Tinnitus: Ringing/Buzzing in Your Ears

Tinnitus is the perception of a ringing, buzzing, roaring, musical, hissing, cricket, or clicking sound in the ears when no external noise is present. It can occur in one or both ears, or sound like it’s in the center of your head. It can also be considered ‘intermittent,’ meaning it comes and goes, or ‘constant,’ meaning it is always present and can fluctuate in volume or frequency. Tinnitus is not a disease but rather a symptom that’s typically related to the auditory system and around 90% of the time is accompanied by hearing loss. It’s a common issue that affects nearly 15% or 50 million Americans according to the US Centers for Disease Control. For websites that include more detailed information about tinnitus, check out the American Speech-Language Hearing Association’s tinnitus page here or Oticon’s tinnitus handbook here.

Causes

Tinnitus may be caused by age-related hearing loss, exposure to loud noise, medications, stress, migraines, smoking, caffeine, temporomandibular joint disorder (TMJ), sinus pressure, barometric trauma, and traumatic brain injuries. For more information about what types of medications are associated with tinnitus, click here. Some diseases like Meniere’s Disease also cause tinnitus.

Two Types

There are two types of tinnitus: subjective and objective. The first type, subjective, is by far the most common accounting for about 99% of tinnitus cases. Subjective tinnitus is tinnitus that only you can hear. Objective tinnitus is very rare, and occurs when other people can hear your tinnitus.

Tinnitus Red Flags

Sometimes, tinnitus is a sign that something is medically wrong. The following are symptoms that your tinnitus might need to be evaluated by a physician.

• If your tinnitus is in only one ear

• Tinnitus pulses with your heartbeat

• Tinnitus is a roaring or whooshing sound

• If the tinnitus occurs along with pain or pressure in your ears

• If tinnitus occurs with facial weakness or paralysis

• If tinnitus began along with a sudden hearing loss or balance problem

Treatment Options

The use of hearing aids alone may be enough to reduce or alleviate some patients’ tinnitus. Most hearing aid manufacturers include sound generators in their hearing aids, which can be applied in a specific hearing aid program, or may be applied to all programs in hearing aid software. There are also free phone apps that allow patients to create and personalize their own sound generators. Cognitive behavioral therapy is another treatment method proven to be effective for people struggling with bothersome tinnitus.

Hyperacusis: Sensitivity to Loud Sounds

Hyperacusis is a disorder which can cause someone to perceive sounds as extremely loud, even though another person wouldn’t consider those sounds loud. Sounds like a car door closing, motor running, dishes being put away, or a high-pitched voice are some examples of sounds that most people wouldn’t consider loud, but people with hyperacusis may be aversive to. Sometimes, hyperacusis can be accompanied by tinnitus, ear pain, and/or ear pressure. Although the prevalence of hyperacusis in the general population is unknown, it’s estimated at 2% based on recent research. You can learn more about hyperacusis on the American Speech-Language Hearing Association’s hyperacusis webpage, here.

Causes

Although research is ongoing, some potential causes for hyperacusis include hearing loss, certain autoimmune diseases, exposure to loud noise, and head trauma. However, hyperacusis may happen without a direct cause or have multiple causes. A loss of dynamic range, or the brain’s ability to react to rapid changes in sound levels, can result in everyday sounds being perceived as overly loud. This is sometimes accompanied by hearing loss and/or tinnitus. Recent research also suggests for some with hyperacusis, the brain may not be producing enough of a chemical that helps us process sounds correctly. Alternatively, a loud blast or head trauma can cause physical damage to the inner ear that can lead to abnormal sound sensitivity.

Treatment Options

When hearing loss is present, the use of hearing aids with sound generators may be enough to reduce or alleviate some patients’ hyperacusis. Sound generators alone help people with hyperacusis acclimate to soft-level sounds in their environment so that perceived loud sounds become less overwhelming. The use of earplugs or limiting social interactions to avoid sounds is discouraged as it can cause your condition to worsen, not improve.

Misophonia: Strong Dislike of Certain Sounds

Misophonia is a disorder which causes some people to have a strong negative emotional reaction to certain trigger sounds. The most common trigger sounds are often related to bodily functions like chewing, breathing, throat clearing, coughing, sniffing, nose blowing, and humming. While an average person may find these sounds slightly annoying, someone with misophonia may feel anxiety, rage, panic, disgust, or fear when they hear these sounds, and often will choose to leave a room in order to avoid hearing them. Sometimes, misophonia can be accompanied by tinnitus and/or hyperacusis. Misophonia is not a disease but rather a symptom that’s typically related to the auditory system. It can happen in anyone, but is common among adolescent girls. Although the prevalence of misophonia in the general population is unknown, it is estimated at 3% based on comorbidity with other auditory conditions. The term ‘misophonia’ was coined in 2001, and since it’s a relatively new term, it isn’t formally listed in medical manuals. Many physicians haven’t heard of it, and it can be difficult for family members to understand how debilitating it can be. For more information about misophonia, you can visit The Misophonia Institute’s website here or read this article published by the American Speech-Language Hearing Association here.

Causes

There is no single cause of misophonia while researchers continue to study it. Misophonia may be caused by age-related hearing loss, exposure to loud noise, medications, stress, anxiety, depression, migraines, smoking, caffeine, temporomandibular joint disorder (TMJ), sinus pressure, barometric trauma, and traumatic brain injuries. Promisingly, two research studies in 2017 and 2019 found that people with misophonia had different reactions in their brains when triggered by common misophonic sounds as compared to participants without misophonia. This led the researchers to speculate people with misophonia may have different wiring in their brain, which causes them to perceive certain sounds as threatening.

Treatment Options

A simple cure for misophonia is not currently available, and medications have not been proven to be helpful. However, management for misophonia has been proven effective. When hearing loss is present, the use of hearing aids with sound generators may be enough to reduce or alleviate some patients’ misophonia. Cognitive behavioral therapy with a focus on habituation is another successful treatment method for people struggling with misophonia. The goal is not to mask or cover up the offensive sounds but rather get used to them comfortably so the negative emotion associated with the sound changes to a neutral one.