Anaïs Behaeghel is the author of this contribution.[/caption]
In our modern society, tinnitus, also known as ear ringing, is a phenomenon that is becoming increasingly common in the general population. That it can have a major impact on the lives of people who suffer from it is not surprising to anyone, yet to this day many questions still arise about this symptom. Tinnitus is in principle a phantom sound, which means that it is a sound that no one else can hear. But how does tinnitus actually arise and why does one person suffer more from it than another?
In audiology, we speak of both objective and subjective tinnitus. According to many explanatory models, subjective tinnitus often results from hearing damage. However, this is not necessarily the same as hearing loss: hearing damage can be present without hearing loss being measured on a standard hearing test (namely audiometry). Hearing damage can result from various things: regular exposure to sound intensities that are too high, age-related factors, genetic factors, or trauma. Because there is damage to certain regions in our auditory system, less sound reaches our brain than before. The brain, which is used to receiving this input, compensates for this loss of stimulation by increasing activity in the auditory system: this is how the tinnitus tone arises.1
However, subjective tinnitus can also arise as a result of certain pathologies such as Ménière's disease and acoustic neuroma (a benign tumor on the hearing nerve) or due to sensorineural hearing loss, which is a type of hearing loss in which there is damage to the inner ear or hearing nerve. This can, for example, occur due to age-related hearing loss, genetic factors, but also due to the pathologies already mentioned above.
It is important in clinical practice to determine where tinnitus comes from. In the first place, it is examined whether the symptom is related to a pathology, as described above. These matters must be ruled out on the basis of audiological testing with, for example, audiometry and, if certain conditions are suspected, also by means of imaging. Emphasis is placed on this when a patient has had persistent tinnitus for more than 6 months, has associated hearing loss, or when they only hear the tinnitus in one ear. To make a diagnosis, patients are also asked about the characteristics of the tinnitus: whether the tinnitus sounds pulsating, whether certain neurological problems have emerged in combination with the tinnitus, or whether there is asymmetrical hearing loss. It is also examined whether the patient experiences unilateral or bilateral tinnitus, hearing changes that accompanied tinnitus, and the impact of the tinnitus complaint on the patient's life. To determine the impact of complaints, the Tinnitus Handicap Inventory (THI) is often used, a questionnaire that asks about the impact on specific situations in daily life.2
Now one might wonder why tinnitus does not develop in everyone with hearing damage or hearing loss. The perception and maintenance of tinnitus depends on various underlying factors, including attention and emotional experience of the complaints. There are tinnitus patients who experience the complaints but do not suffer from them. Other patients suffer greatly, and this may be related to the way they (unconsciously) react to it. This can, for example, cause fear in certain patients, causing them to pay more attention to the complaints. This brings the complaints to the fore and keeps them alive. However, in many people, the complaints fluctuate in intensity or the tone is sometimes present and sometimes not. This can be due to individual factors: is there a lot of stress, sleep problems, ...? then the complaints can increase at certain times. Jaw and neck complaints or even trauma (in the past) can also influence the complaints and their aggravation.
Based on this, it can be stated that tinnitus does not have a single cause and that its treatment must be tailored to each patient and customized. A treatment method that is often used in tinnitus patients who do not suffer from one of the mentioned pathologies (Ménière, acoustic neuroma, ...) is cognitive behavioral therapy. This teaches one to cope with the complaints and the negative, sometimes fearful feelings around the complaints in order to reduce their impact. Furthermore, any sleep problems are addressed and, when there is hearing loss, this is also treated. This is done by means of hearing aids, which compensate for the hearing loss, allowing the brain to be optimally stimulated again and the tinnitus tone decreasing in many patients.3
A good understanding of the complex interplay of hearing-related, psychological, and physical factors that lead to the complaints is an important step in developing a good treatment plan for patients with tinnitus.
1 Auerbach, B. D., Rodrigues, P. V., & Salvi, R. J. (2014). Central Gain Control in Tinnitus and Hyperacusis. Frontiers in Neurology, 5, 206. https://doi.org/10.3389/fneur.2014.00206
2 Dalrymple, S. N., Lewis, S. H., & Philman, S. (2021, 1 juni). Tinnitus: Diagnosis and Management. AAFP. https://www.aafp.org/pubs/afp/issues/2021/0601/p663.html
3 Dalrymple, S. N., Lewis, S. H., & Philman, S. (2021, 1 June). Tinnitus: Diagnosis and Management. AAFP. https://www.aafp.org/pubs/afp/issues/2021/0601/p663.html