Woman cupping ear

However you pronounce it and however you describe it, tinnitus, or ringing in the ears, frequently accompanies ear problems or hearing, loss and it is an important reason to see your audiologist for a baseline evaluation.

The ear transmits sounds on a complex pathway from the ear canal, through the eardrum and three middle-ear bones, to the inner-ear hair cells, which convert the auditory signal into electrical impulses that travel through the auditory nerve to the hearing centers of the brain. Your doctor may want to evaluate you for some kind of obstruction in the ear, from wax to fluid, before referring you for a hearing evaluation. An obstruction anywhere along that pathway can result in head noise. An audiologic evaluation provides further information in the absence of any noticeable blockage, and it helps identify whether the cochlea or hearing nerve is part of the problem.

An audiologic evaluation usually begins with history intake, during which patients often describe their tinnitus as sounding like a high-pitched humming or buzzing sound, cicadas, or even eggs frying in a pan. The head noise can be constant or intermittent, steady or pulsatile. Our patients are also asked to complete a tinnitus-handicapping questionnaire to provide their own assessment as to how annoying their tinnitus is. Cochlear sensitivity is then evaluated from low-pitched to high-pitched sounds. The sensitivity evaluation is the traditional procedure of pressing a button or raising a hand when a tone is heard. Many times a patient can match the tone of their tinnitus with a particular sound presented during the evaluation. Often, the match is in the same area that identifies a Sound Void™ or decline in cochlear function.

The function of the cochlea and hearing nerve is still somewhat of a mystery and an area of ongoing research, but basically the nerve endings serve both an excitatory and inhibitory purpose. Simply put, the excitatory function of the ear allows us to hear our surroundings for communication, information, and safety, and the inhibitory function allows us to NOT hear, or to acknowledge quiet when we are in quiet. If the cochlea or hearing nerve has been damaged or deteriorated in any way, either one or both of these may malfunction. Hearing and ringing in the ears may be the result.

However you pronounce it, the question is: What can be done about your tinnitus? Its effect can be slightly noticeable to some and debilitating to others. Our patients often report their tinnitus is more bothersome when they are under stress and most noticeable when it is very quiet or at nighttime. Your audiologist will help you identify the reason for your tinnitus and whether or not it is due to changes in your cochlea. It is helpful to learn what you can do about your tinnitus. Often the more knowledge you have about a problem, the better you can accept it and take control. Aerobic exercise and massage have shown to be helpful by improving circulation throughout the body, especially, in this case, to the delicate structures of your ear, and in providing you with a peaceful state of mind. Caffeine, nicotine, alcohol, and excess aspirin should be avoided since they may contribute toward making your tinnitus more noticeable.

Since the exact cause of tinnitus is still a mystery, it is important to note that there is no specific cure. There are many over-the-counter medications advertised to “cure” tinnitus, but none of them have been proven to do so. The placebo effect can be very powerful and has been the explanation for most reported medicinal cures. Your physician can advise regarding medication and tinnitus. In general, avoiding very quiet environments by using masking noise, such as turning on a fan or radio, can be very helpful, and there are tinnitus-masking apps available if you have a smartphone. Biofeedback with counselling can also help desensitize a person to their tinnitus. Finally, there are many small ear-level masking devices, which can be especially helpful when some degree of hearing loss is present. The tinnitus-masking hearing aid has been an extremely successful tool to help control head noise and improve your hearing to provide multiple benefits. If you are bothered by head noise, ask your audiologist for help. Not every technique works for every person, and your audiologist will work with you to find the best solution.

Nora L. Fuchs, Au.D.
Doctor of Audiology