Tinnitus means noises in the ears, heard when there are no physical noises in your environment. Tinnitus is normally associated with a hearing loss, which you may or not be aware of. Most people experience tinnitus at some point or other, e.g. after a loud concert. When you come to see me, I would ask you if you hear the tinnitus in one or both ears, get any spinning (vertigo), had loud noise exposure over prolonged periods of time, and if you have taken any medicines which might have affected your hearing or balance lately.
I would then examine your ears. At its simplest, tinnitus can be caused by wax blocking the ears. This causes deafness, and results in tinnitus. If I remove the wax, it might help eliminate the tinnitus. I would also check for any infection, perforation of the ear drum, and fluid behind the ear drum (glue ear).
The most basic investigation for tinnitus is a hearing test (audiogram), which is sometimes combined with a pressure test (tympanogram), to check the level of hearing and to see if there is any fluid behind the ear drum. The most accurate hearing tests are performed in a sound-proof booth in the hospital. In short, these tests check for the amount and type of deafness. The type of deafness could be a problem with the conduction of sound into the ear or could be related to wear and tear of the inner ear. The hearing test will also allow me to decide if you need a scan. Rarely, a one-sided tinnitus and hearing loss could be caused by a benign lump on the nerve of balance (vestibular schwannoma). This can be detected by an MRI scan of the inner ears (MRI IAMs).
One of the theories, of why tinnitus happens, is that the inner ears produce a natural electrical activity which goes along the nerves to the brain. Most people don’t hear this, because the ambient noises in their environment cover it up. However, if you have a hearing loss, you can’t hear the ambient noises in the environment to cover up the natural electrical activity, which manifests as noises in the ears, or tinnitus.
I have seen a massive increase in the number of people visiting with tinnitus, since the COVID crisis began. The COVID crisis has been a cause of stress for many people, and stress makes the tinnitus louder. Coming to see me, to make sure there is no serious cause for the tinnitus, can help diffuse this stress, and make the tinnitus quieter.
Other ways to cope with the tinnitus include covering it up. Increasing the ambient noise, in your quiet environments, covers up the tinnitus. If you are on your own in the kitchen, and it is quiet, switch on the radio. In your bedroom, you can switch on a radio in between frequencies, or play white noise from your iPhone: go to your iPhone settings, tap on "Accessibility", find "audio/visual" and select it, from there, search for "Background Sounds" and toggle it on.
This is called “masking”. Likewise, a hearing aid can boost the amount of ambient noise you hear, in the environment, to mask out the tinnitus.
Don’t seek out the tinnitus. Don’t sit in a quiet environment and ask yourself if you can hear the tinnitus. If you ignore it enough, then eventually the tinnitus will fade off into the background and it won’t bother you anymore.
A small percentage of people with tinnitus cannot cope with it. It turns their world upside down. I work with specialist audiologists who run a program of “tinnitus retraining therapy”. This is a form of cognitive behavioural therapy which is designed to eliminate the tinnitus.