What is Tinnitus?

Tinnitus is a “disturbing” noise that a person hears without it actually existing.

All about Tinnitus

They can be whistling, buzzing or clicking noises, for example. It can be heard in one or both ears, but it can also seem to be present inside the head, either in the front or the back. Tinnitus can be occasional, intermittent or continuous. It results from a dysfunction of the auditory nervous system. It is a symptom that can have many causes.

Temporary tinnitus can occur after exposure to very loud music, for example. It usually resolves without intervention.

This sheet focuses on chronic tinnitus, i.e. tinnitus that persists and can become extremely annoying to sufferers. However, in the vast majority of cases, tinnitus does not have a significant impact on quality of life.

Symptoms of tinnitus

There is a long list of types of noise heard by people with tinnitus. It seems that the most frequently mentioned noise is whistling, but patients also name the following sounds:

• pulsing ;
• clicking;
• buzzing; ;
• hissing;
• tinkling sounds;
• humming; buzzing;
• rustling ;
  etc.

Depending on the cause, tinnitus may be accompanied by hearing loss, nausea, drowsiness, dizziness, pain or a persistent feeling of having a plug in the ears.

Many sufferers also experience intolerance to loud noises or have loud or painful perception of sounds perceived as normal or soft by healthy people. This condition is called hyperacusis.

Tinnitus is usually less annoying during the day because it is “masked” by other noises in the workplace or home. However, it is more noticeable in the evening and can cause sleep disturbances for many people.

The different types of Tinnitus

There are 2 main categories of tinnitus.

• Objective tinnitus
  Some of these can be heard by the doctor or specialist consulted, as they are caused by disorders that, for example, make the blood flow more audible. They can also sometimes be manifested by repeated “clicks”, sometimes related to abnormal movements of the ear muscles, which can be heard by those around. They are rare, but usually the cause can be identified and the patient can be intervened and treated.
• Subjective tinnitus
  Subjective tinnitus is when the sound is audible only to the person affected. This is the most common form of tinnitus, accounting for 95% of cases. The causes and physiological symptoms of subjective tinnitus are not yet well understood and are therefore much more difficult to treat than objective tinnitus. However, it is possible to improve the patient’s tolerance to these internal noises.

The intensity of tinnitus varies from person to person. Some people have little tinnitus and do not seek help. Others hear noises all the time, which can affect their quality of life.

Note: if voices or music are heard, this is another disorder, called auditory hallucination.

Prevalence of Tinnitus

In general, it is estimated that 10% to 18% of the population suffers from tinnitus. The proportion is 30% in adults. Between 1% and 2% of the population is severely affected.

The widespread use of personal stereos and MP3 players among young people leads to fears that the prevalence will increase in the medium term.

Causes of Tinnitus

Hearing tinnitus is not a disease in itself. Rather, it is a symptom that is very often linked to hearing loss. One hypothesis is that it is a “phantom signal” generated by the brain in response to damage to the cells of the inner ear. Another hypothesis is that the central auditory system is dysfunctional. Genetic factors may be involved in some cases.

The most common factors associated with the onset of tinnitus are:

• in adults, excessive exposure to noise;
• in older people, hearing loss due to ageing.

Other possible causes include:

• an injury to the head (such as a head injury) or neck (whiplash, etc.);
• long-term use of certain medications that can damage the cells of the inner ear (see Risk factors section);
• spasm of a small muscle in the inner ear (stapedial muscle);
• blockage of the ear canal by an earwax plug.

Some diseases can also cause tinnitus:

• Otosclerosis, a disease that reduces the mobility of a small bone in the middle ear (the stapes) and can cause progressive deafness (see diagram);
• Meniere’s disease and sometimes Paget’s disease;
• ear or sinus infections (e.g. recurrent ear infections);
• a tumour in the head, neck or on the auditory nerve;
• misalignment of the temporomandibular joint (which allows jaw movement);
• diseases affecting the blood vessels; these can cause so-called pulsatile tinnitus (about 3% of cases).

These diseases, such as atherosclerosis, hypertension or abnormalities of the capillaries, carotid artery or jugular vein, can make the blood flow more audible. This tinnitus is of the objective type: objective non-pulsatile tinnitus may be caused by an abnormality of the eustachian tube, by neurological disorders or by abnormal contractions of the muscles of the throat or middle ear.

Course and possible complications

Some tinnitus occurs very gradually: before becoming permanent, it is heard intermittently and only in quiet places. Others appear suddenly, following a particular event, such as a sound trauma.

Tinnitus is not dangerous, but when it is intense and continuous, it can become very disturbing. In addition to causing insomnia, irritability and concentration problems, it is sometimes associated with depression.

Tinnitus Treatments

Treatment of the condition can reduce the tinnitus. Correcting the hearing loss (e.g. with a hearing aid) relieves tinnitus in up to 50% of patients.

Stress and other psychological factors (e.g. depression) can exacerbate symptoms, so efforts to recognise and treat these factors can lead to improvement. Many patients are reassured that their tinnitus is not a serious medical problem. Tinnitus can also be made worse by caffeine and other stimulants, so patients should try to stop taking these substances.

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Although no specific medical or surgical treatment is available, many patients are relieved by background noise that masks the tinnitus and allows them to fall asleep. Some patients benefit from a tinnitus masker, a device worn as an external hearing aid that emits a low tone that can suppress the tinnitus. Guided habituation tinnitus treatment, offered by specialised tinnitus treatment programmes, is useful for some patients. Electrical stimulation of the inner ear, e.g. by a cochlear implant, can reduce tinnitus but is only indicated in cases of profound deafness.

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