Tinnitus is an experience lived by millions of people who hear a constant noise “in their head” in the absence of an identifiable external sound source and nothing seems to be able to reduce these extremely disturbing noises. For anyone who suffers from tinnitus and wants to reduce their disturbance, it is first imperative to understand the facts and not the myths about their symptoms.
TINNITUS FAQ
Tinnitus is not a disease but rather a symptom. Tinnitus is the perception of a sound in the ears or head and is not connected in any way to the presence of external sound stimulation to the person. It is a sound that is present in one or two ears or even in the head and that lasts more than 5 minutes and occurs more than once a week. A sudden transient sound in the ear or in the head that fades within 1 minute is not a tinnitus. If it sounds in your head for a duration of more than 6 months, it can be said that it is a chronic or permanent tinnitus.
Hyperacusis is an increased or exaggerated sensitivity to sounds compared to the norm. Sometimes the hearing of affected people is normal, but their degree of tolerance is weakened compared to someone with good hearing. Although it can present itself, hyperacusis accompanies nearly half of patients who suffer from tinnitus. The origin of this pathology is not yet known. However, it seems that the hyperacusis is due to disturbance in the auditory system.
For the majority of cases, an underlying hearing loss is the source of tinnitus. Because of hearing loss, the brain receives less auditory stimulation (heard sounds) from the ear. To respond to this lack of external stimulation, the brain increases the volume of certain tones (example: high-pitched sound) to compensate for this lack of auditory stimulation. The brain thus translates this hyperactivity into a “ghost” sound, which is called tinnitus.
The answer to this question is in the brain. First of all, it is important to understand that your brain is divided into several areas as a puzzle. All these areas are interconnected by connections such as electrical cables and each provides a particular function. The auditory area, responsible for hearing and other areas of the brain are connected to two main systems:
1) The autonomic nervous system which regulates all the automatic functions of the body such as heart rate, respiration and digestion.
2 )The emotional system that is responsible for creating and regulating emotions as well as behaviours. For example, when you feel hunger, thirst, fear, or joy, this is due to your limbic (emotional) system.
The emotional system and the autonomic nervous system are the dominant and responsible systems for the development of the disturbance caused by tinnitus. When you have tinnitus, the emotional system and the autonomic nervous system are activated using two ways:
1) The upper path that involves the conscious areas of the brain and is responsible for perception, analysis, evaluation, verbalization and fear. This is an important pathway in the initial phase of tinnitus, so when the person begins to become aware of his/her tinnitus.
2) The lower pathway involves the unconscious areas of the brain and is responsible for the emotions and automatic behaviours. This is an important loop in the chronic phase of tinnitus, so when the person begins to be disturbed by his/her tinnitus.
The two pathways will therefore activate the autonomic nervous system, the negative reactions and the patient’s disruption to his/her tinnitus. Tinnitus itself is not dangerous and does not cause any harm. The problem comes when tinnitus is associated with negative thinking, such as thinking tinnitus is an important disease or you’re going to become deaf, or when you say there’s nothing you can do. These negative thoughts reinforce the connection between tinnitus, the emotional system and the autonomic nervous system. They therefore produce a strong reaction in these systems, which makes your tinnitus become disturbing. So, if tinnitus is disturbing, it is not only due to an injury in the auditory system, but rather to the strength of the nerve connections between the emotional system and the autonomic nervous system. Conversely, people who do not complain about tinnitus do not have this strong connection between the limbic system and the autonomic nervous system.
No. Tinnitus is often a good indicator of hearing loss, but that does not mean that the patient is becoming deaf. Tinnitus does not cause hearing loss; however, both often occur at the same time.
The audiologists at ODYO offer tinnitus treatment and counselling solutions that are adaptable to your specific needs. All of our treatments are based on Tinnitus Retraining Therapy (TRT) and Cognitive-Behavioural Therapy (CBT). TRT and CBT are therapies that have the most robust scientific proof for the treatment of tinnitus.
