The tinnitus clinics run by the North Devon Audiology service are led by specialists who are qualified in tinnitus counselling. Our clinicians regularly attend courses to update their knowledge in the advances that are being made in the understanding and treatment of tinnitus. We offer modern and evidence based therapeutic approaches for patients with troublesome tinnitus.
What is Tinnitus?
Tinnitus is the perception of sound that does not come from an external source. The type and quality of the sound can differ greatly from person to person. Sounds might include: ringing, buzzing, humming, hissing, rushing, whining, clicking or droning. Commonly, the sound is heard in both ears or feels like it is coming from within the head. It’s not unusual to hear tinnitus is only one ear; however, more investigation may be needed to understand why this is. Tinnitus is not a disease or a condition. Although we don’t know the exact causes of tinnitus, current research generally agrees that it is the product of physical or psychological changes. Many people with hearing loss experience tinnitus but this is not the only reason for it. Furthermore, experiencing tinnitus does not necessarily mean a person has or will develop hearing loss.
Tinnitus can also be rhythmical; either in time with a person’s pulse or at a faster or slower pace. This is known as pulsatile tinnitus or might be described as objective tinnitus. Unlike other causes of tinnitus, where there is no external sound or physical internal structure causing it, objective tinnitus is caused by the noises created by structures close to or within the ear and can be heard by others. In some cases someone else might be able to hear these sounds either with a stethoscope or just by listening.
Who Hears Tinnitus?
It is difficult to know with certainty how many people experience tinnitus. Current estimates suggest approximately 10% of the population of the UK hear tinnitus; the actual number might be higher and is believed to be increasing. Research conducted in the past tells us that, given the right circumstances, perhaps everyone has the potential to hear tinnitus. It is widely accepted that the sound of tinnitus is generated along the pathway between the hearing parts of the brain and the nerve that connects the brain to the ear. Typically, the brain is very good at ignoring unimportant signals. From a hearing point of view, this might be a ticking clock or road traffic noises for example. When a person begins to hear tinnitus it is believed that this is a result of increased signals being sent to the brain or the brain no longer ignoring existing signals. The brain decides not to ignore the sound of the tinnitus because it perceives the sound as a threat. There are a variety of reasons why this might happen and may not be related to the ear at all. Stress for example, can be the underlying reason for someone’s tinnitus.
Other Types of Unusual Auditory Perceptions
As well as tinnitus there are other auditory perceptions that can troublesome.
Hyperacusis, for example, refers to intolerance or sensitivity to everyday sounds. This sensitivity could be finding everyday sounds as intrusively or uncomfortably loud; sounds could even be painful to listen to. There is a point at which anyone finds sound uncomfortable and this can vary from person to person. Some people, however, develop an unusually sensitive intolerance to sound. Whilst there are similar problems that can occur as a result of hearing loss in some people, Hyperacusis is a particular form of sensitivity to sound. Commonly, this can occur following a temporary hearing loss, certain infections of the ear or distressing life events. Many people with Tinnitus also experience Hyperacusis and they can share a common cause.
Misophonia is also a form of intolerance to sounds. Unlike Hyperacusis, Misophonia is often a severe intolerance or aversion to specific sounds; regardless of loudness. Common triggers can be mouth sounds such as chewing or whistling but can be any sounds. It is not unusual to some sounds irritating or distracting, although, those with Misophonia have a severe, negative emotional reaction to the triggering sound; such as anxiety, disgust or anger. It is unclear how common Misophonia is but it is likely to be under-reported; partly because it can be confused with other problems or disorders.
What can be done about tinnitus?
The reasons for tinnitus and other auditory perceptions can vary, so can the difficulties a person may have because of them. Owing to this, there isn’t a single treatment or management strategy that works for everybody. It is widely said that ‘nothing can be done about tinnitus’. This is not true. While there is no way turn the sound of tinnitus off, there are numerous ways that someone who finds their tinnitus troublesome and/or distressing can reduce the impact of it. Strategies for managing tinnitus involve using methods to break the negative cycle of tinnitus and help the process of habituation. Put simply this means helping the brain to no longer think the tinnitus is important to listen to. Tinnitus management looks at the way the brain is involved in this perception of sound. It is important for a person to see the relationship between the physical, mental and emotional impact of tinnitus and how this can help habituate them to their tinnitus, just like any other sounds in the environment but which may not always be desirable or necessary to hear.
