sung most often as a child at school, or in church.  Periods of attack may vary in length but are usually longer lasting than 'earworms' which is when a tune you recently heard gets stuck in your head.   

Pulsatile tinnitus is where the tinnitus appears to fluctuate or pulse rhythmically, usually with your heartbeat.   This may indicate changes in the flow in the blood vessels near your ears.   There may be an underlying cause for this which you should speak to your GP about, as treating the cause may help alleviate some or all of the tinnitus.  This is a referrable condition if not previously investigated.

Other forms of rhythmical tinnitus are Myoclonus and Patulous Eustachian Tube Syndrome.

Musical tinnitus

The worst thing you can do with tinnitus is to focus on it.   The more you focus on, and stress about it, the louder it appears to be, which in turn makes you more stressed and the tinnitus gets louder still, so it becomes self perpetuating.   In most cases it's better to develop coping mechanisms which enable you to live with your tinnitus.   There are many tinnitus organisations and support groups  that can help with this.