What is Tinnitus?

Tinnitus is a conscious experience of an involuntary sound that originates within the auditory system. It is a symptom, not a disease. It is commonly referred to as ‘ringing in the ears’. Depending on the severity, it can lead to a poor quality of life, anxiety, and depression.

Why are my ears ringing?

Tinnitus can be perceived as many different sounds including wind noise, chirping, ringing or whistling. In addition, the frequency and severity of the tinnitus can vary widely. If you experience any of these symptoms you may be one of many adults suffering from tinnitus.

What Causes or Affects Tinnitus?

Tinnitus is the perception of sound without any environmental source. It is relatively common in adults. Tinnitus can be subjective, which means that the person perceives the sound, but the sound does not actually exist inside or outside of the person. Tinnitus can also be objective, which means that there is an actual sound created by body functions, such as vascular or cranio-cervical sources. Tinnitus related to vascular issues is likely to be perceived as an auditory pulse. Cranio-cervical issues that can cause tinnitus include temporo-mandibular joint dysfunction (TMJ) or along the higher vertebrae. This form of tinnitus is commonly associated with pain or fullness in or around the ear, and might sound like a transient clicking or humming.

The direct cause of tinnitus is still unknown, but there are over a hundred factors that can contribute to symptomatic perception. The best thing you can do is to observe your lifestyle and your tinnitus. Any information regarding when tinnitus happens or worsens is important information if you decide to pursue with a program. Take notes of your activities, your medications, your nutrition, your injuries, and anything you feel could be relevant, like noise exposure. Among others, tinnitus can be related to a physical problem in any part of our hearing system: cerumen in the outer ear, fluid or pressure in the middle ear, or damage to the cells in the inner ear to name a few. Certain medications are particularly worth mentioning, such as quinine, loop diuretics, anti-inflammatory medication, as well as antibiotics. For a list of Ototoxic medications that can increase perception of tinnitus symptoms, visit our page on Ototoxicity. There are also external factors that can be controlled, like nutrition or noise exposure. Finally, your psychological state can affect tinnitus. Anxiety, stress, sleep deprivation and other emotional responses can exacerbate tinnitus symptoms. There is no miracle cure for tinnitus, however there are certain solutions available such as hearing aids or sound therapy which have the ability to reduce the perception of tinnitus.

What is Tinnitus Associated With?

  • Cognitive function: Tinnitus can be present along with cognitive strain. When attention is focused on tinnitus, concentration is difficult as cognitive resources are taxed.
  • Sleep deprivation: Tinnitus can be present along with difficulty in sleep initiation (falling asleep), maintenance (staying asleep), or quality of sleep.
  • Mental health: Tinnitus is also associated with Post Traumatic Stress Disorder (PTSD), depression and anxiety.
  • Hyperacusis: Tinnitus can be associated with this experience of inordinate loudness that others tolerate well, which means that sounds that are comfortable to others can seem loud and uncomfortable to you. It can cause distress and intolerance to sound. Sound is usually better tolerated when the listener is in control of it.
  • Autophony: Along with tinnitus, some people experience autophony, which means your own voice sounds loud and hollow. This can be caused by middle ear dysfunctions, such as Eustachian tube dysfunction (chronically open) or Semi-circular canal dehiscence (SCD).

Tinnitus can also be associated with other disorders or illnesses, including migraines, fibromyalgia, brain injuries, and Lyme disease.

Symptom Management Options

Consulting your family doctor or an Audiologist about your tinnitus is the first step to gaining insight on symptom treatment options available. Each person may have a different management technique that works for their tinnitus. Tinnitus is extremely unique to each individual therefore their course of treatment may differ widely from other individuals suffering from tinnitus. 

Maskers: Maskers are table-top noise generators, typically white noise or pink noise (like the sound of a fan), but can also use other nature or musical sounds. It shows short-term benefits, but not as pronounced in the long term as other methods. Most hearing aids now have maskers incorporated into them.

Hearing Aids: 2/3 of individuals will feel relief from their tinnitus by simply correcting their hearing (should they have any hearing loss). With hearing aids alone, 43% of people noticed a decrease, 35% reported suppression, and 22% noticed no change at all while wearing their hearing aids.

Sound-based therapies: These therapies address the fact that the brain gives priority status to tinnitus because it thinks it is meaningful. Their goal is to change that, with the use of masking or sound generators, often combined with hearing aids and counselling. They are long-term involvements, and results are variable between people.