Often understanding reasons for the tinnitus and why the brain is listening to it is the first step in the habituation process. Simply knowing what the noise is and what’s causing it can be all that some people need to find their tinnitus becomes less intrusive and noticeable. How significant of an impact a person’s tinnitus has and what is causing it can influence which management strategies are likely to help. The level of scientific evidence for ways of managing tinnitus varies but there a number of methods that could be useful and some that research demonstrates is effective. These might include:
This is a common technique used in the management of tinnitus. Sound enrichment is the use of background sounds like; music, the radio or natural sounds, to reduce the prominence of the sound of tinnitus. This can be used both day and night depending on when someone finds their tinnitus problematic. As well the television or radio, there are purpose made devices that play a range of sounds and smartphone or tablet apps are available for sound enrichment.
A Tinnitus counsellor may suggest trying digital hearing aids if a hearing loss has been detected or sound generators which may be beneficial with the desensitisation process. Hearing aids combined with other sounds in the same device can also be used.
Many people with tinnitus also experience difficulties getting to or staying asleep. This could be a result of the tinnitus itself but might also be affected by other factors that also influence the tinnitus. A tinnitus specialist will help a person unpick what is causing sleep to be problematic and develop methods of improving sleep. Sleep habits can have a significant effect on how much tinnitus impacts on sleep. Hearing tinnitus may not be the main cause of sleep problems but can certainly exacerbate underlying problems. A tinnitus specialist will take a broad view of a person’s sleep habits and help to address other factors that cause them difficulty sleeping as well as the tinnitus. Often this is combined with other treatment methods in a holistic approach.
Cognitive Behavioural Therapy
The experience of tinnitus is both perceiving a real, physical sound and reacting to it psychologically. Whether we’re conscious of it or not, we all have thoughts and feelings about the sounds we hear. As a result of how we feel about sound we have thoughts about them and often adapt our behaviours to respond to them. When it comes to tinnitus these behaviours are very much unhelpful. Trying to change these thoughts and/or behaviours can help manage their impact. Perhaps the most well scientifically demonstrated way of helping someone manage their tinnitus is cognitive behavioural therapy (CBT). The purpose of CBT is to help a person understand their thought process and behaviours toward a particular experience and help adapt them to reduce the impact. The current scientific evidence tells us that CBT is an effective way of helping reduce the impact of tinnitus and improving quality of life.
The reason many people with tinnitus cannot ignore their tinnitus is the mind getting stuck on the thought that tinnitus is important to listen to. Unconsciously and understandably the brain thinks that the sound of tinnitus is important to listen to. It’s normal for a single event or experience to influence the way we perceive similar experiences or project into the future how we will feel about future experiences. The purpose of Mindfulness is becoming more aware of the present and breaking the negative cycle of basing past or current experiences on what will happen in the future. While this can be a difficult skill to master, the scientific evidence tells us Mindfulness can be very useful for people with tinnitus. A tinnitus specialist will be able to identify how this might benefit patients and direct them to appropriate resources including local groups and self-directed programmes.
The strategies mentioned above can be adapted by your Tinnitus specialist in helping with other problems such Hyperacusis and Misophonia. As there is a clear difference between these problems it may be necessary to alter the method of managing these difficulties in different ways. Your Tinnitus specialist will be able to first understand the nature of your problems and then tailor the therapeutic approach to best meet your needs. It is very important to understand the problem and expectations as well as the ear assessment so that we may do to best help with your difficulties.
What to Expect in the Tinnitus Clinic
The initial appointment will last between 60-90 minutes with a detailed history taken about your tinnitus, a thorough hearing assessment and a discussion about the impact it is having on your life. You can expect to be asked some detailed questions about the experience of tinnitus, for example:
- What does your tinnitus sound like?
- Is it continual or intermittent?
- How long have you been experiencing these sounds?
- Were there any significant things going on in your life when you first noticed it?
- How does your tinnitus impact or intrude on aspects such as concentration and sleep?
- What coping strategies do you already use?
By asking questions like these, the tinnitus specialist can help a patient build a treatment plan, in terms of what might be the best strategies for helping manage their tinnitus. These questions also help to explore views that patient’s have about their tinnitus and whether these are realistic and helpful.
The therapy prescribed will depend on the needs of the individual and the cause of the tinnitus. Understanding and having some information about your tinnitus is the first step towards effectively managing it and for some, simply knowing why they have tinnitus is all that is needed to reduce anxiety levels and actually help improve the perception of the tinnitus.
Further follow up appointments will be made as and when required. We aim to help patients with their tinnitus as quickly as possible. But just like many other problems, the speed at which our help takes effect and how many appointments it takes varies widely. The Tinnitus specialist will take a very personalised approach which goes at the pace the of each person. Improving tinnitus is a collaborative approach and takes as long as it takes. Some patients are able to manage their tinnitus well after their first appointment, others may take longer.
Where can you be seen?
If you do have problems with Tinnitus, you may choose to have you appointment at one of the following locations:
North Devon District Hospital
Neetside Community Centre – Bude
South Molton Hospital
How to get a referral?
Ask your GP for a referral into the North Devon Audiology service.