Managing Tinnitus

Managing Tinnitus: What’s All The Noise in My Head?

Dr. Rex Banks, Doctor of Audiology, Chief Audiologist and Director of Audiology, Canadian Hearing Society

Rex Banks
Rex Banks, Au.D

Most people would be surprised to learn that there is an internal alarm system located within their brain that is constantly monitoring the world around them. Basically, our central nervous system is idling in a state of readiness to respond to any type of "red alert" it may encounter. This idling causes "brain noise" that runs in the background. The majority of us are completely unaware of this brain noise until something triggers it to cross a threshold to become audible to some in the form of what’s called tinnitus.

Tinnitus is an auditory perception of a sound in the in the ear that can only be heard by the person experiencing it. Each person who has tinnitus describes it in their own way. Many people report that it sounds like a ringing, buzzing, humming, clicking, whistling or roaring. It can be loud or soft, constant or intermittent, can change in pitch, and be heard in one or both ears. About 15% of the population experiences tinnitus with 5% reporting severely intrusive tinnitus that affects their day-to-day activities.

It’s important to understand tinnitus itself is not a disease, but a symptom. It’s your body’s internal alarm system going off and telling you that something is not quite right. Tinnitus can be caused by a number of health conditions including high blood pressure, head trauma, dental problems, certain types of tumours, hearing loss and much more. Your ears are always working but relax when they find a soothing background sound to listen to. They are geared to naturally want to listen to sound and are always scanning the environment for it. For people with hearing loss, the amount of environmental sound they are exposed to is reduced. This causes their ears to strain to hear what’s around them and all of this straining increases their sensitivity to their internal brain noise which manifests as tinnitus.

So if you do have tinnitus, you should avoid silence as it only intensifies your sensitivity to your internal brain noise. For this reason, hearing aids are often recommended as a front line defence against tinnitus because hearing aids expose people with hearing loss to sound. For those who experience tinnitus but don't have hearing loss, custom ear sound generators may be recommended. In a nutshell, external sound decreases your sensitivity to internal sound.

Tinnitus can also be managed with the implementation of Tinnitus Retraining Therapy (TRT). Developed in 1990 by neurologist Dr Pawel Jastreboff, and audiologist Jonathan Hazell, TRT is the gold standard for tinnitus treatment. For those individuals whose tinnitus has become a significant annoyance, a systematic approach to "habituate" to their condition can be delivered through TRT. To understand how TRT works, it is important to understand tinnitus in greater detail. Tinnitus can be divided into two components.

The first component is the auditory component, or the perception of the tinnitus (arises from the inner ear and auditory centres in the brain).

The second component is the non-auditory component, and this refers to the ‘bothersome’ nature of tinnitus. This non-auditory component arises from the limbic system (the emotional centre of the brain) and the autonomic nervous system (the brain’s ‘alert system’ designed to give the message to the individual of ‘fight’ or ‘flee’ from a dangerous situation). When the limbic system is activated by the tinnitus, the person may feel a sense of extreme discomfort or panic.

TRT can help a person ‘habituate’ to their tinnitus. To ‘habituate’ to something means to grow accustomed to it. To habituate to tinnitus means to reach a state of mind where there is no longer a negative emotional response to the tinnitus. Tinnitus Retraining Therapy is delivered by Audiologists, who have received specialised training in this therapeutic model. TRT includes:

1. Directive Counselling 
Intensive client education about the auditory mechanism and the role of the brain plays in tinnitus perception. With education, the tinnitus will be demystified. This will help reduce distress and anxiety about the tinnitus.

2. Sound Therapy 
Use of ear level or table-top sound generators and/or hearing aids to provide continuous stimulation of the auditory system to interfere with the perception of tinnitus. This would also include the use of environmental sounds. This will also help reduce distress and anxiety about the tinnitus.

3. Time 
It takes time for the brain to habituate to the perception of tinnitus. Most clients report a noticeable improvement is as little as 6-8 weeks. The duration of the TRT program can last between 16 – 24 months.

Regardless of the cause of the tinnitus, with or without hearings loss, the success rate of TRT is 80%. This is the highest success rate of any treatment or therapy currently available. The effects of TRT are long lasting, and there are no side effects.

If you have difficulty understanding speech or following a conversation in background noise if sounds seem muffled or you are suffering from tinnitus – you are probably experiencing hearing loss. Make an appointment with an audiologist to get your hearing checked and get advice on how to manage your hearing loss and how to prevent more from occurring. Whether you need a hearing aid, assistive listening device, tinnitus therapy or strategies for communication, an audiologist can help you get reconnected to the world around you.