Tinnitus

Tinnitus is the perception of sound in the ears or head in the absence of external sounds. The perceived sound is different for each person but can commonly be reported as ringing, hissing, buzzing or insect sounds.

Most people experience subjective Tinnitus, which is Tinnitus that only that person can hear. There are many possible causes of subjective Tinnitus and each person will experience it in a different way. Tinnitus can be present all of the time or come and go. It may change in volume and pitch and can be heard as more than one sound at a time. Tinnitus can be perceived as coming from one ear, both ears, or any part of the head.

Some people experience objective Tinnitus, which is Tinnitus that may be heard by the examiner. This form of Tinnitus is often caused by a vascular issue and tends to pulse in time with the person's heartbeat.

It is important to remember that Tinnitus is actually quite common and most people are not bothered by their Tinnitus. A smaller number of people have severe Tinnitus that becomes bothersome due to its interference with sleep, mood and/or quality of life.

Reduced sound tolerance is a broad category of issues related to our perception of soft and loud sounds. Some people find that sounds that do not bother other people are too loud for them and can even cause physical discomfort. Some people develop a fear of sound because of a past trauma caused by loud sound. There are even some people who report that particular sounds, such as chewing or sniffing, are very unpleasant and can even cause them to be anxious or angry.

Patients have described the sound that they perceive in the ear or head in many different ways, such as ringing, whistling, vacuuming, hammering, buzzing and humming sounds.

For people experiencing severe Tinnitus, pulsatile Tinnitus, Tinnitus in only one ear or any form of reduced sound tolerance, it is important to seek medical evaluation to determine if there is anything causing the Tinnitus or reduced sound tolerance that could be resolved medically or surgically. If the Tinnitus remains after medical intervention, Tinnitus/sound tolerance management can be provided by an audiologist specialising in these conditions. The audiologist can develop management programmes that reduce the impact of the conditions and restore quality of life.

The first step in any good Tinnitus and sound tolerance programme is a comprehensive medical examination by an ENT doctor to rule out any active disease process that may be causing the Tinnitus or reduced sound tolerance. A complete history will be taken and a thorough physical examination will be performed. Testing will be completed to determine hearing ability and middle ear function. If active disease processes are discovered, they will be treated medically or surgically prior to any further management. If no disease processes are discovered or if the problems continue after medical or surgical treatment, then the next step is to proceed to management of the Tinnitus or reduced sound tolerance by an audiologist who specialises in these conditions.

The next step after medical examination is the referral to an audiologist who will determine the specific needs of each person with Tinnitus or reduced sound tolerance. An audiologist specialising in these conditions will meet with each person to determine the severity of the condition and the impact of the condition on the person. It is through this interaction that each person can be referred to the audiologist who can best serve that person’s very important and individual needs.

Once the person has been assigned to an audiologist, the audiologist will review the comprehensive questionnaire filled in by the patient that provides specific information about their Tinnitus, sound intolerance, hearing, medical, and psychosocial histories and details relevant to conditions that may be triggering or exacerbating the Tinnitus or sound intolerance. Factors critical to patient evaluation and care that were identified in the questionnaire will be pursued further during the personal interview. Previous medical records will also be reviewed by the audiologist.

Education will be provided about the person's individual condition, what may be causing it, why it can be bothersome and how it can be managed. Directive counselling will be given to the person and their family members on how to reduce the impact of the Tinnitus or sound intolerance. We encourage each person to bring a family member or close friend with them to the appointment. These individuals serve as important sources of information, as reminders to the person of what transpired during the visit, and as contact people during follow-up.

Based on the person's condition and individual needs, categories of devices and sound delivery systems that would potentially be helpful in providing relief from and control over the Tinnitus or sound intolerance are selected. These may include hearing aids, Tinnitus instruments/combination units, table top sound generators, MP3 players, CDs, bluetooth streaming devices to hearing aids, pillows with speakers for use during sleep and other devices. The purpose and potential benefits of each device are explained to the person, who will try them to determine which tools are helpful and which are not. Sound sources that are helpful will be ranked by the patient in terms of effectiveness, cost, practicality and other factors. Specific instructions on when and how to use the devices are given to the person according to his or her specific needs. At the conclusion of the clinic appointment with the audiologist, the management plan is reviewed and presented as a starting point for the person. Elimination of counter-productive behaviours (self-monitoring of the Tinnitus, exposure to loud noise or stress, dietary considerations) are summarised as well as the plans to address any confounding medical or psychological issues.

With chronic conditions like Tinnitus and reduced sound tolerance, continued follow-up with the audiologist is very important. Each person is provided with the contact information of the audiologist they have been working with during the visit. They are instructed to maintain regular contact with feedback on progress, especially during the first six months after the visit. Accompanying family members/friends are also provided with the contact information. The audiologist may also need to establish contact with the person's other healthcare providers to coordinate care on all factors related to the Tinnitus or reduced sound tolerance.