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Can you hear sounds that just aren’t there? Your ears whistle, ring, hum, hiss or throb, apparently without any reason. One in two people experiences noises in their ears at least once in their lifetime, and one in five people develops chronic tinnitus. The problem is that the sounds seem very real to those affected. Tinnitus is a phantom noise that is really quite difficult to deal with. What exactly is tinnitus? Does it go away on its own? Can it be cured? Or do you have to learn to live with it? You can find answers and useful tips here.

What is tinnitus and how is it identified?

Tinnitus is a phantom noise without an external sound source. Its development in the inner ear and the brain remains a mystery to the scientific community. The only thing we do know is that it’s not a illness, but a symptom.

The sounds in the ear differ from patient to patient in terms of tone, pitch, volume and level of perception. Sometimes it is perceived in one ear, and sometimes in the very center of the head. It may appear in passing phases, in wave-like intervals or may be continuous – and you can never forget that it’s there. Tinnitus is frequently associated with hearing loss.
Friends walking on the beach

Is tinnitus harmful?

Purely from a medical perspective, no; however, permanent exposure to noise may affect the mind. This is because some people affected feel that their tinnitus is a form of never-ending torture. It disturbs their concentration during the day and robs them of sleep at night.

This is the background: If the noise in the ear of the person affected is perceived as threatening or significant, emotional reinforcement mechanisms are activated in the limbic system (responsible for processing emotions in the brain) that set off a vicious circle.
This person is then almost virtually constantly aware of the tinnitus.
 
But far from all of those affected by tinnitus feel severely afflicted by the noises in their ears. There is therefore a difference between compensated tinnitus and decompensated tinnitus.
Compensated tinnitus
Compensated tinnitus is described by those affected as not particularly intrusive. Ideally, they can block out the noise and be unaware of it most of the time.
Decompensated tinnitus
Decompensated tinnitus is always present and causes high levels of psychological strain. It has a direct negative impact on quality of life. This means that insomnia, stress, anxiety, depression and social isolation can all be the result of decompensated tinnitus. In some patients, the phantom noise also triggers headaches, earaches, dizziness and muscular tension.

How long does tinnitus last?

Tinnitus may occur briefly, then immediately disappear again. It may remain for several months, or last a lifetime. Generally, medical professionals distinguish between three forms:
  • Acute tinnitus: Persists for less than three months, and often stops spontaneously. Treatment with medication may sometimes help in this case.
  • Subacute tinnitus: Always recurs within three to twelve months. Treatment with medication and/or relaxation exercises may improve the condition.
  • Chronic tinnitus: The symptoms persist for over twelve months, and only rarely subside without therapeutic or pharmaceutical intervention.

How do I get tinnitus?

Even if no-one other than the person affected can hear the noise and there are no doctors who can diagnose it using conventional methods, subjective tinnitus is neither a hallucination nor an imaginary disorder. But how the phantom noise develops is still not entirely clear. Although there are various theories, none has been proven.
 
But one thing is clear: Only in rare cases do these annoying noises in the ear occur for no reason at all. The most common causes of tinnitus are injuries, illnesses and anatomical changes.

These are the main causes of tinnitus:

Inner ear

Tinnitus may develop in the inner ear due to an acoustic trauma, acute hearing loss or age-related hearing loss. Scientists suspect that, after damage to the sensory cells in the cochlea, certain sounds are only faintly transmitted to the brain,  or not transmitted at all. The auditory response area in the brain then tries to compensate for the missing frequencies by "turning up the volume" – even if the person is not hearing that sound at all. Therefore, it has been calculated that the sound of the tinnitus ironically often corresponds to those frequencies that the person affected has difficulty hearing, or can no longer hear at all.

