Interest in tinnitus and its treatment has grown in recent years, largely due to increasing awareness that tinnitus is the most common service-connected disability for veterans returning from recent military service in Iraq and Afghanistan (Department of Veterans Affairs, 2010). Tinnitus is a medical term for acoustical perceptions heard in the ear(s) or head, but not produced by external sound. This sound, which is often described as a ringing, buzzing, pulsing, whistling, or humming, can be experienced in one or both ears with varying intensity, loudness, and pitch. Approximately 50 million people in the United States experience tinnitus at some point in their lives. Around 16 million of these Americans experience tinnitus bothersome enough to consult their doctor. Two to three million are so severely affected by their tinnitus that their ability to function is severely impaired.
Tinnitus is a symptom rather than a disease and may develop from exposure to loud noise; a head injury; aging, outer, inner, or middle ear problems; neck or jaw disorders; cardiovascular disease; or use of prescription or non-prescription drugs. While many theories have been proposed to explain the occurrence of tinnitus, it is a multimodal disorder that may have different causes and different pathophysiologies. This makes tinnitus difficult to treat; oftentimes, interventions meet with only variable success.
Tinnitus can have a major impact on a person’s life. Severe tinnitus is most commonly associated with anxiety, distress, sleep disturbance, and depression. Disrupted sleep is the most significant complaint, affecting as many as 70% of tinnitus patients. Studies report a lifetime prevalence of 62% for major depression, with 48% of people with tinnitus displaying current depression, and 45% reporting an anxiety disorder. Poor attention and concentration, interference with work, and negative impact on personal relationships are commonly reported by patients. Almost all patients indicate that stress or tension makes their tinnitus worse.
Most—as many as 95%—of people with tinnitus have some degree of hearing loss. But not all people with hearing loss have tinnitus (about 50% of people with hearing loss have tinnitus).
Although we do not always know the exact cause, it is largely accepted that sensorineural hearing loss (loss of hair cells in your cochlea or inner ear) is somehow related. But while the damaged hair cells and the resulting hearing loss is part of the tinnitus picture, it is how the brain processes—or doesn’t process—the sound that is then experienced as the ringing, buzzing, chirping, and roaring that so many with tinnitus describe. For this reason, tinnitus is happening in the brain and not in the ears.
Did hearing loss cause my tinnitus?
Noise exposure is one of the leading causes of hearing loss, which, in some, co-occurs with tinnitus as described above. From loud concerts to blasting music through earphones to power tools, few would argue that noise exposure is an increasing facet of modern living.
Head injuries are another top cause of tinnitus. The natural course of aging can leave us with diminished hearing as well. Once hearing loss occurs, it is hard or impossible to restore, so efforts to reduce noise exposure should start early. As the old adage states, “An ounce of prevention is worth a pound of cure.”
Tinnitus is not a “disease” but is rather a “symptom” of some other change in the body. Examples of such changes in the body that may cause the symptom of tinnitus are loss of hearing related to the normal aging process, an injury to the ear, or a circulatory system ailment.
Other causes of tinnitus may be from exposure to loud noise; a head injury; outer, inner, or middle ear problems; neck or jaw disorders; cardiovascular disease; or use of prescription or non-prescription drugs. It has been estimated that as many as 40% of people with tinnitus can’t narrow down a specific cause or incident leading to tinnitus.
While many theories have been proposed to explain the occurrence of tinnitus, it is a multimodal disorder that may have different causes and different pathophysiologies. This makes tinnitus difficult to treat, and oftentimes interventions meet with only variable success. Three common causes of tinnitus are:
Noise exposure is one of the most common causes of tinnitus. In fact, tinnitus is the number one medical complaint of Veterans returning from recent wars due to loud blasts and gunfire. Listening to loud music for prolonged periods of time can also damage the ear resulting in hearing loss and tinnitus. The best way to protect your ears is, of course, to avoid loud noise. But if you must be in a noisy environment—such as a music concert or loud factory—start protecting your ears NOW. Wearing ear plugs when you are in a very noisy environment is one great way to protect your ears from further damage. Ear plugs can easily and inexpensively be purchased at a local pharmacy, or you can have them custom made by a hearing health professional.
Aging is a beautiful, inevitable part of life. And with aging comes a certain amount of wear and tear on the body. For this reason, hearing loss due to advancing age is quite common. The medical term for age-related hearing loss is presbicusis. Not all people with presbicusis develop tinnitus but quite a few do. Again, there is no use in fighting the aging process so being good to your ears from this moment forward is best.
Prescription or Non-Prescription Drugs
The side effect of certain drugs can cause or worsen chronic tinnitus in some patients. Tinnitus triggers include: various antibiotics, pain killers, anti-anxiety and anti-depression drugs, diuretics, anti-malarial medications, anti-cancer drugs and blood pressure controlling medications. It is important to ask your doctor about medications that may harm your hearing. Use these drugs only if the benefits outweigh the risks.
Mindfulness-based meditation—with its power to bring relief to troubling symptoms—is a therapy that shows great promise in the present-day treatment of disease and management of health. Jon Kabat-Zinn, a biologist at the University of Massachusetts Medical Center, can be largely credited with bringing a mindfulness therapy, specifically an 8-week treatment program called Mindfulness Based Stress Reduction (MBSR), to modern medicine. In a 2007 interview, he stated, “The idea was to actually…train medical patients in Buddhist meditative practices, but without the Buddhism.” His mindfulness program has been well accepted in many clinics and hospitals throughout the nation as a treatment for stress related to illness.The widespread acceptance of MBSR stems from clinical trials demonstrating effectiveness for a range of illnesses. It has been successfully used for such conditions as depression, anxiety, stress, fibromyalgia, chronic fatigue, psoriasis, symptoms associated with cancer and pain.
Mindfulness Based Tinnitus Stress Reduction (MBTSR) was designed by Dr. Jennifer Gans at the University of California, San Francisco (UCSF) Audiology Clinic in 2009. MBTSR is designed after the MBSR program but with important differences. The curriculum for the course is specifically tailored to working with tinnitus. Education on tinnitus is woven into the weekly lessons. Meditations are also geared for those living with chronic tinnitus. Emphasis is placed on exploring the sensation of hearing and sounds.
The results of the MBTSR pilot study conducted at UCSF highlights the potential benefit of MBTSR as an intervention for chronic tinnitus. Results showed moderate to large improvement with respect to reduced tinnitus annoyance and awareness, increased mindfulness (specifically for non-judging of inner experience or refraining from evaluations of one’s thoughts, sensations, and emotions), reduction in mood disturbance (primarily for depression, phobic anxiety, and somatization), and meaningful improvements in patient quality of life. After the MBTSR intervention, subjects reported an increase in well-being and reduced depression, anxiety, body concerns, and sleep difficulty.