INTRODUCTION

What is tinnitus?

It’s an odd word and an old one.  Latin.  It comes from the word tinnire, to ring.  In the United States the name is pronounced tin-I-tus; in other English speaking countries we hear TIN-i-tus.  Either pronunciation is correct. 

Tinnitus is a broad group of sensations that are caused by anomalous neural activity in the brain that is not elicited by sound activation of the sensors in the inner ear. The patient perceives the sound to be located in the ear or inside the head.  Some call it the ‘auditory phantom’ for its ghost like nature, present but not created by any real, identifiable source; it is sensed somewhere in the ears or in the head.  The experience of it has been compared to chronic pain for its debilitating and distressing effects.  Patients describe it in many ways: ringing, buzzing, hissing like gas escaping from a Bunsen burner, clanging, roaring, screeching, singing like a field of beetles.  A few patients report snatches of music in between the other sounds.

Patients experience these sounds, of whatever description, as very disturbing.   They experience a range of feelings in response to it: fear, anxiety, frustration,

Who gets tinnitus?

Tinnitus is common and it occurs in all age groups, even young children.  Many of us experience the sensation of a high-pitched ringing in our ears when we have a hot shower, after we have been for a run or to a gym session.  But this does not last more than a few seconds or minutes.  When people have the experience of tinnitus for more than 6 months Audiologists refer to this as ‘chronic tinnitus’ and offer interventions to manage the distress it causes the patient.

How many people in the population have tinnitus?

Tinnitus is one of the commonest somatic symptoms affecting humanity and the estimates are that around 10 to 15% of the population has tinnitus. 

Of these half will have effects that alter their quality of life to the extent that their sleep is disturbed; they become anxious and/or depressed about the symptom; they have difficulty concentrating and focusing on even small, seemingly unimportant tasks. A key aspect is that they spend hours in a never-ending spiral ruminating about tinnitus and checking to see whether it is still present and how loud it is ‘today’.  About 3% have tinnitus that completely disrupts their life.

About a quarter will seek medical help from a General Practitioner first and then an ENT surgeon or the latter professional directly.  Unfortunately this is where patients are given the message that ‘nothing can be done; there is no cure for tinnitus’.  Giving a negative prognosis is actively harmful since this tends to focus the patients’ attention on the tinnitus and exacerbate the patients’ distress.  Audiologists who have a special interest in tinnitus and its holistic management are skilled in the tools, techniques and strategies to help patients manage tinnitus well.

Key points:

  • Tinnitus is a symptom and must be considered in the context of hearing loss and other audiological or neurological symptoms.
  • Tinnitus usually co-occurs with a hearing loss that may not be evident at the time of first assessment since only the ultra-high frequencies may be involved; this is especially the case if tinnitus follows noise exposure such as a live concert performance with floor mounted speakers or a soccer match where vuvuzelas are plentiful.
  • Underlying pathology is rare but Audiologists will want to exclude medical conditions such as Meniere’s Disease, otosclerosis, or a vestibular Schwannoma.  If tinnitus has a pulsatile quality or is unilateral and of sudden onset, then an Audiologist will always refer the patient to a doctor.