Tinnitus is the perception of noise or ringing in the ears. It is a common condition that affects about 15 to 20 percent of people. Tinnitus is not a disease, but rather a symptom that can result from a range of underlying causes. There has been debate over whether tinnitus should be classified as a neurological or psychological condition. Research suggests that in most cases, tinnitus has origins in the auditory system and brain. However, psychological factors may play a role in how bothersome or distressing tinnitus symptoms are for some patients. Understanding the neurological and psychological aspects of tinnitus can help guide effective management strategies.
What causes tinnitus?
In most cases, tinnitus is initiated by damage or dysfunction in the auditory system. Potential sources include:
– Noise exposure – Exposure to loud noises can damage hair cells in the inner ear that detect sound. Military service, work in noisy environments, concerts, and listening to loud music are common causes of noise-induced hearing loss and tinnitus.
– Aging – As people age, hair cells in the inner ear gradually become damaged and die off. Hearing tends to worsen with age, and tinnitus becomes more common.
– Ear blockages – Built up ear wax, ear infections, and benign growths can put pressure on structures of the ear and cause tinnitus.
– Ménière’s disease – This inner ear disorder causes dizziness, ringing in the ears, hearing loss, and a feeling of fullness or pressure in the ear. It results from a buildup of fluid in the inner ear.
– Head or neck injuries – Trauma to the head or neck can affect the auditory pathways and result in tinnitus.
Tinnitus and hearing loss often go together
Many underlying causes of tinnitus also result in some degree of hearing loss. When sensory hair cells are damaged, signals from the ear to the brain are interrupted or diminished. While tinnitus may arise from damage anywhere along the auditory pathway, hearing loss and tinnitus often coincide.
How the brain processes sound
Our perceptions of sound originate in the auditory cortex of the brain. Even in the absence of external noise, spontaneous neural activity in auditory areas of the brain produce weak nerve signals. Normally, we do not notice these background signals because our brains tune them out.
However, damage to the auditory system may change the brain’s ability to filter out neural noise. These changes cause some people to become more aware of the constant background neural activity. The result is perception of phantom noises like ringing, buzzing, clicking, hissing, or roaring.
Is there a psychological component to tinnitus?
While tinnitus begins with dysfunction in the auditory system, psychological factors may influence the severity of symptoms and level of distress. Features that suggest a psychological component include:
– Onset related to a significant life stressor
– Fluctuating intensity and severity of tinnitus
– Exaggerated emotional response to tinnitus
– Beliefs that tinnitus signals mental illness or brain damage
– Hypervigilance and focusing excessively on tinnitus sounds
For some patients, tinnitus triggers anxiety and depression. The constant noise can make it difficult to relax or fall asleep, leading to fatigue and distress. Feelings of anxiety may actually exacerbate tinnitus by enhancing awareness of and attention to the sounds.
Conversely, tinnitus may lead to depression. Coping with the ongoing bothersome noises can wear people down over time. Tinnitus may interfere with work and relationships, reducing quality of life.
Tinnitus and mental health disorders
Several studies show connections between tinnitus, anxiety, and depression:
– A meta-analysis of 28 studies found a strong correlation between tinnitus severity and symptoms of anxiety and depression.
– A study of 1700 tinnitus patients found 62% displayed symptoms of anxiety, while 55% had symptoms of depression.
– Military veterans with tinnitus show high rates of depression, anxiety, insomnia, and PTSD.
– Tinnitus is associated with stress-related conditions like generalized anxiety disorder, panic attacks, and phobias.
So while tinnitus starts in the auditory system, psychological factors clearly influence patient well-being and quality of life. Treating anxiety and depression alongside tinnitus may improve coping and resilience.
Evaluating the neurological and psychological aspects of tinnitus
Determining the underlying causes and psychological factors involved in a patient’s tinnitus can guide effective treatment. Practitioners often conduct a comprehensive tinnitus evaluation looking at:
– Medical history – when tinnitus began, associated conditions, medications, noise exposure, etc.
