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Changing Lives Through Better Hearing


Tinnitus: Perception of sound in the absence of external sound.

Hyperacusis: Abnormal sound sensitivity.

What is tinnitus?

Tinnitus (pronounced tin-night-us or tin-nit-us) is not a disease; it is a symptom. It can be a hissing, ringing, roaring, whistling, or any other sound in your ears or head. Tinnitus is real, not imaginary.

If you can relate to this, you are not alone. About 50 million Americans, or 15% of the population, experience tinnitus to the extent that it significantly affects their lives. It interfers with sleep, work or social interaction and 2 million Americans are disabled from it. Patients often report feeling anxious with no escape from this “unending noise.”

What causes tinnitus?

Currently, most causes of tinnitus are unknown. Tinnitus has been linked to the following:

  • Conditions of the Ear Canal, which include impacted ear wax and/or foreign substances
  • Conditions of the Middle Ear, which include infection, allergies, Eustachian tube dysfunction, muscle spasms, benign tumors, and vascular tumors
  • Conditions of the Inner Ear, which include sensorineural (nerve) hearing loss, noise exposure, and certain ear diseases such an Meniere's disease.
  • Medications such as aspirin, ibuprofen, quinine, sedatives, and antidepressants can cause tinnitus that is usually temporary and subsides when the medication is stopped. Medications such as antibiotics and chemotherapy can cause tinnitus that can be permanent.
  • General Health issues, such as high blood pressure, thyroid dysfunction, diabetes, and hormonal changes and/or imbalances
  • Physical problems such as neck and temporal mandibular joint (TMJ) disorders and trauma to the head and neck

How do I find out possible causes?

Audiologists specialize in:

  • Complete, comprehensive hearing evaluation that includes a tinnitus assessment (pitch and loudness match plus maskability)
  • Evaluation of the tinnitus severity and its impact on daily living
  • Tinnitus and hearing loss education
  • Audiologic rehabilitation (hearing aids, maskers, sound machines, etc.)
  • Tinnitus retraining and habituation therapies

What are some specific treatments for tinnitus?

Unfortunately, in many cases the cause of tinnitus cannot be identified. In these cases, the tinnitus or the reaction to tinnitus may need to be the focus of treatment.

  • Medications do not make tinnitus disappear. However, it has been found that certain medications such as antidepressants and anti-anxiety medications may address some of the issues associated with tinnitus. Of course, this recommendation must be made and monitored by a physician.
  • Tinnitus retraining and habituation actually incorporates counseling and sound therapy. The sound therapy consists of wearing devices that look like hearing aids and that emit soft broadband noise so the brain hears both the noise and the tinnitus. Extensive counseling and education are integrated into the therapy, with the goal of retraining the brain to de-emphasize the importance of the tinnitus. This can take up to one year.
  • Hearing aids provide some of the most effective treatment for tinnitus. Since about 90% of those with tinnitus have hearing loss, this is one of the most recommended treatments. Tinnitus itself is a very “small” sound, averaging 5.7dB, and it often is reduced or completely masked by the amplification of a hearing aid.
    • Masking or “covering up” the tinnitus by introducing an outside sound source can be accomplished in a number of ways.
    • Tinnitus maskers — instruments that look like a hearing aid but are really sound generators that produce noise, often a white noise.
    • Tinnitus maskers and hearing aids — hearing aids that add a sound generator to the device when the hearing aid is not enough to mask the tinnitus. Often there are two volume controls, one for the hearing aid and one for the masker.
    • Sound generators — relaxation devices that produce various types of sounds that are pleasing to the listener and mask the tinnitus, These often are used to enhance sleep and relaxation.
    • Televisions, radios, and fans — these often are used as maskers and can be helpful if the tinnitus is affecting sleep.
  • Counseling may include various techniques that help patients reduce their focus on or attention to the tinnitus. Forms of therapeutic management may include biofeedback, hypnosis, relaxation therapy, habituation therapies, and stress management.

Why see a TPA audiologist for tinnitus care?

The Tinnitus Practitioners Association (TPA) awards the Certificate of Competency in Tinnitus and Hyperacusis Care to audiologists who have demonstrated exceptional knowledge and skill in the evaluation and management of the tinnitus and hyperacusis patient. Dr. Rebecca Rich is a certified Audiologist with the Tinnitus Practitioners Association (TPA).