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VANDERBILT UNIVERSIT Y, DEPARTMENT OF HEARING AND SPEECH SCIENCES
TINNITUS IN 4 PAGES
HOW DOES THE EAR WORK?
The outer ear is the part of the ear we can see. The outer ear ends at the ear drum and that begins the
middle ear. The middle ear contains the 3 smallest bones in the body. These bones are set into vibration
by sound waves that vibrate the ear drum. These sound vibrations are then sent
into the inner ear of hearing. The inner ear functions exactly like a microphone.
Microphones convert sound waves into an electrical code. This electrical
code is sent through the hearing nerve and up through brain pathways to the
hearing part of the brain.
The hearing part of the brain decodes the electrical pattern. In order for
sound to be clear, the inner ear of hearing must create the electrical code and
the hearing part of the brain must faithfully decode the electrical code. This means if the inner ear is
impaired it will not create a normal electrical code. In this case, even if the brain decodes normal sound it
will be distorted either in loudness, or in clarity. That is what happens when hearing loss is present.
OUTER, MIDDLE AND INNER EAR
QUICK FACTS
ABOUT TINNITUS
•Tinnitus is not
a disease but a
condition that can
result from a wide
range of causes
•Tinnitus can be
perceived in one or
both ears
•Persistent tinnitus
may cause irritability,
fatigue and stress
The inner ear and the hearing part of the brain must function
normally for sounds to be clear and understandable.
•People with severe
tinnitus may have
trouble hearing,
working or even
sleeping
WHAT IS TINNITUS?
Tinnitus describes the perception of a sound, or sounds, when none is present. It may
be described as any one or combination of sounds such as: ringing, hissing, buzzing,
white noise, or roaring. Tinnitus usually only can be heard by the patient. Rarely, a
person’s tinnitus can be heard by others.
COMMON
TINNITUS
SOUNDS
Ringing
Hissing
Buzzing
White noise
Roaring
WHAT IS HYPERACUSIS?
Hyperacusis is the perception that sounds of normal loudness are
painful. It has been estimated that between 1 and 3 out of 10 patients
with tinnitus also are bothered by painful loudness. For 1 out of 10
of those patients, the hyperacusis, and not tinnitus, is the primary
problem.
WHERE DOES TINNITUS COME FROM?
Even though a great deal of research is being conducted on the best ways to treat patients who have tinnitus,
the origins of tinnitus still are not known. Current belief is that there are probably multiple causes of tinnitus.
For example, it is common for tinnitus to be present in ears with even mild hearing loss. This suggests that
even minor damage to the inner ear (the microphone) can result in the inner ear creating electricity even
when no sound is present. Or, damage to the inner ear may result in changes in the function of lower brain
pathways that normally carry the electrical code to the hearing part of the brain. These changes result in a
greater than normal amount of electricity reaching brain hearing centers. This results in the perception of
sound that is not actually in the environment which is tinnitus.
HOW COMMON IS IT FOR PEOPLE TO
HAVE TINNITUS?
Unfortunately, tinnitus is a very common disorder. It has
been estimated that as many as 30-40 million Americans
It has been estimated that as
have experienced tinnitus. Approximately 8-10 million of
many as 30-40 million Americans
those people have sought medical help because of their
have experienced tinnitus.
tinnitus. For approximately 2-4 million people the tinnitus
has had a significant effect on a patient’s quality of life and
those people around them. It is more common for patients above the age of 40 years to complain of tinnitus.
Patients who are seen in tinnitus treatment centers usually have either just become aware of their tinnitus,
or have had their tinnitus for years and have reached a point where they are having difficulty tolerating it
without help. For about 40% of patients there is no known “trigger” that started the tinnitus. For about half
the patients they have become aware of their tinnitus gradually over time. Tinnitus causes irritability or
nervousness almost 80% of the time. The most common complaint(s) of tinnitus patients is interference with
concentration and the inability to sleep at night.
