I was sitting in the doctors lounge the other day and I overheard two physicians talking about a patient. One doctor was telling the other how his patient had ringing in his ears. He said it was causing a lot of discomfort but he didn't see anything wrong on the exam. He went on to say that there wasn't anything we could do for it and so he told the patient to live with the problem.
So is that true, do you have to live with noise in your ears?
I would like to talk about about this disorder of hearing sound in the head and share my thoughts about what can and should be done. First of all, we need to be using the proper terminology. The sensation of a sound in the head is called "Tinnitus". A diagnosis of tinnitus is just a medical way of acknowledging how to describe the problem.
There are many causes of tinnitus but most essentially relate to the same general problem. The inner ear communicates with the brain constantly by sending signals back and forth. When a problem occurs in that path such as when you have lost hearing the signal increases in intensity and frequency and you hear ringing. If hearing is restored or the path is repaired then hearing goes away.
We have all experienced this when we have been exposed to a loud noise and we have a sudden loss in hearing with the onset of ringing in our ears. A few of us may have experienced this at July 4th celebrations yesterday. Fortunately, healthy ears will often times recover over the next few hours.
We have a problem when the ringing never goes away. So, if someone develops ringing in the ears what should they do? First of all, don't panic. Second, be wary of what you read on the internet. Third, don't let your doctor dismiss your problem without an adequate evaluation. An adequate evaluation includes a complete look at the head and neck area.
I often times find the culprit of the ringing when I look in the ears. One very common cause is wax impacting the ear canal or touching the eardrum. Fortunately, this is easy to fix. I even had a patient this morning whose main cause of her tinnitus was wax. Another common cause is fluid trapped behind the eardrum from a recent upper respiratory infection. Once the fluid resolves most times so does the tinnitus.
Unfortunately, looking in the ears doesn't always identify the cause. Usually I will proceed with a detailed hearing test. Most patients who have tinnitus will have hearing loss and that hearing loss is usually in the frequencies that the sound is heard. If the hearing loss is due to injury to the eardrum, the middle ear or the tiny bones then surgery may be offered. More commonly the loss is to the sensory apparatus itself. This is called sensorineural hearing loss.
The next question I usually get asked is what can be done. This is where the frustration was expressed by that physician I was mentioning at the beginning of this article. Since we can't cure sensorineural hearing loss what is the benefit from going through this whole process? Most hearing loss can improve with hearing aids and up to 70% of people who use hearing aids who have tinnitus will have improvement in their tinnitus symptoms. There are even hearing aids that have the ability to place a sound in the ear that helps quiet the tinnitus.
Some of my patients don't have poor enough hearing to benefit from a hearing aid. I had a middle age woman present with that scenario today. We talked about the various ways to try to handle the tinnitus.
In addition there are several things that can exacerbate tinnitus or trigger it. Any medication that affects the nervous system can be trouble. Also aspirin in high doses and in some people even low doses. Stress, anxiety, tension and fatigue all will worsen symptoms. Jaw clenching and teeth grinding is another source of trigger.
Currently I recommend several things to try to help mitigate the symptoms:
1) Play masking sounds to quiet the tinnitus. This could be a water fountain or a music player. You can download masking sounds in the Apple and Google app stores.
2) Consider meditation and relaxation exercises when the tinnitus worsens.
3) Supplements known to improve symptoms include zinc 40-50mg/day, Gingko Biloba, and bioflavinoids often called "Tinnitus Relief Formula" in pharmacies. A well known version on the internet is Arche's Tinnitus Relief. With these supplements changes may not be felt for 30 to 60 days but if there is no relief by 90 days they probably aren't worth continuing. In addition, I have had some success having patients start melatonin about 1-2 hours before bedtime to help you fall asleep.
4) Tinnitus suppression-This is based upon the idea that if sound is presented in the ear at the frequency of tinnitus it can help with the feedback loop between the ear and the brain to calm the ear down. There are studies that show that if the sound is played up to 2 hours per day for several weeks, long lasting suppression can occur. I have recommended that patients try downloading an application from their smart phone. A number of these are free and are found by searching "Tone Generator". Once installed on your smartphone find the tone that matches the frequency of your tinnitus and play it at a low volume, just loud enough to be louder than your tinnitus. Start off at a few minutes per day and increase based upon your tolerance up to 2 hours per day. If you begin to observe the tinnitus improving then continue with the program as long as you wish. Most studies suggest 2 to 6 months of treatment.
5) Don't give up, new ideas are coming up every year and most people will have some spontaneous improvement in 3-6 months after symptoms start.
I strongly recommend my patients check out www.ATA.org The American Tinnitus Association puts out a quarterly journal that is understandable and relates the latest research and ideas for tinnitus management.
I hope those of you who have tinnitus or know someone who suffers will find some comfort in reading this article and you are welcome to print this and share it.