    • Notching sound therapies: A masking sound or music based on the frequency of the tinnitus is used. Tinnitus reported to be reduced for most participants by about 15% after 6 months, 25-30% after 12 months.
    • Sound Options: Music based on the individual type and frequency of the tinnitus is used. Tinnitus is reduced for most participants by an average of 40% after 3 to 6 months.
    • Tinnitus Retraining Therapy: Combines the use of masking, hearing aids, and counselling. Most participants report between 20 to 50% reduction in tinnitus over 18 months.
    • Acoustic Coordinated Reset Neuromodulation: Induces dys-synchrony of neural activity using frequencies above and below tinnitus frequency. Results are not well documented.

Physiotherapy: When tinnitus is caused by cranio-cervical issues, physiotherapy is worth considering. If you notice your tinnitus is affected by neck or jaw movements, inquire about local options.

Medications or alternative solutions: Presently, there are NO medications, supplements or natural remedies that were scientifically proven to be effective for treating tinnitus (including ginkgo biloba, magnesium or antioxidants). Acupuncture has also not been proven effective to directly treat tinnitus.

Hearing protection: Some people find noise aggravates their tinnitus. Be wary of the overuse of hearing protection as they can increase hyperacusis. Remember that discomfort is not necessarily equal to damage. If hearing protection gives you a sense of control and relief, opt for an electronic hearing protection, which offers mild amplification with loud sound attenuation.

Available Resources:

Hearing aids & Maskers

  • Most hearing aids are now available with built-in maskers (sound generators) that are useful if you are combining hearing aids with a sound-based therapy. Feel free to book an appointment at any of our locations for an assessment and consultation.

Hearing protection

  • Hearing protection that is custom-built to your ear can be provided by most hearing aid clinics.

Sound-based therapies

  • Sound-based therapies are commonly offered by audiologists, but are not very accessible in our area due to a lack of trained professionals offering this service.

Physiotherapy

  • Head, Neck and Jaw Physiotherapy (1335 Carling Avenue, Ottawa 613-798-0004)

Relaxation

  • We have many service providers in our area who can inform you and guide you through different relaxation techniques, such as:
    • Meditation (sessions and classes are offered in many centers in the Ottawa area)
    • Yoga (local gyms and yoga centers offer guided group sessions)
    • Massage therapy (spas, physio centers and beauty salons often have massage therapists on staff)
    • Spa experience (Ottawa/Gatineau offers retreats, wellness centers and Scandinavian-style spas)

Sleep hygiene

  • www.sleepfoundation.org
  • Sleep consultants at Good Night Sleepsite (613-857-9119)
  • Testing and workshops from Sleep Efficiency (613-852-8324)

Readings

  • The tinnitus treatment toolbox: a guide for people with ear noise by J.L. Mayes
  • Living with Tinnitus & Hyperacusis by Laurence McKenna, David M. Baguley and Don J. McFerran
  • Tinnitus: A Self-Management Guide for the Ringing in Your Ears by Jane L. Henry and Peter H. Wilson
  • Tinnitus: A Storm Within by Elizabeth Marie Kobe

Apps (can be found in Apple App Store or Google Play Store)

  • Widex Zen Tinnitus Management (masking) APPLE and ANDROID
  • Tinnitus Therapy by Sound Oasis (masking) ANDROID only
  • Whist Tinnitus Relief (masking/matching) APPLE and ANDROID
  • Tinnitus Therapy Tunes (notched music) ANDROID only
  • AudioNotch (notched masking) APPLE – app is free but membership required
  • Tonal Tinnitus Therapy (acoustic neuromodulation) ANDROID only

Oher online resources

www.mindfultinnitusrelief.com (8-week tinnitus meditation course based on teachings of Dr. Jon Kabat-Zinn)

References:

1. Stevens et al., 2007
2. Andersson et al., 1999
3. Baguley et al., 2012; Anari et al., 1990
4. Henry et al., 2006
5. Kockin et al., 2011
6. Jastreboff, 2000; Tavora-Vieira & Miller, 2011
7. Zetterqvist et al., 2011; Henry et al., 2006; Herraiz et al., 2005
8. Hoare et al., 2014
9. Zenner et al., 2017
10. Gold et al., 2003

*Please note: Davidson Hearing Aid Centres is not affiliated with any product, person or service mentioned in this document. We are not liable for any consequence, expense or experience that result from your contact with any of these. This document is for information purposes only. It is not a recommendation based on your specific needs.