Tinnitus Effects Vary Between Individuals – So Do the Causes and TreatmentsAlthough their symptoms are most frequently referred to as a sensation of ringing in the ears, in practice, tinnitus sufferers may experience a wide range of phantom sounds. Among those most frequently reported are buzzing, whooshing, roaring, hissing, and whistling, while some people have also claimed to hear music or even sounds that appear to resemble voices. In quite a number of cases, those affected report experiencing different sounds on different occasions. Also the intensity of these undesirable sounds varies between individuals.
For the lucky ones, rather than being persistent, the symptoms are short-lived and tend to clear up spontaneously after no more than a day or two at most. Typically, this will have been the result of exposure to a sudden load noise – something one might experience at a firework display or as a spectator at a firing range when failing to wear the ear defenders provided. In fact, most of us are likely to have experienced such temporary tinnitus effects as a result of acoustic shock, and probably on more than one occasion.
Along with the phantom ringing, one usually experiences a sensation of muffled hearing. Fortunately, in such circumstances, this too is only a temporary symptom, so hearing tends to improve gradually as the ringing sensation becomes progressively less noticeable. Nevertheless, the relationship between hearing loss, whether of a temporary or permanent nature, and these bizarre internal noises is well-established. Even though it occurs in subjects with normal hearing, the fact that more than half of those with auditory impairment also experience the effects of tinnitus to some degree lends support to the notion of a common origin.
While a symptom of some underlying abnormality rather than an illness per se, it can be divided into two distinct types. In the rarer objective form, the noises are caused by some abnormality of the tiny muscles within the middle ear, the flow of blood in local vessels, or some physical injury. These are real sounds which can actually be overheard by an examining physician. By contrast, the sounds experienced by those with the more common subjective form of tinnitus originate within the auditory cortices of the brain, and these sound effects remain completely inaudible to a third party.
The exposure to loud noise mentioned earlier can result in damage to specialised sensory cells within the cochlea. These cells are characterised by hair-like projections termed stereocilia. They respond to ripples in the cochlear fluid produced by external sounds, converting them into neural impulses that are relayed to the auditory cortices in the brain for interpretation. The damaged cells cannot be repaired or replaced, so any hearing loss will be permanent. It is thought that the damage also causes the release of free radicals that may trigger the anomalous responses by the auditory cortices to produce the typical effects of tinnitus.
Apart from acoustic shock, there are a number of other known causative agents. The phantom ringing or other sounds may be permanent or just a temporary phenomenon and, in most cases, are likely to be accompanied by hearing loss. A simple ear infection, for example, can give rise to both of these symptoms which, upon treatment with a suitable antibiotic, are readily reversed. If the infection is left untreated and allowed to become chronic, however, these symptoms can become permanent. Ironically, some antibiotics may actually induce tinnitus effects in susceptible subjects, as can a number of common medications. Generally, however, a prompt change of medication should see the symptoms subside.
For most of those whose symptoms are entrenched, the subjective noises are usually intermittent and of an intensity that can be ignored with comparative ease, except during periods of extreme quiet. For around 5% of subjects, however, living with these noises can be extremely debilitating. It can interfere with their concentration, make it difficult to sleep and, ultimately, near impossible to hold down a job. Many of those affected become severely depressed, which in turn tends to intensify the phantom sounds.
While there is no cure for tinnitus, there are ways to alleviate its effects. Counselling can help to modify the way one responds to these intrusive sounds, while white noise provides a highly effective means with which to mask them. A white noise source may be integrated into a hearing aid or provided by an external device. For those whose hearing is unaffected, a CD or a downloadable smartphone app can deliver similar benefits.