Ringing in Your Ears: Understanding Tinnitus Causes, Management, and Relief
Current estimates are that nearly 50,000,000 American adults live with tinnitus and almost 1.5 billion people worldwide. Along with hearing loss, tinnitus is the most common sensory disorder on the planet! And while the ‘Average Joe’ may think of people with hearing loss as ‘suffering in silence’, the exact opposite is true for most as the ringing can be incapacitating.
Tinnitus is often described as the experience of hearing a sound in your ears, sometimes in your head. In medical publications and dictionaries, you will most often find the definition of tinnitus as the phantom perception of sound. The key word in that definition is phantom.
Some people with tinnitus only notice the sound in a quiet room, whereas many others experience the sound all day long, and it can interfere with daily life. These phantom sounds can cause depression and anxiety, affect concentration, sleep, and work, and get in the way of hearing. And tinnitus is experienced by over 90% of people living with hearing loss. (And vice versa – over 90% of people with tinnitus have some hearing loss.)
Nearly every patient with tinnitus is seeking the answers to ‘why’ they have the ringing and ‘how’ they can get rid of it. The simple answers for a vast majority of cases are:
- Tinnitus is the result of damage to neural connections within the brain, and
- YES, there are very effective treatments available.
The initial cause of tinnitus can vary; however, the #1 cause (by a landslide!) is aging, followed by noise exposure, either a single intense noise (like a shotgun blast) or long-term exposure either from work or play (musicians, concert attendees, carpenters, machinists, landscapers, etc.), medication, and virus (i.e., Covid). Regardless of the cause, the underlying pathology in almost every patient is the same – a breakdown of the neural integrity of connections between the ear and brain (the ear-to-brain connections). Irrespective of the cause of the neural damage, the result is nearly the same – ringing in the ears and/or head that can be effectively treated in (90%) patients.
The remaining 10% of tinnitus cases can result from other medical conditions, including:
- hypertension (high blood pressure)
- thyroid disease
- vascular disorder
- temporomandibular joint (TMJ) disorder
- craniofacial abnormalities/differences
- and more.
In some patients, prescription and over the counter (OTC) drugs, such as pain relievers, can result in damage to the auditory system and cause or exacerbate tinnitus. Several hundred drugs listed in the Physician’s Desk Reference (“PDR”) cite tinnitus as a possible side effect! In some, but very few of these cases, the tinnitus may reduce or disappear when the prescribed medication is discontinued. While some of the drugs on this list are life-preserving medications, i.e., chemotherapy, many everyday non-prescription medications, including NSAID pain relievers like ibuprofen, acetaminophen, and acetylsalicylic acid (aspirin), can significantly increase the risk of developing tinnitus.
The Theory of Tinnitus: when the brain is not adequately stimulated by the ears (even in the very earliest stages of hearing loss), the brain will increase neural activity to make up for the missing input – and the result is that you will hear a sound (that you shouldn’t be hearing!). The more technical way to describe this is that tinnitus is most often the result of a ‘central gain’ in neural activity that occurs when there is a loss of proper neural stimulation from the ear (after there is damage to the cells inside the ear and in the brain).
This ‘central gain’ results in the false, aka phantom, perception of a sound and is neurologically analogous to an amputee’s perception of a ‘phantom limb’.
For example, in cases where a limb is amputated (perhaps as the result of a traumatic accident or injury sustained while at war), the peripheral nervous system that connects that limb to the brain is damaged. Hence, the central nervous system (the brain) will undergo adaptive changes, resulting in the person erroneously perceiving the limb as still being connected. In some cases, the amputee can even feel extreme pain in that missing limb.
Our ears do not have traditional ‘pain receptors’; rather, the perception of ‘pain’ that results from damage to the ear is perceived as a ‘phantom sound’ (tinnitus). As the brain tries to adapt to the decrease in sound stimulation from the ears and the damage to the nerves in the brain, it will begin to experience a gain of activity that results in our (false) perception of sound.
Understanding Tinnitus – Treatment Options: Unfortunately, too many patients think there is nothing that can be done about the ringing. Frankly, in most cases, this isn’t true. Below are some of the most effective treatment options available for managing tinnitus:
Tinnitus and Sound Stimulation: The single-most effective treatment option available for patients suffering from tinnitus is prescriptive technology capable of stimulating the ear-to-brain neural connections. This technology is FDA-regulated for individuals with tinnitus. In fact, 100% of clinical studies between 2010 and 2020 indicated that patients who use tinnitus treatment technology have a significant reduction in their daily tinnitus experience – with some even reporting that ‘the ringing is gone all day.’
Tinnitus and Brain Training: Treating tinnitus with sound stimulation may be enhanced with brain training in many patients by providing additional support to the brain. Exciting new research was recently published in the Journal of American Medical Association (JAMA), pointing to a new BrainHQ game that can significantly reduce a patient’s perception of tinnitus.
‘Researchers found that patients with tinnitus, in the group with tinnitus, had improvements in tinnitus perception, memory attention, and concentration as compared with patients in the control group.’
~Dr. Piccirillo. Journal of American Medical Association, Otolaryngology
There is still significant research to be done in this area – there needs to be new exercises and improvements to the existing set – but seeing brain plasticity in patients with tinnitus is a great start!
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