The Tricky Treatment of Tinnitus

Because tinnitus is multifactorial, treating the disease is difficult--

In the vacuum of space, there are no air molecules to transmit sound.  That's why you can't hear somebody scream in space.  Moreover, you can't hear anything in space.  Unless of course you're William Shatner or Leonard Nimoy of Star Trek fame.  Why is that?  Because Shatner has and Nimoy had tinnitus or a constant noise in the ears.

Tinnitus is the sensation of sound in the absence of auditory stimulus.

  People with tinnitus hear hissing, buzzing, screeching, ringing, clicking, roaring or so forth that won't go away. Auditory hallucinations, which happen to people with schizophrenia and some other mental illness, are different; people with auditory hallucinations hear voices or music.

About 20 percent of men and 16 percent of women have some degree of tinnitus.  About 4 percent of men and 2 percent of women have severe tinnitus.  The prevalence of tinnitus is fairly distributed throughout the world, making the maddening and incessant noise of tinnitus one heard by people all over the world.

If you've ever been to a loud rock concert, you may have experienced a ringing in your ear the day afterwards.  Fortunately, in most this ringing goes away.  Nevertheless, this ringing gives you a time-limited appreciation of what a person with tinnitus experiences on a daily basis.

Tinnitus can affect one or both ears and can either be pulsatile, constant or intermittent.

  This disease is classified as either objective tinnitus or subjective tinnitus.  Objective tinnitus means that the sound is in your head and audible by the examiner (for example, contractions of the tensor tympani muscle or altered blood flow in the ear).  Subjective tinnitus refers to a sound that the patient can only hear and is much more common.

Tinnitus arises from damage or disease affecting any part of the auditory pathway including the bones of the inner ear (cochlea), auditory nerve, blood vessels in the ear as well as parts of the brain (for example, the cortex, amygdala, hippocampus, thalamus and so forth). 

Many people complain that their tinnitus became noticeable after noise trauma.  However, there are many other causes of tinnitus including hearing loss, presbyacusis (age-related sensorineural hearing loss), brain trauma, tumors, ear infection, Ménière's disease, microvascular changes (changes to small blood vessels) or drugs like some antibiotics or diuretics, which are ototoxic and damage hearing.  Interestingly, even diseases like trigeminal neuralgia, which causes facial pain, can mess with the auditory pathway and contribute to tinnitus.

Because the causes of tinnitus are often multifactorial and involve the sensory structures ear as well as various parts of the brain, the triggers of tinnitus can be complex and include stress and emotional disturbances.


Ultimately, the pathophysiology of tinnitus is complex and is best summarized in a review titled "Tinnitus: causes and clinical management" from Lancet Neurology

Compelling evidence exists for a dynamically changing widespread tinnitus brain network that includes sensory auditory areas and cortical regions involved in perceptual, emotional, memory, attentional, and salience functions.

In addition to hearing a mind-addling noise in the ear, a person with tinnitus can also experience other symptoms including:

  • annoyance
  • irritability
  • anxiety
  • frustration
  • depression
  • hyperacusis (over-sensitivity to certain sounds)
  • hearing difficulty
  • insomnia
  • difficulty with concentration

Tinnitus is usually, although not always, accompanied by some degree of hearing loss; thus, people with tinnitus should have their hearing assessed with audiometry.  If the hearing loss is only on one side, MRI is ordered to rule out tumor or some other abnormality (lesion).  Magnetic resonance angiography (MRA) or venography can be used to assess vascular causes of tinnitus such as blood vessel pathology.

Tinnitus is very difficult to treat, and because there are so many causes that contribute to the disease, there is no uniform treatment.  Instead, treatment is individualized and consists of preventive behaviors.  Here are treatment options for tinnitus:

  • avoidance of loud noises or ototoxic medications
  • avoidance of total silence
  • masking the tinnitus with music or soothing sounds (acoustic therapy)
  • masking the tinnitus with a hearing aid combined with a sound generator that emits white noise
  • antidepressants
  • cognitive-behavioral therapy that targets negative thoughts and makes them positive or realistic
  • habituation techniques
  • tinnitus retraining therapy
  • transcranial magnetic stimulation of the central auditory system (experimental)
  • implantable brain stimulators (experimental)
  • stress management
  • support groups
  • biofeedback
  • exercise
  • natural remedies
  • fatigue reduction

If you or a loved one suffers from tinnitus, you should make an appointment to see an audiologist who is trained to evaluate, diagnose and treat your problem. The American Tinnitus Association also provides online resources for those with tinnitus.

In a 1997 interview with People magazine, William Shatner claims that he was more bothered by tinnitus than was Leonard Nimoy.  Of note in both men, loud explosions heard on sets of Star Trek likely contributed to their disease.  Nimoy learned to live with his tinnitus, however, the screech of Shatner's tinnitus kept getting worse.  Shatner's tinnitus made it nearly impossible for him to sleep.  At the time, Shatner was fitted with a hearing aid with a sound generator, which helped him a great deal.

Selected Sources

Review titled "Tinnitus: causes and clinical management" by B Langguth and co-authors from Lancet Neurology published in 2013.

Lustig LR, Schindler JS. Ear, Nose, & Throat Disorders. In: Papadakis MA, McPhee SJ, Rabow MW. eds. Current Medical Diagnosis & Treatment 2015. New York, NY: McGraw-Hill; 2014. Accessed September 27, 2015.


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