Tinnitus is one of the most common afflictions in the United States, affecting approximately 32 percent of the population. Tinnitus is the perception of sound when no actual external noise is present. Roughly 20 million people struggle with burdensome chronic tinnitus, while 2 million have extreme and debilitating cases. Our experts are here to help you understand bothersome vs. non bothersome tinnitus, and what you can do!
What is Tinnitus?
While this may be commonly referred to as a ringing in the ears, tinnitus can manifest many different perceptions of sound, including buzzing, hissing, whistling, swooshing, and clicking. In some instances, tinnitus patients report hearing music. Tinnitus can be both an acute (temporary) condition or a chronic (ongoing) health malady.
Objective vs. Subjective Tinnitus
Those with subjective tinnitus suffer from head or ear noises that are perceivable only to the specific patient. Subjective tinnitus is frequently traceable to auditory and neurological reactions to hearing loss but can also be caused by an array of other stimuli. More than 99% of all tinnitus reported tinnitus cases are of the subjective variety.
Objective tinnitus is head or ear noises that are audible to other people and the patient. These sounds are usually produced by internal functions in the body’s circulatory (blood flow) and somatic systems. Objective tinnitus is very rare, representing less than 1% of total tinnitus cases.
Tinnitus cases can vary significantly from patient to patient, with some tinnitus being extremely bothersome and even life-altering, while other cases of tinnitus can just be a mild inconvenience.
Since tinnitus is generally a subjective condition, it can often be challenging to measure. However, there are clinical ways to measure its audiometric qualities and impact on a patient.
Diagnosing and Measuring Tinnitus
The first step in treating tinnitus is appropriately diagnosing and measuring tinnitus.
Trained audiologists and other hearing health professionals have tools and clinical protocols to help evaluate and diagnose tinnitus. Because tinnitus is so often caused by hearing loss, most audiologists will begin with a comprehensive audiological evaluation that measures the patient’s overall hearing health.
Some of these tests include a speech recognition test or a subjective measure of how well the patient hears and can repeat certain words. Another is a pure tone audiogram. This subjective test measures the patient’s hearing across multiple frequencies (measured in Hertz) and volumes (measured in decibels).
Another test that can be performed is a tympanogram, an objective test that measures the functioning of the middle ear, or an acoustic reflex test. This objective test measures the contraction of the middle ear muscles in response to loud sounds.
Another middle ear test is an otoacoustic emission testing. This is the use of very sensitive microphones to objectively measure the movement of hair cells within the middle ear.
It is crucial to determine the specific gaps in a tinnitus patient’s hearing because this often correlates to the nature and quality of their particular tinnitus. A classic example of this would be high-frequency hearing loss, often corresponding with high-frequency tinnitus.
It is important to note that specific hearing markers may inform different potential treatment options for tinnitus.
Evaluating Tinnitus Results
When evaluating tinnitus cases, hearing health professionals use an additional set of tests. While there is currently no way to test for tinnitus objectively, there are several protocols to measure the patient’s subjective perception of tinnitus sound, pitch, and volume.
One such protocol is tinnitus sound matching. This is the presentation of common tinnitus sounds back to patients to help them identify their specific perception of tinnitus. The health professional may adjust the pitch and layer multiple sounds to create an exact audio recreation of the tinnitus. Sound matching provides an essential baseline for subsequent tinnitus management therapies, often customized for each patient.
It is also important to determine the minimum masking level or the volume at which an external narrowband noise masks the perception of tinnitus. Determining the minimum masking level provides an approximate measure of how loud a patient perceives their tinnitus and can be used in subsequent tinnitus masking and sound therapies.
The loudness discomfort level is the volume at which external sound becomes uncomfortable or painful for a tinnitus patient. Determining loudness discomfort levels is particularly important for patients with hyperacusis, extreme sensitivity to noise. This measurement informs the feasibility of sound therapy, masking, and hearing aids as potential tinnitus treatments.
Other Impacts of Tinnitus
But tinnitus doesn’t just impact hearing. It can cause a cascade of negative mental, cognitive, and physical consequences. The difference between tinnitus being a minor or major issue of the patients is less often related to how loud tinnitus is, but rather how the tinnitus impacts other facets of patients’ lives.
There is currently no verified cure for most types of tinnitus. There are, however, treatment options that can ease the perceived burden of tinnitus, allowing patients to live more comfortable, productive lives.
If you or a loved one believes you may be suffering from tinnitus, it is essential to contact a hearing specialist immediately. A simple action such as taking a quick hearing test can frequently be the difference between stopping your tinnitus in its tracks and letting it escalate and disrupt your life.