Today’s topic is a vexious problem that gets far less attention by hearing health professionals than you would think. Tinnitus is a big issue for patients, but not one that is treatable by pills, surgery, or other traditional treatments. However, there are treatments that are effective for some people.
What It Is
Tinnitus (pronounced “tin EYE tus”) is a frequent, unpleasant companion to hearing loss. Moreover, it is an invisible, unpleasant companion because it is heard in almost every case only by the person who has it, not by others. Many people describe their tinnitus as sounding like bells or crickets.
For some, tinnitus is occasional, low level and largely ignored. For others, it is worrisome or frightening – they wonder if they have mental problems or if they have a brain tumor. Fortunately, tinnitus is not a sign of mental problems and only a tiny fraction of a percent of people with tinnitus and/or hearing loss have so-called “eighth nerve tumors.”
There is one small but important group of people who are tinnitus sufferers – their tinnitus is constant, extremely distracting, loud- to-blaring. For those people, tinnitus is a disabling condition.
The Clinical Picture
“Tinnitus is one of the most common clinical syndromes in the US, affecting 12% of men and almost 14% of women who are 65 and older. It only rarely afflicts the young, with one significant exception: those serving in the armed forces. Tinnitus affects nearly ½ the soldiers exposed to blasts in Iraq and Afghanistan” (Gropman, 2009).
Important neurophysiologic research is being conducted on tinnitus. Researchers are using rats to test theories of tinnitus and find drugs that suppress tinnitus. They have yet to identify a successful suppression treatment, but they have definitively proven that tinnitus is caused by biological changes in the brain, not by psychological processes. In other words, it’s not just something people imagine –although it certainly affects those who have it psychologically.
The idea that brain changes underlie tinnitus is a game-changer for audiologists and their patients. We used to think that tinnitus resulted from damage to the inner ear. That’s still the case, especially for tinnitus caused by high aspirin dosage. But now we know that it’s not that simple. There is a “central” origin (or probably multiple centers) in the brain which regulates a person’s perception of tinnitus. This is in line with new thinking on hearing loss and hearing aids: the initial insult that causes hearing loss occurs in the inner ear, but the changes in auditory perception that occur because of that insult are in the auditory centers of the brain. That is why hearing aids are now considered to be a first line of defense against losing auditory perceptual capability, and possibly auditory cognitive deficits as well.
Help for Tinnitus Sufferers
What is available to help people who suffer from tinnitus? There are no FDA approved drug therapies for tinnitus treatment, but antidepressants and anti-anxiety medications are prescribed for some people to ease their suffering, much as they are for people who suffer from chronic pain. Those drugs do not suppress tinnitus, they just make it more bearable.
On the other end of the treatment spectrum, Tinnitus Retraining Therapy relies on sound therapy and patient-centered psychological counseling to remove negative connotations of tinnitus. TRT takes 12 to 18 months, which makes patient compliance a serious concern. In general, success rates with drugs or counseling based treatments are hard to pin down but none are stellar.
The most successful treatment for tinnitus is some form of amplification, either with hearing aids alone or those fitted with tinnitus “masker” circuitry which pumps tailored noise into the wearer’s ear to cover or compete with the sound of the tinnitus. In one report, hearing aids “often have a beneficial effect on the underlying tinnitus. Relief from tinnitus may persist for hours after the hearing aid has been removed” (Castillo & Roland, 2007). In another study, about two thirds of 1440 patients fitted with hearing aids on one or both ears reported improvement in their tinnitus (Trotter & Donaldson, 2009). In a survey of hearing health care providers, 88% reported that they recommended hearing aids as the treatment of choice for tinnitus (in the presence of hearing loss). Those providers reported a success rate of 60%: 22% of their patients experienced major benefit and 38% found their tinnitus reduced to some extent.
What Tinnitus is Not and What to Do About It
Tinnitus is a symptom and not a disease. That makes it confusing to patients and primary care physicians when it comes to deciding how to handle it, especially in cases of mild hearing difficulty.
The first step in EVERY case is a comprehensive diagnostic audiology evaluation to rule out or identify presence of an auditory nerve tumor, middle ear disorders, and even impacted wax. Audiometric testing takes about an hour, can be covered under Medicare, and points patient and physician to the appropriate management strategy.
Additionally, audiologists can administer the Tinnitus Handicap Inventory, a self-report measure, to assess the impact of tinnitus on a patient’s daily life. If audiometric test results show deficits in speech audibility and intelligibility, hearing aids may be in order to correct speech processing deficits as well as potentially mitigate tinnitus effects reported by patients.
Castillo MP & Roland PS. Disorders of the auditory system. In Roeser R, Valente M & Hosford-Dunn H (eds), Audiology: Diagnosis (2007, 2nd Ed). New York: Thieme.
Groopman J (2009). That buzzing sound: The mystery of tinnitus. The New Yorker, Feb 9 & 16, 42-49.
Henry JA et al (2009). Tinnitus Retraining Therapy: Clinical Guidelines. San Diego: Plural Publishing.
Kaltenbach JA (2009). Insights on the origins of tinnitus: An overview of recent research. Hearing Journal 62(2), 26-31.
Kochkin S & Tyler R (2008). Tinnitus treatment and the effectiveness of hearing aids: Hearing care professional perceptions. Hearing Review, Dec, 14-17.
Korres S, et al. Tinnitus Retraining Therapy (TRT): outcomes after one-year treatment. Int’l Tinnitus Journal, 2010; 16(1): 55-9.
Newman CJ et al. Development of the Tinnitus Handicap Inventory. Arch Otolaryngol Head Neck Surg. 1996;122:143-148.
Sereda M et al. Consensus on Hearing Aid Candidature and Fitting for Mild Hearing Loss, With and Without Tinnitus: Delphi Review. Ear Hear. 2015 Jul; 36(4): 417–429.
Trotter M & Donaldson I (2008). Hearing aids and tinnitus therapy: a 25-year experience. J Laryngol & Otol 122(10):1052-6.
feature image courtesy of thisismedtech