– Hearing tests – identify hearing loss and auditory damage
– Imaging – CTs or MRIs identify neurological abnormalities
– Psychological assessment – screens for anxiety, depression, insomnia
– Impact of tinnitus – questionnaires measure severity and life disruption
This information helps categorize the type of tinnitus:
Objective tinnitus
Objective tinnitus arises from sound generated in or near the ear. Causes can include:
– Turbulent blood flow through narrowed vessels
– Muscle spasms in the middle ear
– Auditory hallucinations in psychoses
Objective tinnitus may be treatable by resolving the mechanical issue in the ear.
Subjective tinnitus
More common subjective tinnitus originates in the auditory nerves or brain itself. It may result from:
– Noise damage
– Age-related hearing loss
– Ménière’s disease
– Head injuries
Since the sound is neurological rather than mechanical, treating the underlying condition may not resolve tinnitus. Therapeutic approaches aim to make tinnitus less noticeable and distressing.
Somatic tinnitus
Somatic tinnitus is caused by interactions between the auditory system and the somatosensory system – nerves, muscles, and bones. Movements like clenching the jaw or turning the eyes can alter tinnitus volume. Underlying disorders include TMJ and neck arthritis. Somatic tinnitus may respond to therapies like bite splints or physical therapy.
How is tinnitus treated?
Once the origins and factors involved in tinnitus have been evaluated, targeted treatments can be implemented. A multidisciplinary approach addressing both auditory and psychological aspects offers the best chance of managing debilitating chronic tinnitus.
Hearing aids
Hearing aids compensate for hearing loss and amplify ambient sounds. This auditory stimulation engages auditory channels and may make tinnitus less noticeable. Hearing aids may incorporate soothing background sounds or music.
Sound therapy
Constant, low-level soothing background sounds can shift focus from tinnitus. White noise machines, fans, radio static, or music during activities or sleep may provide relief. Custom programs combine multiple frequencies to distract the auditory system.
Counseling
Talk therapy can help identify and modify thought patterns that exacerbate tinnitus. Cognitive behavioral therapy aims to reduce negative thoughts and beliefs about tinnitus. Mindfulness training teaches patients how to direct attention away from tinnitus perception.
Relaxation techniques
Progressive muscle relaxation, deep breathing, yoga, meditation, guided imagery and hypnosis counter the anxiety and stress that can worsen tinnitus. Reducing tension and promoting relaxation moderates the body’s fight-or-flight response.
Medications
There are no FDA-approved drugs solely for treating tinnitus. However, medications that reduce anxiety, improve sleep, or decrease depression may indirectly moderate the emotional response to tinnitus. Tricyclic antidepressants like amitriptyline are sometimes prescribed off-label for tinnitus.
What is the best way to manage tinnitus?
Since tinnitus arises from a complex interplay of auditory dysfunction and psychological response, an individualized multidisciplinary approach provides the best outcomes. No single cure reliably eliminates chronic tinnitus, but a range of therapies can improve quality of life and prevent disabling symptoms. Key components of effective tinnitus management include:
– Treating any medically addressable cause of tinnitus
– Compensating for hearing loss with hearing aids
– Creating enriching background sound environments
– Equipping patients with psychological coping strategies
– Addressing associated anxiety, depression, and insomnia
– Fostering acceptance of benign chronic tinnitus
With time and perseverance, patients can gain control over tinnitus and improve their ability to function and enjoy life. Consistently applying an evidence-based combination of therapies tailored to individual circumstances offers the best chance of successfully managing chronic tinnitus.
The takeaway
In most cases, tinnitus originates from dysfunction in auditory pathways in the ear and brain. However, psychological factors like stress and associated mental health disorders often exacerbate the annoying symptoms of tinnitus and hinder habituation. Therefore, the most effective approach to managing chronic tinnitus addresses both the neurological auditory dysfunction as well as the psychological aspects that can worsen the condition. Multidisciplinary treatment combining sound therapy, counseling, stress reduction techniques, and medications as needed can significantly improve quality of life for tinnitus patients. While tinnitus cannot always be entirely eliminated, its disabling effects can be substantially reduced through evidence-based management strategies.
