Tinnitus refers to the sensation of hearing sounds in the ears or head in the absence of an external sound source. It is a very common phenomenon and is reported in all age groups, with an estimated 1 in every 8 adults in the UK experiencing persistent tinnitus.
Though commonly perceived as a ringing noise, tinnitus can also take the form of a wide array of other sounds like buzzing, whistling, humming, whooshing, clicking and even musical notes to name but a few. It can come and go, be high or low pitched (or fluctuate between the two), and its loudness can also vary. Everyone’s experience of tinnitus is different and unique to them. Some are unaffected by it, whereas others become severely distressed by their tinnitus–sadly leading to debilitating and devastating effects on quality of life.
Causes of Tinnitus
There are two sub-types of tinnitus:
Subjective tinnitus is a phantom auditory sensation in the absence of a real sound. These sounds are only perceivable to the specific patient. This is the most common type of tinnitus, accounting for 99% of cases, and is predominantly linked to some degree of underlying change in the auditory system. Causes of this type of tinnitus include:
Objective tinnitus are sounds that are produced by internal functions in the body’s circulatory (blood flow) and/ or somatic (musculo-skeletal) systems. These sounds are audible to the patient and can also be detected during an examination. This type of tinnitus is uncommon, accounting for 1% of cases, and is mainly caused by either spasms of small muscles in the middle ear or by a change in blood flow to the ear–typically resulting in pulsatile tinnitus (tinnitus that is synchronous to the heartbeat). Causes of this type of tinnitus include:
If you have been experiencing tinnitus that is causing you distress, please do not hesitate to get in touch with us as there are many forms of help available to help you overcome your current problems.
The first step in treating tinnitus is appropriately diagnosing and measuring it. Our tinnitus evaluations are comprehensive and are grounded on evidence based clinical protocols to help assess and diagnose your tinnitus. Our experts will initially obtain a detailed medical and audiological history and ask you to complete a set of tinnitus inventories to ascertain degree of tinnitus burden and impact on your quality of life. They will then perform a number of diagnostic tests aimed at assessing your tinnitus profile and identifying any underlying hearing loss that may be contributing to your tinnitus. Your results will be discussed following testing, after which you will then commence the first session of tinnitus therapies.
A tinnitus assessment may include the following where appropriate:
- Audiological / Medical history.
- Tinnitus Handicap Inventory.
- Tinnitus Functional Index.
- Clinical Otoscopy – Performed to inspect the condition of the outer ear and ear drum in order to detect any abnormalities or contra-indications.
- Pure Tone Audiometry – Test to identify hearing thresholds and the degree of any loss.
- Speech Audiometry – Used to determine the weakest intensity for word recognition.
- Speech in noise testing – Used to determine speech discrimination ability in the presence of background noise.
- Tympanometry – Test to examine the health of the middle ear and ear drum movement.
- Otoacoustic emissions – Test to determine the health of the inner ear by measuring its response to noise stimuli.
- Tinnitus pitch matching – Test to determine the specific pitch of tinnitus being perceived.
- Tinnitus loudness matching – Test to determine the specific loudness of tinnitus being perceived.
- Minimum masking level – Test to establish the volume at which an external narrowband noise masks the perception of tinnitus.
- Consultation and individual management plan.
- First session of Tinnitus Retraining Therapy.
- First session of Cognitive Behavioural Therapy, where appropriate.
- Onward referral to ENT/ other specialists for further medical evaluation as appropriate.
- Comprehensive audiological report or e-report provided to you and/ or your referring specialist.
Whether you’ve recently developed tinnitus, or have a longstanding diagnosis, we understand that everyone’s perception of and reaction to tinnitus is different. Some people are able to carry on with their lives as normal whereas others become severely distressed by it to the point it may feel like tinnitus is taking over their life. In our experience, most people that experience tinnitus fall somewhere in between. The key point to note is that there are things that can be done to help minimise its impact on your quality of life.
Our treatment options are grounded on the best evidence-based protocols available, incorporating the latest in tinnitus research. We also use a multidisciplinary approach, including clinical psychologists who can help manage the emotional triggers of tinnitus. Additionally, we can also recommend lifestyle changes like changing certain medications, adapting your diet or removing obstructions like earwax from your ears, to ensure that you are fully equipped to take back control of your wellbeing.
Our treatment options fall into three main categories:
Tinnitus Retraining Therapy (TRT) is a mixture of tinnitus specific counselling together with sound therapy and relaxation techniques. It is a therapeutic approach based on the neurophysiological model that tinnitus is caused by abnormal processing of a signal generated in the auditory system. TRT is aimed at redirecting your brain’s attention away from the tinnitus and thereby enabling natural habituation process to occur. This therapy includes the following:
- Tinnitus specific education and counselling
- Sound enrichment therapy
- Assistive technology
- Lifestyle modifications
- Sleep hygiene
- Relaxation training
- Advice on hearing conservation/ protective ear plugs
- Advice on alternative/ complementary therapies
Cognitive Behavioural Therapy (CBT) is a form of mindfulness-based treatment for tinnitus that explores how negative thought processes adversely affect behaviour and how you can change those thoughts. It is a proven method for reducing depression and anxiety and is aimed at reducing the distress caused by tinnitus. CBT uses a combination of relaxation, cognitive restructuring of thoughts, and different situations to help improve your feelings about tinnitus and is carried out by a Clinical Psychologist.
If you have an underlying hearing loss, this is likely causing your tinnitus to be more apparent. The use of hearing aids has long been recognised as one of the best and most effective means of managing tinnitus as they lead to an increase in stimulation of the auditory system by speech and environmental sounds, subsequently leading to a reduction in tinnitus awareness. Using the latest technology and software, our experts will be able to advise on and fit you with the most suitable hearing aids for your specific hearing profile and lifestyle needs.
* Please note, we always include the first session of TRT as part of your initial tinnitus assessment. We will also arrange for an additional session of CBT with a clinical psychologist following this depending on your degree of tinnitus severity and burden. Though we recommend a completing a minimum of 3 sessions of therapy, you will have the flexibility to choose which therapy you would like to continue with and for how many sessions depending on which you feel is providing the most benefit to your individual situation.