In today’s world we are constantly bombarded with sound. Many sounds are enjoyable, but unfortunately there are often situations where sound becomes noise. So what is noise? Any unwanted sound. Everyone perceives “noise” differently because we all have different levels of sensitivity to noise.
Noise can be a soft continuous sound such as an air conditioner or motor running. Noise can be described as moderate levels (inside of an airplane) or a radio or TV that interferes with concentration. Extremely loud noises include a jack hammer or the firing a gun. These excessively loud noises can cause hearing loss.
Individuals with a hearing loss have greater difficulty hearing and understanding in background noise due to the damage to the ear. Understanding specific speech sounds in noise is reduced and results in a limited amount of understanding. Added to this is a problem that some hearing aids not only amplify speech, but also background noise, making hearing clearly in noisy situations very difficult.
The inner ear can be damaged by the impact of loud sound. The sensory hair cells within the inner ear (the cochlea) which are shown can become damaged or destroyed when exposed to very loud sounds. The inner hair cells cannot be repaired or regenerate, in most cases resulting in permanent hearing loss. Therefore, it is important to take care of our hearing by being cautious about our exposure to noise and utilizing ear protection whenever possible.
Deterioration of our hearing, like other senses, begins early and continues as we grow older. The degree of decline differs across individuals. It is related to heredity, genetics, aging and environmental factors. Reduction in hearing is often considered a common part of aging (the medical term used is presbycusis). This does not mean that hearing loss should be accepted passively — and by wearing hearing aids, you are taking positive steps to improve communication with family and friends.
While hereditary/genetic factors cannot be changed, we do have control over environmental factors. Loud noise is the biggest environmental factor involved in hearing decline. Noise affects the sensory (hair) cells within the cochlea.
You may find yourself misunderstanding certain sounds, making confusions between ”s,” “f” and “th” sounds and feeling that you can hear, but not understand. Initial noise exposure results in loss of high frequency (high-pitched) sounds. With repeated noise exposure, there is a greater range of frequencies that are affected.
Nearly 36 million Americans suffer from tinnitus or head noises. It may be an intermittent sound or an annoying continuous sound in one or both ears. Its pitch can go from a low roar to a high squeal or whine. Prior to any treatment, it is important to undergo a thorough examination and evaluation by your otolaryngologist and audiologist. An essential part of the treatment will be your understanding of tinnitus and its causes.
Tinnitus is commonly defined as the subjective perception of sound by an individual, in the absence of external sounds. Tinnitus is not a disease in itself but a common symptom, and because it involves the perception of sound or sounds, it is commonly associated with the hearing system. In fact, various parts of the hearing system, including the inner ear, are often responsible for this symptom. At times, it is relatively easy to associate the symptom of tinnitus with specific problems affecting the hearing system; at other times, the connection is less clear.
Most of the time, the tinnitus is subjective—that is, the internal sounds can be heard only by the individual. Occasionally, tinnitus is “objective,” meaning that the examiner can actually listen in with a stethoscope or an ear tube and hear the sounds the patient hears. Tinnitus may be caused by different parts of the hearing system. At times, for instance, it may be caused by excessive ear wax, especially if the wax touches the ear drum, causing pressure and changing how the ear drum vibrates. Other times, loose hair from the ear canal may come in contact with the ear drum and cause tinnitus.
Middle ear problems can also cause tinnitus, such as a middle ear infection or the buildup of new bony tissue around one of the middle ear bones which stiffens the middle ear transmission system (otosclerosis). Another cause of tinnitus from the middle ear may be muscle spasms of one of the two tiny muscles attached to middle ear bones. In this case, the tinnitus can be intermittent and at times, the examiner can also hear the patient’s sounds.
Most subjective tinnitus associated with the hearing system originates in the inner ear. Damage and loss of the tiny sensory hair cells in the inner ear (that can be caused by different factors) may be commonly associated with the presence of tinnitus. It is interesting to note that the pitch of the tinnitus often coincides with the area of the maximal hearing loss.
One of the preventable causes of inner ear tinnitus is excessive noise exposure. In some instances of noise exposure, tinnitus is the first symptom before hearing loss develops, so it should be considered a warning sign and an indication of the need for hearing protection in noisy environments. Certain common medications can also damage inner ear hair cells and cause tinnitus. These include non-prescription medications such as aspirin, one of the most common and best known medications that can cause tinnitus and eventual hearing loss. As we age, the incidence of tinnitus increases. Hearing loss associated with aging (also known as presbycusis) typically involves loss of and damage to the hair cells.
A special category is tinnitus that sounds like one’s heartbeat or pulse, also known as pulsatile tinnitus. At times, the presence of pulsatile tinnitus may signal the presence of a vascular tumor in the general vicinity of the middle and inner ear. When noting this type of tinnitus, it is advisable to consult a physician as soon as possible to rule out the presence of this type of vascular tumor.
Conditions that affect the hearing nerve can also cause tinnitus, the most common being benign tumors, typically originating from one of the balance nerves in close proximity to the hearing nerve. These are commonly referred to as acoustic neuroma or vestibular schwannoma. Tinnitus caused by an acoustic neuroma is usually unilateral and may or may not be accompanied initially by a hearing loss.
Tinnitus may also originate from lesions on or in the vicinity of the hearing portion of the brain, called the auditory cortex. These can be traumatic injuries with or without skull fracture, as well as whiplash-type injuries common in automobile accidents. Benign tumors known as meningiomas that originate from the tissue that protects the brain may also be a cause for tinnitus that originates from the brain.
There are a number of non-auditory conditions that can cause tinnitus, as well as lifestyle factors. Hypertension or high blood pressure, thyroid problems, and chronic brain syndromes can all cause tinnitus without any specific auditory problems. Stress and fatigue may cause tinnitus, or can contribute to an exacerbation of an existing case. Poor diet and lack of exercise that may cause blood vessel and heart problems may also either cause it or exacerbate an existing condition. It is also possible that tinnitus could be caused by food or beverage allergies, but these causes are not well documented and are difficult to sort out.
If an otolaryngologist finds a specific cause for your tinnitus, he or she may be able to offer specific treatment for the cause that also eliminates the noise. This determination may require extensive testing, including x-rays and other imaging studies, audiological tests, tests of balance function, and other laboratory work. While there may currently be no specific medication for tinnitus that is supported by rigorous peer reviewed scientific evidence, there is science to support a number of treatment options such as hearing instruments with or without amplification (hearing aids) that include background tones or music, cochlear implants or electrical stimulation, cognitive therapy, and sound therapy/tinnitus retraining therapy (TRT).
It is relatively rare but not unheard of for patients under 18 years old to have tinnitus as a primary complaint. However, it is possible that tinnitus in children is significantly under-reported, in part because young children may not be able to express this complaint. Also, in children with congenital sensorineural hearing loss that may be accompanied by tinnitus, this symptom may be unnoticed because it is something that is constant in their lives. In fact, they may habituate to it; the brain may learn to ignore this internal sound. In pre-teens and teens, the highest risk for developing tinnitus is associated with exposure to high intensity sounds, specifically listening to music. In particular, virtually all teenagers use personal MP3 devices and nearly all hand-held electronic games are equipped with ear buds. It is difficult for a parent to monitor the level of sound children are exposed to. Therefore, the best and most effective mode of prevention of tinnitus in children is proper education relative to excessive sound exposure, as well as monitoring by parents or other caregivers.