Middle ear

 Subjective tinnitus cannot be measured externally. This makes it very hard for a doctor to determine the specific trigger, thus rendering treatment even more difficult. The cause may originate in different areas of the ear, as well as the nerves or the brain. Tinnitus may also occur when the auditory canal is blocked.
  • It may occur in the inner ear due to an acoustic trauma or acute hearing loss, or as the result of age-related hearing loss . Researchers suspect that specific tones are no longer transmitted to the brain following damage to the inner ear. The brain therefore attempts to compensate for the unavailable sound by creating them. In this case, a sound often develops in the ear that is affected by the hearing loss.
  • In the middle ear, the trigger may be a defective eardrum . Inflammation is another cause.
  • In some patients, tinnitus may also be due to a malfunction in the brain . In this case, the tinnitus disappears if the auditory nerve is severed. Potential causes of the malfunction include meningitis or a tumor in the auditory center of the brain. In addition, tinnitus sometimes has a psychological cause.

Brain

In some patients, tinnitus may be due to a malfunction in the brain. In these cases, the tinnitus does not disappear even if the auditory nerve is severed. There are only rarely concrete causes of this malfunction, but sometimes meningitis or a brain tumor can be behind it.

Objective tinnitus

In rare cases of what is known as objective tinnitus, however, the noises in the ear can be measured by an ear nose and throat (ENT) doctor using special equipment. Anatomical changes in the blood vessels in the inner ear or damage to the middle ear are usually responsible for the noise in the ear.
 
Objective tinnitus is usually a side effect of another disorder, for example Ménière’s disease (disorder of the inner ear, with dizziness, nausea and hearing loss). This kind of tinnitus can be treated with medication or with surgical intervention.

Typical characteristics of objective tinnitus:

  • A noise in a person’s ear that is in time with their pulse indicates vascular constriction in the inner ear. At best, this is just some earwax in the ear canal in the vicinity of the eardrum.
  • can lead to a clicking noise in the ear.
  • If the sound of the tinnitus is linked to breathing, the cause may be a damaged closure of the auditory tube (Eustachian tube). This tube, which is around 4 cm long, connects the ear to the neck and throat area.
  • Grinding and crunching noises in the ear may occur in the case of disorders and wear of the mandibular joint.

What are the main triggers of tinnitus?

Stress
What was previously just a suspicion has now been confirmed: Stress leads to the development of tinnitus. Studies have shown that those affected by acute hearing loss and tinnitus have more frequently been under severe stress than other ENT patients. Tinnitus is particularly frequently linked to chronic, continuous stress due to family and work-related worries – or is a result of traumatic life events, such as a death in the family.
Medication
Unpleasant noises in the ear may be a side effect of certain medication. In particular, specific pain and rheumatism medications, remedies for malaria, and some antidepressants may trigger the symptom of tinnitus. It is suspected that various remedies for high blood pressure, such as ACE inhibitors and betablockers, also trigger tinnitus, however.
Noise
Excessive strain on your hearing by loud noises is the most common trigger of tinnitus. In this case, time is an important factor: Those who have regularly been in a noisy environment (workplace noise, traffic noise, loud music) for years without suitable hearing protection are at much higher risk of tinnitus. The same applies to patients with acoustic trauma.
Stimulants
Some experts think that alcohol and nicotine can lead to the development of tinnitus. It used to be thought that another possible trigger was caffeine, but since then there have been studies suggesting that high caffeine consumption actually lowers the risk of tinnitus.

What should I do if I’m affected by tinnitus?

Suddenly occurring, intrusive noises in the ear usually disappear again on their own. It is often sufficient to give yourself and your hearing a rest. But what should I do if the whistling or whooshing noises in my ear just don’t stop?
 
Important: If the noise in your ear lasts longer than 24 hours, you should seek the advice of an expert, because the earlier you do something about acute tinnitus, the better your chances of recovery, and the more likely you are to prevent chronic tinnitus.

You can find important information about treatments and therapy for tinnitus here: Tinnitus - Prevention and Treatment

Who should I go to for help?

You will get the best information and help from an ear nose and throat doctor or an audiologist. Depending on the type and severity of your impairment, the doctor at the ENT practice will give you an individual treatment plan, and will start you on appropriate therapeutic measures.

Other topics

Preventing and treating tinnitus
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