Why is the concept of tinnitus so important?
Well, for starters, nearly 90% of people with hearing loss have tinnitus and vice versa – over 90% of people with tinnitus experience hearing loss. Depending on the research you cite, there is evidence that these numbers are even higher. But here is why this topic is so important - over 54% of people with tinnitus find it bothersome and annoying, and report that it gets in the way of enjoying life. This is a staggering number – with over 25 million in the U.S. and close to 750 million worldwide. Therefore, we must talk about tinnitus more, and we must let people know that effective treatment options are available.
In addition, we can’t talk about tinnitus and not talk about so-called “hidden hearing loss”. One of the most common statements from patients is, ‘I have tinnitus, but I was told that I have normal hearing’. Here’s a little secret that most people in hearing healthcare don’t even know – ‘normal hearing’ as measured by a traditional hearing test (the audiogram) is a farce. The issue is – many hearing healthcare providers do not understand the premise that tinnitus is often (50% of the time) the first symptom of ear-to-brain neural damage. Rather than understand the science, most providers tend to rely on statements like ‘but the patient isn’t complaining about hearing loss’ or ‘but the hearing test says the hearing is normal’.
The term ‘hidden hearing Loss’, as coined by brilliant scientists at the Massachusetts Eye and Ear Infirmary, means – damage to the auditory system that results in symptoms of tinnitus and/or hearing loss that traditional hearing tests cannot detect. The more appropriate medical term for this is subclinical hearing loss and tinnitus (or early-stage tinnitus and hearing loss).
The perception of tinnitus is a sign of a progressive degenerative disorder and an ear that is no longer appropriately stimulating the brain. Therefore, the withering neural connections go haywire and falsely tell the brain it is hearing sounds that are not present.
Like the concept of phantom limb, the concept of tinnitus is neurologically similar. Once the doctor has severed the nerves from hand to brain, the reason the brain can still feel the hand is because the central system has gone haywire. As we age, listen to loud sounds, take medicine that impacts the ear, etc., we are left with the perception of phantom sound. This is called subjective tinnitus. Subjective tinnitus accounts for 99% of all types of tinnitus.
A minuscule percent (less than 1%) of people with tinnitus have ‘objective tinnitus’. This type of tinnitus is not self-perceived (aka not a phantom sound) and can be recorded by a microphone (and, in some cases, even heard by other people). Spontaneous muscle contractions or vascular deformities can lead to this rare form of tinnitus, and in some cases, surgery can stop the tinnitus.
Here are the top five adjectives’ patients have reported over the past 20 years about their subjective tinnitus:
- crickets chirping
Now, let’s discuss Van Gogh. Everybody’s got their theories about what happened with Van Gogh and why he cut his ear off. But most historians will tell you, if you investigate his writings and if you understand everything he did, Van Gogh was not mad. He, if anything, is a perfect example of how tinnitus can drive people to harm themselves. So, if you’re asking, did you just say that Van Gogh cut his ear off because of tinnitus? Yes. That is the most widely accepted story about his self-mutilation. He reportedly suffered from tinnitus. He also suffered from vertigo, hearing loss, hyperacusis (sensitivity to loud sounds) and otalgia (ear pain). Today, this would likely be diagnosed as Meniere’s Disease.
Fast forward to the 2000s, and fortunately more people are willing to share their stories of tinnitus—for example, Huey Lewis. Huey Lewis is a great entertainer who was forced to retire due to his debilitating tinnitus. He has spoken publicly about his depressive state and that he had contemplated suicide multiple times because of tinnitus. If you just do a quick Google search, you’ll see countless tragic stories about people who have committed suicide to end their suffering from tinnitus.
The multimillionaire owner of Texas Roadhouse committed suicide because of tinnitus. He noted that COVID dramatically exacerbated his tinnitus. It’s estimated that 15% of people who’ve had COVID suffer from post-COVID tinnitus. Although the connections between COVID and tinnitus are not well understood, it is plausible that the virus impacts the ear-to-brain neural connections.
There are many different reasons a person can get tinnitus. We know that obesity can impact circulation, which can impact hearing, which can cause tinnitus. We know that diabetes and the accompanying neuropathy can compromise blood flow to the ear and thus lead to tinnitus. We know that smoking can compromise blood flow to all parts of the body, including the ear, which can lead to tinnitus. We know that many medications can cause damage to the ear and lead to tinnitus, including chemotherapy and many over-the-counter pain relievers.
But what is the number one risk factor for tinnitus?
The number one risk factor is age. Unequivocally, age is the most common risk factor for developing tinnitus.
With age comes a natural breakdown of the neural pathway connecting the ear to the brain. This progressive degenerative condition is called presbycusis (age-related hearing loss) and is routed in our DNA. Yes, it’s genetic – therefore, there really isn’t much we can do about it, and there’s no sense in being mad at your parents for it! Most mammals, whether they walk upright or on all fours, will experience presbycusis with age – and therefore are likely to experience tinnitus.
In addition to age – we must acknowledge that our post-industrial revolution life is a lot louder than our ears were designed to handle. Thus, the more ‘use and abuse’ we put on the hearing system, the younger we are likely to experience tinnitus and hearing loss. Throw in a round or two of chemo or some long-term use of pain relievers, and you get yourself a Molotov cocktail that wreaks havoc on the ear-to-brain neural connections and results in tinnitus starting in our 40s and 50s, not in our 60s or 70s.
But why is tinnitus so different in every person?
The simple answer is that it is a personal perception, i.e., it is a subjective experience. Thus, it will be different for everybody. The experience of tinnitus will vary greatly depending on where exactly the damage is, what caused the damage and, believe it or not, how the person copes with the experience of tinnitus. Yes, a person’s coping skills and history of mental illness, depression, and anxiety all factor into the perception of tinnitus and the extent to which it impacts a person’s life.
Among numerous individuals experiencing tinnitus, it affects their sleep patterns, their thoughts and emotions, and ability to work and concentrate on tasks. It can get in the way of their hearing (even the ones who don’t necessarily complain about having hearing loss). While tinnitus can impact everybody differently, it often will impact every situation in everyday life. For questions or more information concerning this subject, please visit www.excellenceinaudiology.org.