Tinnitus is a noise heard in the ears or in the head which is not related to any external source. It is often more noticeable in quiet surroundings when there is an absence of competing sounds.
Tinnitus may affect up to 20% of the population during the course of their lives with no serious consequences. A smaller percentage will experience ongoing distressing tinnitus which may require professional intervention.
Tinnitus is mostly but not always the symptom of an ear disorder. Untreated tinnitus may become chronic and cause life disruptions such as sleep disorders, social withdrawals and impact on work and family relationships.
Conditions Associated with Tinnitus
Hearing Loss is present in up to 90% of people with tinnitus. In fact, tinnitus may be the first symptom of a hearing loss. In some cases the loss of hearing may be very mild and not noticeable in everyday situations. However, any hearing loss, no matter how mild, will always cause some effort into hearing. The greater the effort into hearing the more the tinnitus is perceived. As a general rule, the worse the hearing the louder the tinnitus is noticed.
Acoustic Shock Injury is a physiological trauma to the ear caused by an episode of direct exposure to extremely loud sound which may lead to TTTS.
TTTS (tonic tensor tympani syndrome) is a spasm like activity of the tensor tympani muscle in the middle ear. This spasm may cause a series of physiological symptoms such as fluttering of the ear drum, a sensation of heat, pain, blockage and fullness in the ear and sometimes dizziness. Tinnitus and hyperacusis may also be associated (Westcott et al, 2013).
Hyperacusis is a hypersensitivity to every day sounds which may be perceived as painfully loud. In extreme cases it may lead to complete social isolation to avoid any contact with sounds. Hyperacusis may present as a single entity not associated with any other hearing symptom.
Misophonia is an abnormal sensitivity to selected sounds which cause an irrational reaction of annoyance, disgust and anger. It may also lead to social isolation to avoid exposure to sounds that may trigger the symptoms. Misophonia may also be an isolated condition but it is mostly associated with other psychological disorders such as anxiety and obsessive compulsive behaviour.
Management of Tinnitus, Hyperacusis and Misophonia
Our clinicians have extensive experience and are internationally recognised as experts in tinnitus and related hearing disorders. The first step of treatment is to diagnose the possible cause using a comprehensive history and audiological test battery. Following audiological evaluation you may be referred to one of our ENT specialists to diagnose and treat any suspected ear disease. Imaging tests such as CT-scans or MRI may be recommended to unravel a pathological cause. After medical intervention, if distress still persists, you will be referred to our management program with our audiologists and counsellor.
Hearing Aids are the most effective form of tinnitus treatment when in the presence of a hearing loss. Research shows that hearing aids completely abolish tinnitus perception for the majority of patients providing the tinnitus pitch is within the frequency response of the hearing aid (McNeill et al 2013). Prescription of hearing aids is based on individual’s hearing and tinnitus profile as determined by audiological tests.
Cochlear implant is an effective option when hearing aids cannot be of assistance due to a very severe hearing loss.
Sound desensitisation is an important part of treatment when dealing with hyperacusis, TTTS and misophonia.
Music based therapy and noise generators are useful tools in the desensitisation process. Appropriate music genre and tempo must be selected for optimal therapeutic results.
Some hearing aids also have an in-built music and or noise generator which are programmed by the audiologist according to the levels of hearing and characteristics of tinnitus.
Smart phones, MP3 players and tablets also offer a range of useful apps which may assist in the treatment.
Our audiologists will recommend the best option for your needs based on audiological test results.
Celene McNeill, Dayse Távora-Vieira, Fadwa Alnafjan, Grant D. Searchfield, David Welch (2013) Tinnitus pitch, masking, and the effectiveness of hearing aids for tinnitus therapy. IJA Vol. 5:12, 914-919
Westcott M, Ganz Sanchez T, Diges I, Saba, Dineen R, McNeill C, Chiam, A,O’Keefe M, Sharples T. (2013) Tonic Tensor Tympani Syndrome (TTTS) in Tinnitus and Hyperacusis Patients: A Multi-Clinic Prevalence Study.Noise & Health. Vol 15:63, 117-128