To know if this therapy is appropriate to relieve your tinnitus symptoms,
a comprehensive tinnitus evaluation must be performed by an audiologist.
It is your first step towards tinnitus relief.
TINNITUS TREATMENT FAQ
A tinnitus masker is a product that emits predetermined sounds to the ear of the patient with tinnitus. The sounds emitted by these masks can be noises, pure sounds, sounds of nature or music. Generally, sounds that the patient feels are more pleasant than the sound of his/her tinnitus. Tinnitus masks can be worn in the ear just like a hearing aid or take the form of loudspeakers. Although sporadic listening to these tones to mask tinnitus is not a therapy, targeted listening to these sounds in combination with adequate professional counselling can lead to effective therapeutic results in reducing the disturbance caused by tinnitus.
Amplification with the hearing aid can relieve some forms of tinnitus, especially neurosensory hearing loss related to exposure, noise, or age. If the patient has a hearing loss identified between 250 Hz and 8,000 Hz and tinnitus sounds are found in the same range, the use of the hearing aid can be very beneficial. In addition to amplifying speech sounds and improving speech intelligibility, the hearing aid allows the patient to hear environmental noise instead of tinnitus sounds. Thus, these devices enrich the sound environment of the patient and help him/her hear other pleasant sounds rather than being disturbed by his/her tinnitus. To maximize the benefits obtained with the hearing aid, complementary professional counseling is often recommended to achieve effective therapeutic results in reducing the disturbance caused by tinnitus.
Tinnitus Retraining Therapy (TRT) is a tinnitus therapy program designed to train the brain to become accustomed to tinnitus. This therapy combines directive counseling and sound therapy. The patient wears noise generators that emit constant white noise to the ear. Although the therapeutic process of TRT is long (18 to 24 months), nearly 80% of people who complete this program get effective results in reducing the disruption caused by tinnitus.
A practical tool with robust scientific evidence for reducing the disturbance caused by tinnitus. Cognitive-Behavioral Therapy (CBT) is a goal-oriented therapy that reduces the emotional responsiveness associated with tinnitus. CBT is often perceived as a kind of physical training for the brain. Patients who follow CBT will be led to focus on something other than tinnitus and motivate courageous actions to regain a normal lifestyle. This therapy requires patient engagement to achieve positive results after a few months of training. Cognitive-Behavioral Therapy can be administered in the form of individual meetings between the professional and the patient or in groups led by the professional.
Biofeedback is a relaxation therapy that aims to teach the patient to control his/her reactivity to stress and anxiety. This brain training therapy is based on the observation that an individual can learn to change their responsiveness through feedback. By using electroencephalograms (EEG), biofeedback can see in real time the electrical changes produced by the brain following emotional reactions. Biofeedback is administered as one-to-one clinical sessions lasting 45 minutes to 1 hour each. To complete the whole biofeedback training program, a patient may need 10 to 20 weekly sessions.
RTMS is a technique where certain regions of the brain are stimulated through the scalp to treat tinnitus. This therapy has been shown to be especially effective for patients suffering from depression and it is commonly used for patients with tinnitus or schizophrenia. The perception of tinnitus is associated with overactivity in the central auditory pathways. This procedure involves applying a magnetic pulse to the brain through the skull by placing a coil on the surface of the head. The rTMS is administered as one-to-one clinical sessions lasting from 30 minutes to 45 minutes each. To complete a therapy with rTMS, a patient may need 10 to 20 weekly sessions.
This type of therapy uses a personal listening system (Mp3 player) with headphones that deliver sounds or targeted music to treat tinnitus. These sounds are tailor-made for everyone based on his/her audiological profile (hearing loss) to stimulate the auditory pathways to promote the reorganization of brain connections based on the finding that the brain can reorganize due to brain plasticity. After a daily stimulation for a period of a few months, the new connections help the brain to ignore the disturbance caused by tinnitus. Although this therapy is beneficial for some individuals, complementary professional counseling is often recommended to achieve effective therapeutic results in reducing the disturbance caused by tinnitus.
