Tinnitus is common and it may resolve by itself. Although commonly associated with hearing loss, it is not commonly associated with any underlying physical problems and there are a variety of management strategies that may help people live well with tinnitus. NICE Guidance 2020
What is tinnitus?
Broadly speaking, tinnitus refers to the ‘perception of sound in the head, with no external stimulation’. This broad definition can include things like internal blood flow and jaw movement (somatosounds), auditory hallucinations, music hallucinations (more on that later!) and subjective tinnitus (tinnitus resulting exclusively from activity within the nervous system, without any corresponding vibratory activity within the cochlea).
Most people have experienced the latter type of tinnitus, following a musical event or club night, when typically, there is a high pitch ringing in the ears, as a result of a period listening to loud music. For me personally, my interest in music began in the 1980s and during my University days, my exposure to music events was weekly, regularly setting up sound systems for visiting bands. Looking back, I was experiencing tinnitus regularly after gigs, with one particular gig having a dramatic effect on my hearing (see later).
What causes tinnitus?
For most people, some disruption or degeneration of the very delicate structures within the cochleae, is often the precursor to tinnitus. This can happen following exposure to high levels of sound (music event, gunshot, explosion) or following ototoxic drugs (drugs toxic to the cochleae). It can also occur due to natural deterioration within the cochleae as we age.
Does tinnitus affect hearing?
This questions often comes up in consultations with clients. Firstly, tinnitus can be present in the absence of any detectable hearing loss. That said, tinnitus can often be the first sign that a person’s hearing has deteriorated. Often, a person will notice tinnitus, ask for a hearing test and then find out that they have a mild hearing loss which they weren’t particularly aware of.
But back to the question. Tinnitus is a consequence of some degeneration inside the cochlea, as is a reduction in hearing. So, tinnitus and hearing loss are both the result of cochlear damage. It may feel like tinnitus is affecting a person’s ability to hear, which it may well be, but tinnitus itself is not a cause, more a symptom.
Other symptoms of cochlear degeneration include decreased sound tolerance. Put simply, this is when situations which are typically tolerable by most people (e.g., parties, social events, shopping centres etc) are not able to be tolerated, due to their sound levels. Sometimes called hyperacusis, this again can often be noticed prior to any hearing difficulty but can indicate that some changes in the cochleae have taken place.
For me personally, following one gig that I worked at during my university days, my hearing took a noticeable hit, with a week or so of distorted hearing, very loud tinnitus and decreased sound tolerance. For some time after, just going into a pub or bar, would be quite uncomfortable due to the noise levels there.
Is tinnitus problematic?
This very much depends on a number of things. How loud it is. How persistent it is. What beliefs a person has about these sounds. Also, the general health, both physical and mental of the person experiencing the tinnitus. Although up to 17% of a population may experience tinnitus at any time, typically only 20% of these will have problematic tinnitus.
It appears that some people are just more troubled by the perception of these internal sounds than others. Tinnitus can affect sleep, concentration, mental health, sociability to name a few. Stress can result from tinnitus but can also drive the tinnitus more. For example, in my practice, I have often seen clients with troublesome tinnitus which has just started. On questioning, it often comes up that a significant life event has happened (e.g., death of parent, illness in family) which the client had not linked with the onset of their troublesome tinnitus.
Theories of problematic tinnitus
There have been and still are many attempts to understand the mechanisms involved in tinnitus, its perception, and its effect on people. As humans with complex physiological processes and brain structures, several researchers have pointed to the role of the brain and our nervous system in the role of trouble tinnitus.
Imagine living thousands of years ago, in a cave dwelling or out in the open. Hearing a tiny sound, be it at night or when visibility was reduced, could be potentially a sign of a threat. Hearing tiny sounds and secondly noticing them, could be the difference between life and death and it is not surprising that humas have evolved to ‘notice’ quiet sounds.
For this to happen, several systems in the body have to be online. Both the limbic system (controls emotions) and our autonomic nervous system (controls automatic functions in the body and brain, for example heart rate, breathing) are involved.
The limbic system is usually activated in times of danger or threat, with the autonomic nervous system, more specifically the sympathetic part, activating many bodily systems to allow a response to a threat.
