What’s The Buzz About Tinnitus?

Without a doubt, you’ve heard it—that strange little sound at the back of your mind when the room gets quiet. It might be a ringing, a buzzing, a hissing…it might even sound like cicadas took residence in your temporal lobe. But that persistent noise has a name: tinnitus.

Tinnitus (pronounced TIN-ih-tus with a short I sound because it’s a symptom, not a disease) impactsroughly 50 million Americans. It’s the number one complaint amongst US Veterans, ranking higher than its close cousin, hearing loss. Tinnitus is traditionally defined as a sound in the absence of an outside source; in other words, it’s all in your head. But just because this sound can’t be heard by others doesn’t mean you’re alone, and it also doesn’t mean we can’t identify where it comes from. That’s where your healthcare team comes in.

More often than not, tinnitus indicates untreated hearing loss, which may or may not be significant enough to impact your life in other ways. It might even be the first sign of something amiss in the hearing system. As an audiologist, I frequently hear patients claim that their hearing is fine, “except for the tinnitus that keeps me from hearing certain sounds.” That’s a red herring! In reality, the patient is experiencing hearing loss, but the tinnitus is more important than any perceived communication breakdown, so the natural assumption is that tinnitus caused the deficit. Unfortunately, eliminating tinnitus to restore hearing isn’t possible.

So, what is possible?

First and foremost, because tinnitus is abnormal auditory perception, it stands to reason that one must have their hearing evaluated as a first step to determining the root cause. Hearing loss is low-hanging fruit in the tinnitus world. Much like phantom limb syndrome, in which someone loses a limb but still “feels” it, when sound input is reduced, the brain may generate its own internal sound. That internal signal is what we perceive as tinnitus. This type of tinnitus is considered otogenic, or ear-and-hearing-related. Think of tinnitus as a phantom sound created by the brain to “fill in the blank” of hearing loss; generally, this means the perceived pitch of the tinnitus will correspond with hearing loss results.

While there is a lot of nuance involved in defining hearing loss, there is no universal cure. Unfortunately, this means there is no universal cure for tinnitus, either. However, there are treatments and strategies to address it, especially for otogenic tinnitus cases. Treating any underlying hearing loss reduces perception of tinnitus by increasing what’s called “sound enrichment”, which is the concept of increasing external stimuli to reduce internal disruption.

Another way to think of this is to imagine a candle in a well-lit room. If there’s a lot of competing light, the candle’s flame wouldn’t be very visible. But if the lights go out, the candle doesn’t change—it simply looks brighter because it doesn’t have much to compete with. Amplifying hearing loss effectively “turns the lights on”. The inverse of this—entering a quiet environment with few distractions—can lead to more intense tinnitus perception. This is why most folks with tinnitus report noticing their tinnitus the most at bedtime, when other distractions are at their lowest.

Of all the people who report having tinnitus, very few report it being significantly problematic. That said, the psychological and emotional aspects of tinnitus cannot be understated. These additional qualifiers correspond to a tinnitus patient’s quality of life and can indicate disruptions in sleep patterns and global stress. Resolving deficits in sleep, stress, and diet have proven to have a positive impact on tinnitus perception. A compound approach of amplification and lifestyle changes can provide the most effective and consistent resolution.

But what if my hearing is normal?

Tinnitus in the presence of normal hearing can indicate non-otogenic conditions, such as problems in the temporo-mandibular joint (TMJ), stenosis or narrowing of the cervical spine, nerve disorders such as Ramsay-Hunt Syndrome and Bell’s Palsy, or migraine. Some patients might report a change in their tinnitus with specific head and neck movements or dietary changes. It’s important to discuss any symptoms beyond tinnitus with your healthcare team, and if hearing test results come back normal, further evaluation may be needed to detect breakdown of inner ear structures that are not yet severe enough to manifest as a hearing loss. Some audiology offices can also perform subjective pitch-match testing, which can also help pinpoint the underlying cause.

If you or someone you know struggles with tinnitus, you’re far from alone. Your healthcare team is here to investigate and offer solutions. As we audiologists say, we’re all ears for you! For a hearing evaluation, talk with your primary care doctor, or call MarinHealth ENT, Head & Neck Surgery in Santa Rosa at707-523-7025.

To learn more about tinnitus, listen to this short podcast.

Jo Powner, AuD is a Clinical Audiologist at MarinHealth ENT, Head & Neck Surgery | A UCSF Health Clinic.