To treat tinnitus caused by temporomandibular joint dysfunction, or cervical disorders, follow-up with a physiotherapist, osteopath or dentist may be beneficial.
Following the audiological evaluation and when deemed necessary, patients who suffer from tinnitus will be able to follow up with an Otorhinolaryngologist (ENT). The medical specialist will be able to confirm a diagnosis of the middle ear, internal or upper auditory pathways. If in doubt, the doctor may request a magnetic resonance imaging (MRI) to confirm a diagnosis. Finally, when possible, the ENT physician can perform surgeries or recommend medication to repair some of the ear functions that may be related to tinnitus.
For tinnitus of ototoxic, neurological, vascular or respiratory origin, follow-up with your family doctor and / or specialist physician may be recommended.
Some patients have achieved relief from their tinnitus through therapies such as hypnosis, acupuncture, chiropractic and other natural treatments. Although these therapies may cause the patient to relax and thereby reduce anxiety and stress, their effectiveness in treating tinnitus is inconclusive.
TINNITUS EVALUATION FAQ
When evaluating tinnitus, the audiologist aims to identify the main cause of your symptoms. Tinnitus is an individual experience, unique to each person. In order to be able to offer you an effective treatment for your tinnitus, the audiologist must identify the lesion site (s) in your hearing system to recommend the best solution for your situation. Among the causes of tinnitus that the audiologist aims to identify, we find:
Tinnitus can be caused by one or more hearing, psychological or somatic (bodily) dysfunctions. Following the targeted evaluation of your medical history, hearing and psychological health, the audiologist will be able to position himself on the possible cause of your tinnitus and will determine with you the treatment plan for your symptoms. Among the recommendations that the audiologist can offer you, we find:
1. Case History Questionnaire The first step in this evaluation is a case history questionnaire about your hearing and medical health. Among the questions that await you at this stage of the evaluation: Do you make your interlocutors repeat? Do you have earaches? Have you had ear surgery in the past? Have you been exposed to loud noises at work or elsewhere? Is there a family history of hearing loss? Do you take medication? At this evaluation stage, the questions allow the audiologist to identify some of the risk factors and possible causes of your tinnitus.
2. Questionnaires of disabilities and disturbances caused by tinnitus these questionnaires help determine how much distress you are because of your tinnitus. They also help to assess the disabilities that your symptoms cause in your daily life. Moreover, this tool is very useful for evaluating the effectiveness of a given therapy when comparing the results to the questionnaires before and after the treatment.
3. Anxiety and depression questionnaires these questionnaires allow the audiologist to decide on the state of your psychological health and determine if you have anxiety and / or depression. Although tinnitus may be the source of your anxiety or depression, the opposite may also be true. Thus, in addition to your medical history and the results of the other tests administered, the audiologist can determine your need for the professional support required to manage your tinnitus.
4. Otoscopy The audiologist visualize your ear canals to identify for example a wax plug or a possible dysfunction of the middle ear.
5. Tonal audiometry from 250 Hz to 16,000 Hz tonal audiometry is an objective examination that assesses your hearing. Pure sounds will be presented to you to determine your threshold of hearing to sounds of different tones (frequencies). In case of a hearing loss, this test makes it possible to differentiate between a hyperacusis of neurosensory or conductive nature. Moreover, unlike a traditional auditory evaluation with an audiologist (up to 8,000 Hz), your hearing is evaluated up to 16,000 Hz. This evaluation of the pure high-frequency sounds makes it possible to check if a previously unidentified hearing loss is present.
6. Voice audiometry is a complementary examination to tonal audiometry. While tonal audiometry can identify only hearing, voice audiometry determines understanding and discrimination of speech. This test is very important for cases of hearing aids (hearing aids) and helps in the diagnosis of certain retro cochlear pathologies.