There has been much more discussion over the last few years of the role of the vagus nerve and the parasympathetic nervous system (another blog!). What appears to be emerging, is the link between the ‘balance’ or rather ‘imbalance’ of our sympathetic and parasympathetic nervous systems to a wide range of both physical and mental/emotional conditions. Tinnitus possibly one of these.
Treatment of tinnitus
If you or someone close is experiencing tinnitus, the first thing to do is to get a thorough audiological evaluation from a Clinical Audiologist. This can be done in Leeds at ‘The Hearing Space’. In some very rare cases, tinnitus can be linked to more serious conditions, but typically, hearing loss is the main associated finding.
If a hearing loss is found, then hearing devices may be recommended. Firstly, to improve hearing, but secondly to attempt to reduce the severity of any perceived tinnitus. Several studies have found that after wearing hearing aids for some time, the impact of tinnitus is reduced and tinnitus becomes less problematic.
If no hearing loss is found, there are several options for your Audiologist to suggest. These will depend on a range of factors and your Audiologist will be able to explain these to you.
In the past people have been told to ‘live with their tinnitus’. Thankfully today, there are several proven strategies which have been shown to reduce the impact of tinnitus.
A quick aside on this topic. Several researchers have documented the case of people hearing melodies, music, or song, in the absence of any of these externally. I personally have seen several clients who have discussed articulately the particular song they can hear (e.g., brass band playing a song from childhood). Often there is associated hearing loss and sometimes neurological and brain involvement.
As one can imagine, this could be quite alarming to experience, and some people seem to cope better than others with this condition.
The hallucinations can cease by themselves or lessen with hearing aid use. Sometimes neurological and psychiatric assessment is required.
In the visual world, there is a somewhat similar condition for some people who lose their sight. Charles Bonnet syndrome is a condition in which the brain produces visual hallucinations in the absence of external input. Again, personally I have come across this, with one visually impaired client regularly seeing images from his youth (childhood friends etc).
My tinnitus story
I remember the event well, the Tartan bar in Leeds University. I was involved throughout the day sound checking, and then throughout the evening. It was a loud gig, too loud probably, and I was exposed to sound for too many hours that day. On leaving, the typical high pitch ringing in my ears, but also a strange, muffled feeling. Nothing to worry about. I was 19! The next day, sitting in a lecture, unable to hear the class. A roaring high pitch whistling in my head and that strange, muffled sensation.
A week later and I was still so troubled by the changes to my hearing that I went to my GP. ‘You have damaged your hearing lad. Stop going to gigs!’. Music was my world; I wasn’t going to stop that. My hearing returned back to normal and I continued attending music events, but now my ears seemed more sensitive, as though any loud noise would immediately seem too loud, followed by an increase in the level of my tinnitus.
Cut to a year or two after graduating, I am in the American wild west, desert land. I am surrounded by space and sky. But not silence. My ears are ringing. I want to hear silence, but I can’t. I am aware for the first time of the impact of my love of music.
I then studied to be a Clinical Audiologist and learned about the ear and the potential for damage caused by excessive levels of sound. I realised that on the night of the gig in the Tartan bar, I had caused some irreversible damage to the structures in my cochleae, resulting in a temporary hearing loss, hyperacusis and tinnitus.
Over the years, my tinnitus has become less noticeable, less obtrusive. I can still hear it, particularly at night or early morning. Sometimes it seems louder and loud noises make it worse. But overall, it doesn’t trouble me.
Advice for music lovers
My advice to a young music lover today, would be first to be aware of what you are listening to. How loud and how long, as these two factors combine to impact hearing. Secondly, if attending music events, gigs, or club nights, then to consider using ear protection or at least having some handy, should the sound levels be particularly loud. These can range from non-custom products to custom built ear protection. The benefit of custom products is that the effect on sound quality is minimal, with the option to vary the attenuation provided by the devices. At ‘The Hearing Space’ we can provide a range of custom ear protection devices, depending on your needs.
Please contact ‘The Hearing Space’ to book an assessment of your hearing or to arrange for bespoke ear protection.
Paul the Clinical Director has many year’s experience of tinnitus, both professionally and personally. He would be happy to have an informal discussion abput your particular situation.
T: 0113 8730444 | E: firstname.lastname@example.org