ringing in your ears?

Tinnitus, the condition commonly known as “ringing in the ears,” is something that can affect us as we age, especially if we are experiencing hearing loss or have suffered an ear injury. Other causes of tinnitus can include repeated exposure to loud noises; an ear infection; head or neck injuries; and even such medications as antidepressants.

But let’s focus on age. The cochlea—the part of the inner ear responsible for hearing—contains over 15,000 inner and outer hair cells. These cells can die as we age, and are not replaced, leading to hearing loss. That, in turn, can lead to tinnitus.

While many people with tinnitus describe it as sounding like a “ringing” in the ears, the condition can produce a number of other “phantom” sounds: buzzing, roaring, “crickets” or clicking, or even hissing. These sounds can be constant or present as a regular pulsing, or occur sporadically. It can gradually increase or simply begin without notice.

The reason for these sounds, which usually occur at the higher frequencies we hear, is that the brain is working in an organic way to “replace” the sounds it is no longer receiving.

Common conditions that can lead to tinnitus include a buildup of impacted earwax in the ear canal and a middle ear infection to abnormal bone growth in the middle ear, or can be the result of more serious conditions like whiplash, severe anemia, hypertension and hypothyroidism.

Among the negative effects of tinnitus, beyond the ringing itself, is sleeplessness. Many tinnitus sufferers are more or less unaware of having the condition during the day, when other auditory stimuli are present. But at night, when those stimuli are significantly reduced, the sound can remind you of its presence with a vengeance.

Not getting enough sleep can of course be detrimental to your health, resulting in anxiety, depression, and irritability—and can lead to a chronic condition that may reduce immunity and even cause heart failure. For those reasons, adding a source of ambient sound while you sleep can help mask/overcome the effects of tinnitus. A white noise machine, soft music playing on the radio, even wearing headphones while sleeping can be useful ways of distracting the brain at nighttime. Keep in mind: you don’t want them to play too loudly, lest your sleep be disturbed.

Worth noting is that, as tinnitus is often associated with age-related hearing loss, a hearing aid can help reduce the effects of the condition. Not only do such devices amplify “regular” sounds for the user to hear better, they also increase ambient sounds—often to the point where the tinnitus is drowned out.

We also employ tinnitus and hearing-specific questionnaires to help evaluate the effects of the condition on each patient. When it comes to tinnitus, our greatest challenge as caregivers is that we cannot hear what the patient is hearing, making the patient’s perception entirely subjective.

There can also be a therapy-based approach to tinnitus. One of the pitfalls of having the condition is the temptation to give it undue focus, which accomplishes little other than making it loom larger in your life than it has to. Retraining therapy can demonstrate how to shift your focus away from the condition, by not trying to count how often or quantify how severe each occurrence is. Ultimately, such therapy can help the patient reduce—and ultimately eliminate—the masking tools. I’ve had patients who, when asked the status of their tinnitus, have had to stop to actually focus on it.

That, ultimately, is the goal. Tinnitus can be very disabling, but in most cases it needn’t be. Explore these options and others with an otolaryngologist or audiologist to see what might work for you.

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