Tinnitus: Why Does It Happen?

Tinnitus is not a disease, but rather a symptom associated with a number of causes and aggravating co-factors.

Before we can understand what tinnitus is, we must understand how we hear. 

How do we hear?

Hearing occurs in our brain, not in our ears. Our ears are the vehicle to get sound into the brain, and hearing occurs in the auditory cortex of the brain. If the neurons between the ear and the auditory cortex are triggered to fire, then a sound is perceived by the brain. External sounds cause these neurons to fire, leading to a sound perception. 

But other things can also cause these neurons to fire (inside the brain). The number one cause of tinnitus is hearing loss. When there is a hearing loss, the neurons in the brain are not  stimulated enough by external sound. These neurons are bored and start to fire randomly on their own, which leads to a perception of sound in the brain. When people feel that they cannot hear because the tinnitus is so loud in their head, it is actually the opposite. The ringing is happening because of a hearing loss which is why they are struggling to hear. Hearing aids often solve this problem by providing stimulation to those bored neurons and giving them a job to do - making the tinnitus go away.

Even people with normal hearing can have tinnitus. This can be due to an ultra-high frequency hearing loss that is not detected on a standard hearing test or auditory trauma from noise over the course of one's life. Harmful noise can damage the hair cells (sensory cells) in the inner ear as well as the synapses between neurons in the auditory pathway. This disruption can also lead to tinnitus. 

More causes of Tinnitus

There are many other causes of tinnitus, from medications and pain relievers to neck or jaw issues, sleep deprivation and stress, anxiety, and depression. If someone has a lot of neck tension or jaw issues, these neurons run alongside the auditory nerve. When they are overactive or on fire, that energy bleeds over to the auditory nerve triggering those neurons to fire. Resulting in the perception of sound in the auditory cortex. 

Whether this sound is perceived by the brain as tinnitus can be affected by other factors including medications, pain relievers, alcohol, tobacco, recreational drugs, diet, general health, and the biggest three being fatigue, stress and anxiety. Audiologists have seen a huge uptick in tinnitus patients since COVID, mostly due to the unusual stressors in the life of a pandemic. 

Now we know what can cause tinnitus, how do we manage it?  

It's very frustrating when patients come to The Hearing Solution after being told that tinnitus is not curable and there is nothing they can do about it. This is absolutely not true. Sure, we know that tinnitus is not curable in the sense that a hearing loss is permanent (and usually the cause of tinnitus). We know that the random triggering and firing of the neurons along the auditory pathway will occur, but whether or not the brain PERCEIVES a sound can change and even go away. 

This happens through a process called habituation. Habituation is a fancy term for getting used to a perception to the point it is pushed out of your conscious awareness. A good example of this is if you move next to a loud freeway. At first you hear the freeway and think, wow this loud, how will I ever get used to it? But over time, your brain knows what this sound is and learns that it is not important.

Our brains are very efficient, and they don't like to devote cognitive energy on things that are not important to our lives or survival. Once our brains know the sound is not important, they stop giving cognitive resources to it. It is pushed out of your conscious awareness, unless of course you think about it. 10% of the population has tinnitus, and for most people it is not bothersome because the process of habituation has occurred naturally. However, within that population, 10% have what we call "bothersome" tinnitus, where the tinnitus begins to affect their lives. This is when The Hearing Solution would encourage someone to seek help from a qualified audiologist (tinnitus specialist) or cognitive behavioral therapist to help aid in the habituation process. 

3 important things ways help manage tinnitus

1. Get educated. There is a lot of misinformation online so it’s always recommended seeing a tinnitus specialist who will learn about your history and assess your hearing. This will help educate you as to what is causing your tinnitus and how you can treat it.
   

2. Use sound therapy. This can be done at home with a white noise machine or many different apps with background noise generators. Some favorite apps are Starkey Relax, Widex Zen Tinnitus, or ReSound Relief. Keep in mind, the key to using tinnitus “maskers” is to NOT mask the sound of the tinnitus. Your brain cannot habituate to something it cannot perceive, so if you drown out the sound of your tinnitus, it does not help the process of habituation.
   

3. Change your reactions and feelings to the tinnitus. If your brain has negative reactions and emotions associated with the tinnitus, it will become more of a problem. Changing your feelings about the tinnitus will allow your brain to relax and recognize that the tinnitus is not an important sound you need to focus on. It will then be pushed out of your conscious awareness. Mindfulness meditations are an evidence-based or research-based way you can do this. 
   

“I have constant tinnitus and love the HeadSpace app when my tinnitus is bothering me at night.” - Dr. Kirsten McWilliams, Audiologist

As the only Audiologist board certified for tinnitus management by the American Board of Audiology in the Sacramento area, owner Kirsten McWilliams is trusted by UCSF and has received an extensive list of raving reviews from her patients.

For help managing your tinnitus, schedule a consultation with The Hearing Solution today by calling (916) 646-2471 or click the button below to request an appointment with us.