March 2017

Tinnitus Troubles


The American Tinnitus Association and the CDC state 10-15% of Americans (about 50 million) experience “ringing in the ears.” Tinnitus is not a disease, but a sensorineural reaction within the auditory system and parts of the brain that process sound creating the perception of sound when no actual external noise is present. It is one of the most common health conditions in the country and the #1 service-related disability among US veterans.

The majority of those with tinnitus state their symptoms are simply annoying, yet millions report having disabling symptoms that interfere with sleep, social activities or work. In addition to the personal strain of tinnitus, economic consequences of tinnitus are significant and cost society an estimated $26 billion annually due to lost income, productivity and health expenses.

With so many people suffering from tinnitus and with such hefty financial ramifications, knowledge of the differences between fact and fiction affords healthcare providers the best opportunity to improve their patients’ quality of life.

Myths & Truths:

Tinnitus is always ringing in the ears.

Tinnitus can be intermittent, constant or irregular, pulsatile, monaural or binaural, temporary or chronic. Reported perceived sounds include more than just ringing. People hear hissing, static, crickets, screeching, whooshing, roaring, or buzzing which can be quiet as a whisper or loud enough to impede daily activities. Listen to sample tinnitus sounds at:

Only people with hearing loss have tinnitus.

Tinnitus can occur without hearing loss but is more prevalent in people exposed to loud noises or with hearing loss. Sometimes tinnitus can be the first sign of hearing loss in older people; those between 60-69 years have the highest prevalence rates. Other groups at high-risk include: Caucasians, males, active military personnel/veterans, employees working in loud environments, musicians, people who participate in loud recreational events/hobbies like motorsports or hunting.

Tinnitus can manifest from many other health conditions as well: obstruction in the ear canal or middle ear, head or neck trauma, temporomandibular joint disorders, sinus pressure, barometric trauma, traumatic brain injury, ototoxic medications, metabolic/autoimmune/vestibular disorders, tumors.

There is no cure for tinnitus so I just have to learn to live with it.

Unfortunately, many patients still operate with the belief that nothing can be done for their tinnitus. While there is still no scientifically proven cure for most types of tinnitus, many treatment options or tools do exist that help reduce the perceived hardship of tinnitus. Each case of tinnitus is different and the “best” treatment option usually involves implementing multiple strategies:

  • General Wellness: A healthy lifestyle and diet supports better auditory function.
  • Hearing Instruments: These devices treat hearing loss and can mask tinnitus sound by augmenting environmental noise, forcing the brain to focus on the external sounds. Hearing aids with integrated sound generation technology are especially effective when hearing loss is in the same frequency as the tinnitus.
  • Sound Therapies: Numerous products are available that use one or more effective mechanisms of action (masking, distraction, habituation, neuromodulation).
  • Behavioral Therapies: Various therapies that address the emotional and behavioral response to their tinnitus. Relaxation, mindfulness, cognitive skills are some coping techniques learned by working with a trained therapist.
  • Drug Therapies: No drug is FDA-approved specifically for tinnitus and there are no medications shown to reverse the neural hyperactivity thought to be the root cause of tinnitus. Commonly used medications include antidepressants and antianxiety drugs to manage symptoms of burdensome tinnitus.

Treatment Steps:

Unless provoked by a traumatic physical event (head/neck trauma, concussive trauma), tinnitus is rarely indicative of an emergency medical condition. However, patients with tinnitus symptoms lasting beyond a week, or who are bothered significantly by their symptoms should seek medical care from their primary care provider (PCP) to diagnose or rule out any medical condition that can cause tinnitus. The PCP plays an important role in recommending or referring patients to a specialist with specific capacities in managing tinnitus, which may include an otolaryngologist, audiologist, board certified hearing instruments specialist, neurologist, or behavioral therapist. Tinnitus is a diverse condition unique to each patient and successful treatment and management requires clinical evaluation and multi-disciplinary intervention.