What is Tinnitus?

Tinnitus is the term for a perception of sound in the absence of external auditory stimulus. It is often described as ringing in the ears. However, people may report their internal sound as hissing, buzzing, or chirping. Yet others describe the sound as sizzling, roaring, or humming. In some listeners, tinnitus is intermittent and in others, constant. The perceived volume can range from soft to extremely loud.

Tinnitus is a symptom of dysfunction in the auditory system. It is a common disorder, especially in people with measureable hearing loss. Between 40 and 50 million Americans experience tinnitus, 10 to 12 million of those with severe tinnitus seek medical attention, and 2 million consider tinnitus to be disabling, interfering with their ability to concentrate and sleep.

Hearing is a complex process that begins with sounds in the environment. These sounds or vibrations enter the ear, are conducted through the middle ear, and then are turned into electrical signals in the inner ear. The electrical signals are carried to the brain by the auditory nerve. As soon as these nerve impulses reach the brain, the listener is aware of the presence of sound.

Hearing loss occurs when any structure in the auditory system malfunctions. Tinnitus often accompanies hearing loss due to inner ear disorders such as excessive noise exposure or aging. Sensorineural hearing loss is usually permanent in these cases, and the accompanying tinnitus may also be permanent. However, tinnitus can also accompany temporary hearing problems such as those resulting from an ear infection or ruptured eardrum. In cases of conductive hearing loss, when the medical condition is resolved, the tinnitus can disappear. Audiologists assess the hearing of tinnitus sufferers to determine if there is hearing loss and whether the type is sensorineural, conductive, or mixed -  combination of the two.

Because hearing loss reduces the amount of external sound entering the auditory system, it may lead to listeners becoming aware of their neurological ?noise floor,? in other words, their base level of neurological activity. In addition, auditory pathways of the brain may attempt to increase auditory sensitivity in the inner ear to compensate for reduced auditory stimuli. Another view is that the nerve fibers connecting the brain to the inner ear may no longer function normally to suppress the perception of tinnitus. Regardless of the exact mechanism, listeners react to chronic tinnitus with anxiety and feelings of stress if the limbic system (a system that governs involuntary reactions to stimuli) becomes activated.

Is there any hope for tinnitus sufferers?
Yes! Some ear, nose, and throat doctors and audiologists do not provide treatment for those who suffer from annoying tinnitus. However, other medical and audiological specialists do devote their practice to providing intervention for those distressed and frustrated by their chronic tinnitus.

Audiologists who treat patients with tinnitus ask questions such as the following:
How does the tinnitus sound?
Is it intermittent or constant?
Does the tinnitus fluctuate in intensity?
What makes the sound worse?
What makes it better?

Following assessment of hearing, audiologists ask patients to match their tinnitus to tones presented through earphones. Most patients report their tinnitus closely correlates with the particular frequency at which they have the greatest hearing loss. Audiologists also measure the loudness of the patients? tinnitus, as well as how loud a sound must be to mask or cover up theperception of the tinnitus, and whether the tinnitus can be temporarily reduced after this masking sound has been turned off.

Once the tinnitus has been well defined, audiologists who treat patients with tinnitus choose an intervention method. Various strategies have been used - herbal remedies, counseling, tinnitus retraining, and surgery - with mixed results. In an attempt to relieve severe and chronic tinnitus, some doctors even resorted to cutting the auditory nerve. However, this procedure ended after surgical patients reported their tinnitus persisted.

Recently, a number of tinnitus specialists have investigated a new treatment method called Neuromonics - which arrived in the United States about a year ago. Patients who meet certain guidelines (e.g., degree of hearing loss, etiology of tinnitus) may choose to explore this alternative. The Neuromonics Tinnitus Treatment involves education, coaching, and use of a medical device that is customized for individuals based on their hearing and tinnitus profile. Patients have reported immediate relief at being able to hear sound without simultaneous awareness of their tinnitus.

Initially, the Neuromonics device is used daily for a few hours to permit the tinnitus patient to concentrate on specific tasks or to drop off to sleep. Over time, patients are able to experience the same relief from the aggravation of tinnitus, even when the device is not being worn. When this occurs, the brain has adjusted, at a subconscious level, so that little to no negative reactions are experienced by patients with tinnitus.

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