HOW IS IT POSSIBLE FOR YOU TO KNOW
WHAT I HEAR?
Most of the early research in tinnitus was done at the Oregon Health Sciences University in Portland, Oregon.
The investigators there created a tinnitus assessment where patients were asked to compare a sound
presented through an earphone to their tinnitus. Patients were asked to adjust the loudness and pitch of a
tone presented to one ear and match the loudness and pitch of the tinnitus present in the opposite ear. From
those clinical studies we know that for most patients the tinnitus pitch is equivalent to a tone above 2000
Hz. While tinnitus may sound loud to patients, 95% of the time the tinnitus loudness ranges only between 3
dB and 13 dB. For comparison, a whisper is approximately 30 dB in loudness. Despite this fact, when given
a scale from 0-10 to rate tinnitus loudness (10 being extremely loud) 55% of patients will rate their tinnitus
as a 6 or greater.
IF MY TINNITUS LOUDNESS IS ACTUALLY “SOFT”
WHY DOES MY TINNITUS SEEM SO “LOUD” TO ME?
Actually it is a very good thing that your tinnitus loudness is soft. This means that it will not require much
outside sound to interfere with your ability to hear the tinnitus. For example, we know that for 70% of patients
their tinnitus loudness is 12dB or less. Sound of that loudness, and much louder, occurs in the environment
normally. In fact, you may be sitting in a room right now that has a number of steady sounds that are louder
than 12 dB. An office may have a ventilation system that re-circulates air. Most of the day you cannot hear
the ventilation system because it is steady in loudness and has no significance, however if one was to listen
intently to the sound they would become aware of it immediately and it would become louder. Most of the 40
million Americans with tinnitus are not aware of their tinnitus most of the time because, to them, this internal
noise is as meaningless as the sound of the ventilation system in an office. If a patient fears that their
tinnitus is a warning sign that they have a significant disease it will be as impossible to ignore the tinnitus as
it would be to ignore a fire alarm. This is how a vicious cycle is created.
“
I hear my tinnitus. The tinnitus is unpleasant so I
find it difficult to ignore. The tinnitus irritates me.
Since the tinnitus irritates me and I don’t know
where it comes from I cannot ignore it so I listen to
it more. The more I listen to the tinnitus the louder
it becomes. The louder the tinnitus becomes, the
”
more anxious I become since I cannot escape the
tinnitus. The tinnitus becomes louder yet.
WHAT CAN YOU DO TO MAKE MY TINNITUS
DISAPPEAR?
While, at present, there is no medication or surgery that will make tinnitus disappear, much of the treatment
of tinnitus is directed toward learning how not to not pay attention to tinnitus. Since tinnitus is a soft sound
we can use either pleasant sounds produced in the environment (soft music) or pleasant sounds produced
through ear worn devices that look like hearing aids to make tinnitus either disappear entirely (a technique
called tinnitus masking) or to make tinnitus difficult to hear (a technique called tinnitus retraining therapyTRT). For the latter technique the use of sound generators is
reduced over time, on a schedule until they are not used at
Audiologists are hearing experts
all – a point where the patient is not aware of the tinnitus.
HOW MUCH WILL THIS
TREATMENT COST?
when it comes to understanding
sound, how we hear and the best
ways to improve your hearing if you
have hearing concerns.
If you have already seen a physician, and they have
determined that there is no significant disease causing your tinnitus, you will be invited to attend a presentation
by an audiologist who specializes in tinnitus assessment and treatment. For most patients, just learning
more about tinnitus is enough to de-mystify it and make it easier to ignore. For those patients, the initial
presentation will be sufficient and no further treatment will be necessary. If you would like to obtain sound
generators and undergo tinnitus retraining therapy (TRT) we will schedule you for a tinnitus evaluation.
There will be a fee associated with the evaluation and the therapy afterwards. Rarely does health insurance
cover these expenses. Make sure to check with your health plan to see what is/isn’t covered.