Enemy of Silence: Tinnitus

By: Sean Lennox, Doctor of Audiology, Audiologist. AuD. MSC. BSc.

You are trying to relax after a long day, so you grab your favorite beverage and a good book, but all you can hear is ringing in your ears… If you experience ringing in your ears, you are one of the 30-40% of adult Canadians that experience tinnitus. Tinnitus is the bothersome perception of sound when there is no external sound present. It is often the most noticeable, and annoying, in times when it is quiet – such as when you are trying to relax or go to sleep. The most common tinnitus sounds are ringing, hissing, buzzing, rushing, and screaming.

There are two types of tinnitus: objective and subjective. Objective tinnitus is the perception of true internal bodily sounds whereas subjective tinnitus is the perception of sounds coming from within the head that are not objectively measurable.

TINNITUS IS MOST COMMONLY A SYMPTOM OF HEARING DISORDER. If you are experiencing tinnitus, you should have an assessment done by an experienced professional.

Tinnitus and Your Brain

Tinnitus can be short term or long term. Short term tinnitus can be a symptom of hearing loss resulting from temporary changes to the auditory pathway (ex. Ear infection- outer/middle). Long term tinnitus is often associated with permanent sensory neural hearing loss.

Our brain uses our hearing as a warning detection system to be alert to our external world. The Brain expects constant stimulation for hearing even when we are asleep that is why we do not have ear-lids. When it comes to the sense of hearing, our brain never takes a rest. The brain actively affects how we hear- when it is silent are brain increases the sensitivity of the sensory cells of the ear to be aware of the environment. When we feel threatened or stressed, our brains automatically increase our warning detection system (our hearing). This is a normal physiologic response to the fight or flight part of the autonomic nervous system. For example, when we are asleep at night, and we are startled awake to a sudden noise you might notice that your hearing sensitivity is heightened, and tinnitus is noticeable. Tinnitus is the noise of the active auditory system. The brain requires constant stimulation over the broad range of human hearing. When we have hearing loss the brain tries to increase the internal gain (sensitivity) of the damaged sensory cells (see figure 1) which leads to tinnitus. This makes sense when you think of an analogy of a damaged microphone. A sound engineer might erroneously think that boosting the mic sensitivity will help clarify the signal much like the brain with the damaged sensory cells of the ear. The outcome in both cases is constant annoying noise. Tinnitus really is the noise of a damaged auditory system.

Tinnitus Causes

  • Hereditary, hearing loss is often hereditary and given most people with hearing loss have tinnitus we expect tinnitus to run in families.
  • Age-related changes to the auditory system make hearing loss and tinnitus more common.
  • Occupational or recreational noise exposure
  • Ototoxic medications, certain medications including anti-cancer and diuretics can cause tinnitus.
  • Otologic disease including viral or bacterial ear infections.
  • Stress and anxiety– hearing as threat detector
  • Dental and TMJ disorders
  • Cervical spine issues
  • Rare vestibular/8 th CN tumours 

When is Tinnitus a Problem?

Most people hear tinnitus when in silence so not everyone needs to be concerned when they notice tinnitus. Tinnitus becomes a  problem when it negatively affects:

  1. Ability to concentrate,
  2. Sleep,
  3. Well-being,
  4. Our Relationships.

More concerning when your tinnitus is:

  • Asymmetric, one ear only.
  • Coincides with sudden hearing loss, aural fullness, vertigo.

Tinnitus Evaluation

Evaluating tinnitus is very comprehensive and starts with a visit to a Doctor of Audiology or audiologist. The testing will include:

  • Tinnitus surveys to understand how your tinnitus is affecting your life currently.
  • Hearing evaluation to get an idea of the nature, type, and degree of your hearing impairment.
  • Immittance: evaluation of eardrum and middle ear function. Acoustic reflex testing to check for auditory nerve reflexes to loud sounds.
  • Otoacoustic emissions a test of outer hair sensory cells (type 2 cells) that are involved in the filtering, amplification, and compression of sound.
  • Tinnitus pitch and loudness matching. Tinnitus minimum masking level. Residual inhibition of tinnitus suppression.
  • Loudness discomfort level testing.

Tinnitus Therapy

  • Tinnitus retraining therapy: As the name suggests we are trying to retrain the brain to lower the internal gain compensation that has been applied to the ear with hearing loss. We are also trying to disconnect the heightened warning detection system response that some people experience with elevated stress levels with tinnitus.
  • Proper Education goes a long way. Even if there is not anything you want to do about your tinnitus immediately understanding the causes of tinnitus and potential alleviation techniques can be very helpful. • Protect your hearing. • Use free masking apps when in silence especially at night.
  • Dietary changes: reduce salt, caffeine, nicotine, alcohol.
  • Stress reduction: Relaxation and Exercise.

Our Services

We provide hearing loss evaluations for all ages, hearing aid evaluations and servicing as well as tinnitus and sound sensitivity, vestibular and balance assessments, post-concussion auditory processing and tinnitus/hyperacusis support, wax removal, and much more.