Tinnitus is the sensation of a sound in the ear or head that is not being produced by an external source. In simpler terms tinnitus is noise, heard in the head or the ear that is generated from within the individual. The sound can be of any pitch or type, continuous or intermittent. There are many different disorders that can produce such symptoms. It is quite common to have mild tinnitus, and around one in five people report they are occasionally affected. Around one in 200 people has tinnitus so badly that it affects their ability to lead a normal life.

Symptoms of tinnitus
The sensation of tinnitus is the sound of high-pitched whistling or buzzing, ringing or hissing. It can also be a quite complex sound, like the roar of an ocean. The sounds may be constant or come and go. Whatever the cause of the tinnitus, it is almost always made worse by stress, which can be physical, emotional or psychological. Some people can clearly hear the sound of their tinnitus and are able to live with it quite happily. In others, the sound is terribly annoying and can often drive them to distraction. The sound can be in one or both ears, or perceived elsewhere in the head. It is equally common in men and women and can be associated with almost any disorder of the ear.

Causes and risk factors for tinnitus
Most tinnitus is caused by a problem with the "sensorineural" system, which is involved in transmitting signals from the inner ear to the brain. Tinnitus is often associated with hearing loss. For this reason it is more common in older people who have age-related hearing loss.

Exposure to loud noise at work may also be responsible. For instance, operators of pneumatic drills, workers in noisy factories, musicians and DJs may be at particular risk. Other possible causes of tinnitus are listed below.
  • Ménière's disease, which results from an increased pressure in the inner ear and also causes deafness and vertigo
  • otosclerosis, a condition in which the small bones of the middle ear become immobile
  • ear infections and inflammation
  • wax in the ear
  • otitis media with effusion (an ear infection often known as 'glue ear' in children)
  • acoustic neuroma, a benign (non-cancerous) tumour of the auditory nerve, which carries signals from the inner ear to the brain
  • high doses of drugs including aspirin, quinine and some antibiotics
  • anaemia
  • head injury
  • low thyroid hormone levels (hypothyroidism)
  • disorders of the heart and blood vessels, particularly in the head
  • high blood pressure
  • an autoimmune disorder, such as lupus (systemic lupus erythematosus)
  • problems with the temporomandibular joint (TMJ) - the joint between the jaws, which can also lead to pain in the head or face
  • an abnormality of the Eustachian tube, that can result in a whooshing sound
The type of sound heard with the tinnitus does not necessarily indicate what the underlying cause might be, nor whether the cause is serious or trivial. The sufferer will be carefully examined by a specialist, usually an ENT (ear, nose and throat) surgeon or an audiological physician (doctor specialising in hearing). He or she will take account of the symptoms and may perform a number of tests, which include hearing tests, balance tests and blood tests. If the doctor feels that a further investigation of the inner parts of the ear is required, a magnetic resonance imaging (MRI) scan of the head may be organised

Treatment Any underlying disorder, such as an ear infection, acoustic neuroma or Ménière's disease, must be treated appropriately. People with chronic tinnitus without an easily treatable cause, are encouraged not to listen for their tinnitus and aim to concentrate on other things. If the hearing is impaired, wearing a hearing aid often helps by "masking out" the problem sound with the amplified external signal. In much the same way, special devices (that look like hearing aids) are used as part of tinnitus retraining treatment. These produce particular sounds to mask out the noise of the tinnitus which is accompanied with training to help block out the annoying aspects of tinnitus.

The psychological attitude towards tinnitus is crucial and people with a positive attitude to dealing with it tend to find it more manageable. Depression or anxiety can make tinnitus more of a problem and treatment of these conditions may help bring some relief. A range of other treatments including dietary supplements, electromagnetic stimulation and medicines (including antiepileptics and anti-sickness drugs) have been tried, but their effectiveness has not been proven.

Any therapy that promotes relaxation and a sense of wellbeing may be useful in relieving tinnitus or the distress it causes. Techniques include yoga, the Alexander technique, meditation, hypnosis and acupuncture. The herbal remedy ginkgo biloba and St John’s Wort may help in some cases. It is to be noted that certain prescription drugs may help the condition.

