Tinnitus

Tinnitus is the term used to describe hearing any sounds which are not present externally.  Tinnitus is most commonly heard as ringing, hissing, buzzing or clicking, and can be a single sound or a number of different sounds.

What is tinnitus?

Tinnitus is most commonly a subjective neurological phenomenon triggered by a hearing loss or a change in hearing.  Tinnitus can develop from a range of medical conditions affecting the auditory system, certain medications and neurological conditions.  Tinnitus can be enhanced by periods of high stress and fatigue.  Stress-related jaw clenching and bruxism can cause or aggravate tinnitus. 

Objective tinnitus or “somatosounds” have a physical source generated in or near the ear and may be audible to others.  Somatosound sources can include the TMJ, patulous eustachian tube, palatal and middle ear muscles (particularly tensor tympani syndrome (TTS), dehiscent semicircular canal, intracranial pulsations and vascular flow murmurs.

Research has shown that almost everyone develops temporary tinnitus in an abnormally quiet environment (such as a soundproof booth).

An increased awareness of tinnitus can occur if it changes in some way and becomes louder, or more frequently present. 

Tinnitus becomes significant when:

  • it becomes perceived as intrusive, irritating or distressing
  • it frequently fluctuates or spikes
  • it affects sleep
  • there is an increase in active tinnitus monitoring
  • people doubt their ability to cope with their tinnitus
  • high levels of tinnitus-related anxiety/distress develop.

DWM Audiologist, Myriam Westcott, and a leading neuroscientist were interviewed for the ABC Radio National Health Report on tinnitus.  This interview includes a discussion with person who suffers from tinnitus and her experiences in obtaining help. 

Myriam Westcott was also interviewed for The Saturday Paper on the increased level of people suffering from tinnitus and the impact of Covid on tinnitus.

Habituation

Most people will spontaneously habituate or adapt to their tinnitus over time.  This means, while it may be heard, attention is rarely given to it and an emotional acceptance of it is achieved.  This process involves a gradual increase in the periods of time where the tinnitus is not noticed, as well as a gradual reduction in the annoyance or distress it may cause.

People can become stuck in this process and are unable to habituate to their tinnitus as fully as they would like.  For a satisfactory level of habituation to be achieved, some degree of acceptance of the tinnitus is needed.  Tinnitus acceptance is based on an integration of the tinnitus into the concept of a normally functioning sense of ‘self’, both physiologically and psychologically. 

In a two-way process, tinnitus awareness, volume and prominence are typically influenced by anxiety, depression and stress.  The onset and/or aggravation of tinnitus can be a highly distressing or even traumatic experience, tapping into the primeval parts of the brain where sounds (including tinnitus) are evaluated to identify potential threats to one’s safety, wellbeing and survival.  If this is the case, an intense tinnitus reaction can be involuntarily maintained or become enhanced, so the process of tinnitus habituation is impeded. 

Tinnitus therapy assesses each person’s individual barriers towards habituation, aiming to help them achieve a more comfortable coexistence with their tinnitus.  

DWM audiologist discussing management strategies for tinnitus

Our Program

Myriam Westcott and Kate Moore provide an individualised program to assist you in management of your tinnitus reaction and guide you to achieve a satisfactory level of tinnitus habituation.

Any questions you may have will be addressed to ensure you have an understanding of what this process involves.

Our program involves:

  • an evaluation to assess the impact of your tinnitus 
  • a thorough exploration of your history with regards to your tinnitus and barriers to habituation
  • a hearing assessment (if not already carried out)
  • providing detailed information about your tinnitus – this includes an opinion about the possible cause and the factors that affect tinnitus onset, persistence and reactivity
  • a detailed and personalised explanation of the peripheral and central auditory system, and your hearing test results
  • information on the neurophysiological basis of tinnitus-related distress and annoyance
  • a personalised therapy program to support habituation.

Therapy – Tinnitus Treatment

We will provide you with practical, self-managed evidence-based strategies known to lead to tinnitus habituation.  These strategies will be developed with you and personalised to suit your individual coping style.

This may involve: 

  • the use of hearing aids
  • sound enrichment strategies
  • counselling in cognitive management strategies
  • training in stress management and relaxation
  • specific techniques to cope with periods of heightened tinnitus awareness and/or volume.

For many people, the information and guidance provided in one appointment may be sufficient to move towards tinnitus habituation.  For this reason, our initial appointment time is one and a half hours. 

However, the time involved in a program will vary, depending on the level of your reaction to your tinnitus and the ongoing guidance and support that you require.

Myriam Westcott is the only clinician in Australia invited to contribute to “The Multidisciplinary European Guideline for Tinnitus: diagnosis assessment and treatment” Cima et al, 2019.  Prominent neuroscientists and clinicians in the tinnitus field, as well as tinnitus patients with the condition, contributed to this guideline.  This guideline was designed to set worldwide standards for the provision of tinnitus treatment.

Tinnitus and Hearing loss

A hearing assessment is an essential component of a tinnitus evaluation.  A hearing loss that develops gradually is often unrecognised.  It is not uncommon for a diagnosis of a hearing loss to come as a surprise when tinnitus is being investigated.

Straining to hear a conversation results in communication difficulties.  This causes frustration, fatigue and stress.  A hearing loss creates a “cognitive load or burden”.  These are known tinnitus-aggravating factors, adding to tinnitus-related stress.

People with a hearing loss may blame their tinnitus for their hearing difficulties – particularly when communicating in groups or in background noise.  They may feel they would hear better if they didn’t have tinnitus.  This is not the case – tinnitus is a symptom of a hearing loss, not the cause. 

Hearing aid fitting offers significant benefit to people with tinnitus + hearing loss.  Amplification of external sounds supports the hearing loss and reduces tinnitus awareness.  Contemporary hearing aids can be programmed to produce low volume broadband sound to provide sound enrichment when the hearing aids are worn in silence.  Additionally, many contemporary hearing aids direct connect via Bluetooth to mobile phone/iPad apps.

Once you have adapted to the amplification provided by your hearing aids, you can expect a significant reduction in stress and fatigue.

Book an appointment

To book an appointment to discuss tinnitus treatment, get in touch today. 

DWM audiologist discussing tinnitus treatment

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