7. Evaluation of the psychoacoustic aspects of tinnitus Assessing the psychoacoustic aspects of your tinnitus is an important step in the exam. The audiologist will ask you questions about the timing of tinnitus, activities that amplify or muffle your symptoms and the characteristics of the sounds you hear. Then, the audiologist makes you hear different sounds to identify as much as possible the type (pure sounds vs noises), the tone (frequency) and the subjective intensity (volume) of the tinnitus that you suffer from. This pairing step of your tinnitus helps to make your symptoms “real”. Finally, the audiologist assesses the measurability of your tinnitus and seeks to determine the sounds and sounds of everyday life that most effectively dull your tinnitus. This evaluation step is part of the professional’s approach to propose a personalized treatment plan.
8. Tympanometry and stapedial reflexes these tests make it easier to diagnose diseases of the middle ear. In fact, these tests complement visualization of the external auditory canals and tonal audiometry to detect dysfunctions of the middle ear and the central auditory pathways attached to it.
9. Oto-emission-acoustics (OAS) In the case of a sensorineural hearing loss, this test allows the audiologist to determine if the hair cells of the cochlea are damaged. This may be useful in the professional’s approach to identify the origin of your tinnitus.
10. Tests for somatic tests the administration of this battery of somatic tests allows the audiologist to determine if the temporomandibular joint or cervical dysfunction could be the cause of your symptoms.
Warning! Did your auditory assessment include tone audiometry testing of high frequency sounds? Indeed, unlike a traditional auditory evaluation with an audiologist, tinnitus assessment evaluates your hearing acuity to pure sounds of 16,000 Hz instead of 8,000 Hz. This evaluation of pure high frequency sounds makes it possible to check whether a hearing loss that is previously unidentified is present in these very high-pitched sounds. Hearing loss in high frequencies can actually be the source of your symptoms.
It is possible to have tinnitus after taking medication. The drugs most likely to cause tinnitus are antibiotics, cardiac medications, antidepressants, diuretics and anti-inflammatories (ibuprofen, aspirin). The audiologist will evaluate with you the possibility that your symptoms are caused or amplified by an ototoxic drug. If so, you will be encouraged to discuss this with your doctor to consider other options. In addition, if you are currently suffering from tinnitus and your doctor prescribes a new medication, it is strongly suggested to know if the drug in question can cause tinnitus as a side effect.
A small percentage of tinnitus cases are caused by medical conditions.
Tumors in the auditory nerve, such as acoustic neuromas, in one or two ears compress the auditory nerve and cause tinnitus. People with migraines, multiple sclerosis or any other problems at the cervical level, can also develop tinnitus.
Meningitis, inflammation of the brain’s meninges due to a bacterial or viral infection can sometimes lead to tinnitus. Similarly, Meniere’s disease and labyrinthitis are two pathologies that cause vertigo and are accompanied by tinnitus.
It is called pulsatile tinnitus when its cause is of cardiac and vascular origin, it is perceived as a beat. The pulsation of tinnitus is in synchrony with the heartbeat. In addition, during a physical effort, the tinnitus pulsations increase in speed.
This type of tinnitus is of muscular origin. There is a small muscle in the ear that contracts in the presence of loud noise to protect your inner ear. The contractions of this muscle can cause some people tinnitus in the form of rattling that can be heard.
Respiratory tinnitus is often associated with a tubal open bite, that is, a problem with the closure of the eustachian tube. Often the person will complain about getting along. Following the assessment of tinnitus and if deemed necessary, the audiologist will refer you to the specialist doctors who will be able to follow the process of evaluation and treatment of your tinnitus.
Often, temporomandibular joint (TMJ) dysfunctions, which can manifest as pain, cracking, and jaw blockage, are associated with tinnitus. Following the somatic tests, if considered necessary, the audiologist will send you to the professionals who will be able to conclude the presence and the treatment of the dysfunctions related to the ATM.
About 75% of head injuries will cause damage to the ear, and as a result, tinnitus. This so-called somatic tinnitus is often present in one ear and is more disturbing in the morning. Tinnitus can be modulated by certain movements of the head or by squeezing your teeth. Depending on the severity of the case and the location of the injury, the audiologist may refer you to a doctor or physiotherapist.
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