In “ Tinnitus: Turning the Volume down”, Kevin Hogan defines tinnitus in lay language as “any noise produced in either the ear and/or the unconscious portions of the brain that is experienced, in large part, from the conscious portion of the mind spending time in a feedback loop that is constantly moving from hearing noise to experiencing negative emotions, ad infinitum. In simpler terms yet, tinnitus is noise, heard in the head or the ear that is generated from within the individual.

Jastreboff, the originator of Tinnitus Retraining Therapy, describes it as a phantom auditory perception in the vast majority of cases. This is not necessarily because there is any difference in the volume of quality of the noise, especially in the first instance. It is largely because those who are bothered by it perceive it as a threat to them.

If something traumatic, frightening or just unpleasant has just happened, or is happening, when the tinnitus is first noticed, it is seen by the unconscious as a warning signal, a signal related to a bad experience and negative thoughts about its meaning and outcome. In the same way as an animal is alerted to the sound of a predator and is focused just on that sound for the purpose of survival, those who see tinnitus as a threat or a warning, can do nothing but listen to it. A conditioned response to the tinnitus sound is thus established. This is part of our unconscious and so automatic. Whatever we are doing and thinking at the time, even if we are not thinking about it at all, makes no difference. It is the response, the reaction to the tinnitus, not the tinnitus itself, which creates the distress, and the more negative the feelings and the greater the stress, the more severe is the distress.

So the greater the amount of negative emotion, the more the conditioned reflex is enhanced, with the result that more and more attention is given to the tinnitus. It is important to note that, because emotions are so involved, the limbic area of the brain and autonomous systems are stimulated to ensure that the tinnitus persists. These responses are created outside of the hearing mechanisms and so cannot be helped by audiological approaches alone. Shulman notes that sensory systems and emotions are linked by memory. “The key to understanding tinnitus is realizing that you are hearing an ever present memory, similar to a Pavlovian conditioned response that loops endlessly.” The link between tinnitus and emotion is so powerful and so bonded in the brain that the loop spins endlessly and the question arises “Whichever came first?” Once tinnitus loses its negative associations, it does begin to reduce and finally even diminish, especially once negative beliefs about its meaning and outcome are altered.

Before we are consciously aware of any sound, networks of nerve cells, acting as filters in the subconscious part of our brain concerned with hearing, pick up signals on a need to hear basis. For instance, we may be unaware of the sounds of traffic outside our office or house, or by the twittering of sparrows, or the rain against the window, but we do become aware of that bang or siren, or something else unusual. We are not consciously aware of many sounds because they are not perceived as threats and so we have no reaction to them. If there is no reaction to a particular sound, then habituation occurs. As a result, we no longer feel negatively or are distracted by it. When we habituate the tinnitus we are no longer monitoring it and so we hear it less loudly, less often, start to believe that it can be altered and maybe, after a while, not notice it at all. With habituation we respond less and less to a stimulus – so long as it does not have any negative meaning.

At one time masking was thought to us useful as it made the tinnitus inaudible. However the tinnitus must be audible for habituation to occur. Wearable sound generators are helpful in most cases as they allow the tinnitus to be heard at the same time. These sound generators must be fitted and instructions for their use given, by a trained professional audiologist.

Clients can do much to habituate the tinnitus on a self help basis using sound enrichment. It is most important to realise that silence should be avoided at all costs. Sounds of nature are often the best in order to introduce a pleasant, non-intrusive background sound as are waterfalls, fountains and wind chimes. After all, our hearing system as humans was developed along with ever present natural sounds. Many sufferers of tinnitus experience a very early reduction in the intrusiveness and severity of their tinnitus as a result of such sound enrichment.

In hypnotherapy the healing goal is to change the interpretation of the sound that is heard. To get from “ This noise is driving me to despair” to “It is now just annoying” is a huge step and may take many weeks, maybe many months, perhaps even a year or more. There needs to be a realistic expectation that bad days WILL be experienced but also that it WILL improve in the long term. Progress may be frustratingly slow but progress there will be.