Tinnitus is a condition characterized by ongoing ringing or other noises in your ear that can’t be heard by anyone else. Tinnitus is not itself a disease but rather the name for the particular symptom, which can have a number of different potential causes ranging from the physical to the psychological.
While the causes are wide ranging however, they can be divided into two main categories: objective and subjective. Objective tinnitus is tinnitus that is actually caused by the existence of a small sound that can be heard in the ear. This noise might be caused by the contraction of muscles, by blood pumping through vessels or by fluid draining out of the ear. Objective tinnitus however only describes a small 5% of cases, with the vast majority being subjective.
In both scenarios, stress can make tinnitus considerably worse while in some instances of subjective tinnitus, the problem may even be caused entirely by psychological factors. In either case, there are therapeutic approaches that can help to treat the problem and provide some relief.
Tinnitus and Neurotransmitters
While tinnitus is not generally a dangerous condition, it can be highly frustrating and may negatively impact on your quality of life. Not only can tinnitus prevent you from sleeping properly but it can also distract you from what you are doing thus damaging your productivity and your enjoyment of a range of activities.
But the ironic aspect is that the stress that tinnitus causes may in fact be what makes tinnitus worse to begin with and there are a number of mechanisms through which this could occur.
For starters, stress increases the release of neurotransmitters that heighten senses and sensitivity thereby making you more likely to hear a ‘ringing’ in your ears. In this scenario, your brain becomes heightened to sensory input and starts looking for sounds where none exists, resulting in ‘false positives’ which you may hear as a ringing noise. These are the same neurotransmitters associated with the ‘fight or flight’ response and of course heightening senses in this scenario would be a positive thing – just not when you’re sitting in a quiet room at work. This problem is also more likely if you have difficulty hearing, as your brain might ‘compensate’ for the absent input. This is why studies have shown that tinnitus ‘phantom sounds’ are often heard in the same range as the hearing loss (1).
So when you’re very excited – i.e. stressed – you become so sensitive to noise that you sometimes hear it when it’s not there, especially if you have hearing difficulties. This is mediated by the release of hormones like norepinephrine and glutamate which are excitatory for the nerves. On the other hand, if you can calm yourself down then you will suppress neuronal activity through the release of substances like serotonin and GABA and this will help to alleviate the sound.
Tinnitus and Attention
Moreover, tinnitus gets worse because you focus on it specifically, which in turn tells your brain that that sound is ‘important’.
Chances are that right now you’re sitting in a room with a clock. Only you probably can’t hear the ticking noise unless you’re actively listening to it; when you work, read or chat with friends it will disappear. That’s because the same noise heard repeatedly causes a kind of ‘desensitizing’ effect that causes it to blend it into the background so you can hear more important things.
In theory, this same thing should happen with tinnitus. Only it often doesn’t because those suffering will find it almost impossible to stop focusing on the noise and making it worse.
How Therapy Can Treat Tinnitus
There are three main forms of therapy that can provide relief and long-term treatment for tinnitus. These include:
The Acoustic Desensitization Protocol/Tinnitus Retraining
This looks at retraining the patient to stop focusing on the sound of the ringing so that it blends into the background and they can no longer hear it. This is based around the same concept as the clock ticking and if you can ‘forget about it’ then you may find that the symptoms subside or even go away entirely over time. Actually, tinnitus will often subside over time on its own and this type of retraining can simply work to speed up that process.
Cognitive Behavioral Therapy
Cognitive behavioral therapy is also occasionally used to treat tinnitus and will take a similar approach to the desensitization protocol but with more on an emphasis on stress and the cognitive tools you can use to combat it. Cognitive behavioral therapy can teach specific coping skills for dealing with stress which may help patients to overcome anxiety that could be contributing to their heightened stress. You’ll also learn things like breathing techniques that you can use to relax when trying to sleep. CBT is very effective as a form of therapy particularly because it is fast and cost effective and can even be administered remotely via e-mail.
Sound therapy for tinnitus involves the use of a background noise designed to mask the sound heard in the patient’s ear. This can either ‘drown out’ the sound, or at the very least help them to distract themselves from it.
Antidepressants are also sometimes used in the treatment of tinnitus but generally these aren’t recommended as they have numerous unwanted side effects in many cases. If you can treat your tinnitus through therapy then this is far more preferable. Other non-therapeutic treatments include the use of hearing aids to try and restore lost hearing.