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This guide is meant for people having chronic Tinnitus and suffering from it. It tries to answer every day questions, which typically come to people’s mind and are often posed in medical clinics. The questions were gathered from many personal talks and interviews with patients. Understanding Tinnitus

If you are reading this, you probably already known by your own experience what tinnitus is! Medicine differentiates between acute tinnitus, which is a first-time event, usually of sudden onset, and chronic tinnitus. Acute tinnitus, in particular when accompanied by acute hearing loss, needs to be attended by a doctor quickly to exclude any underlying and possibly serious condition. Treatment of acute tinnitus and hearing loss may vary from country to country- in Europe it is probably given more attention than in the US. If no specific cause for tinnitus and /or hearing loss can be identified, treatment often consists of general measures to improve blood circulation and tissue oxygen supply. Very often, this will make the tinnitus disappear.Today, we know many causes for acute tinnitus and listing them all would consume more space. Trust the knowledge, experience and advice of your doctor.
If a tinnitus which has newly occurred doss not disappear, but rather persists for more than 6 months, we call it chronic. When we speak of tinnitus we refer to chronic tinnitus only. In other words, we assume that your tinnitus has already been subject to various diagnostic regiments, which have produced no specific identifiable and treatable cause. Diagnostic procedures for tinnitus might typically involve an ENT specialist, neurologist and orthopedist. Mandibular causes need also be ruled out. It seems that way, at least at the onset. A typical example is caused by excessive noise (explosion, gum shot).Very often one can find some damage of the inner and outer hair in the inner ear. The individual hearing capability is usually analyzed in an audiogram. When tinnitus is accompanied by partial hearing loss, then many patients will localize their individual tinnitus frequency in the vicinity of their hearing loss, i.e. the tinnitus is neither there where hearing capability still completely normal, nor where it is already significantly reduced. No. the mechanisms of tinnitus are complex and – to be honest – not yet fully understood. Even though very often some degree of hearing loss marks the beginning of tinnitus, tinnitus seems to be a process, which gains momentum on its own. Chronic tinnitus is not caused by a signal that the ear sends to the brain. For this reason, cutting the acoustic never will not eliminate tinnitus. This procedure has been performed on some unfortunate people in deep distress, and has of course left them completely deaf, but has failed to terminate their tinnitus. This is highly indicative of some process talking place in the brain itself. It seems that after a while the brain itself causes you to play increasing attention to and concentrate on your tinnitus. Tinnitus is not heard, rather it is experienced. One of the first steps a doctor or audiologist will take is recording an audiogram. If tinnitus is accompanied by some form of hearing loss, them the individual tinnitus frequency is very often localized where hearing loss begins.
There are certain very forms of tinnitus based on vascular anomalies, where tinnitus can be picked up with a microphone and actually can be made audible for others. This microphone test is usually part of the diagnostic procedure for acute tinnitus. Otherwise, the answer is no. As outline above, one can often suspect from the audiogram where someone’s tinnitus frequency is, but not if someone actually has tinnitus or not. Many people with hearing loss do not have tinnitus. Unfortunately, there is no way to make your tinnitus audible for others. Tinnitus is impairment, which only you can experience. Sadly enough, this leads to a lack of understanding of the environment and very often puts extra strain on partner relationships. Very often, no specific underlying cause for tinnitus can be identified. This implies that there can be no operation for it. When damage of the hair cells in the inner ear is assumed to be the cause (i.e. for example after some noise trauma), the answer is no. these structures can not be operated on. Very often, yes. Many tinnitus-sufferers have some from of accompanying hearing loss, usually affecting the higher frequencies. To be certain, a high-frequency audiogram may be indicated. There are, however, many cases of tinnitus where hearing capability is absolutely normal. If it is accompanied by a hearing loss, then this is often the case. Therefore, we would definitely advise visiting an audiologist. Incidentally, the initial fitting of a hearing aid for testing purpose is usually free of charge and without obligation. Therefore a test is absolutely worthwhile. The audiologist can also advise you, whether a combination aid (hearing aid + noise) might make sense. We will come back to this subject later. Yes and no. With the help of an audiogram one can measure how loud an individual will experience a certain sounds by playing with a distinct loudness for comparison. This is, however, not an ‘’objective’’ measurement. Rather, this type of ‘’measurement’’ is based on the somewhat based judgement of the individual itself. Nevertheless, if the individual is cooperative, then measurement can be reproduced within a very narrow range of deviation, and do give a good picture of the loudness a test person does actually experience. Such measurement have revealed that, interestingly, many tinnitus sufferers do actually record even minute changes in the loudness of their tinnitus, typically after sports or some from of physical strain. The measurable change in loudness will only be in the range of a few dB (i.e. hardly differentiable for ‘’normal’’ people), but tinnitus sufferers will describe them as ‘’substantial’’. This underlines the sensitivity of people towards their tinnitus.
This answer will surprise you – tinnitus is always a very silent sound, comparable to the sound of the leaves of a tree at almost calm. Tinnitus is a sound barely audible, just slightly about the individual hearing level. Typically, it is between 5 and 15 dB at the most. Thus, it is truly a ‘’sound of silence’’. And you think there’s a ‘’freight train running through your head’’. Just for comparison: 10 dB is the ‘’noise’’ background of a forest at almost calm. The sound of swallowing, which is very well audible when one pays attention, has approximately 30 dB and is thus 10 times louder! Nevertheless, you will usually not hear yourself swallow because you don’t actively listen for it. Because tinnitus loudness cannot be measured objectively, it is difficult to make a comparison. Individual experiences will diverge very much, measurement (as described above) show tinnitus to be a very silent sound, in the range of 10 to 15 dB at the most. 80% of all people with tinnitus, even though they may describe it as ‘’fairly Loud’’,are well adjusted to it and report no negative experiences at all, while the other 20% will give all sorts of descriptions from ‘’irritating to ‘’unbearable’’. An unfortunate few are dominated by their tinnitus, are unable to sleep, concentrate or find any more joy in life. The measurable loudness (see above) will not change. Changes over daytime, often depending on activity, will be within very narrow ranges. By judgement of measurement, tinnitus will always remain a very silent sound. Whether it becomes louder in your own individual reception will partially depend on the personal strategy you choose in coping with it. Why does the loudness of my tinnitus change sometimes? The individual loudness of tinnitus is indeed often dependent on situation. Many people report that yawning or chewing will calm it, while after physical strain such as sports or after long car rides, it will become louder. Whatever changes there are, loudness usually quickly returns to its previous “level”.
Part of the answer may be already in the question; to some extent tinnitus is a mental experience. It is not a sound signal being sent from the ear to the brain, rather it seems to be some kind of perceptual irritation, some form of over-interpretation by the brain.

Scholars today assume that ‘tinnitus-experience “is-at least partially – the result of a learning process by the brain, perhaps comparable to a vicious circles. It goes as follows:

You can easily imagine that every second the brain will receive an abundance of information from all ours senses. Because the brain has limited “processing” capacity. Some form of filtering must take place. This is usually done at a very low level (i.e. Sub-conscious) by differentiating between “important” and “unimportant” signals. Sensual impressions which are rated “unimportant”, are usually blocked at a very low level of our neural signal processing chain, well below our level of consciousness.

Typical examples are the ticking of a clock on the wall, the soft humming of a refrigerator, or the scratching of a new pullover when they first occur, but thereafter the brain will usually make a judgement as to whether “important” or unimportant”. Sounds with no “information value” receive no attention by the brain and are consequently banned form our consciousness. Your ear does pick up the clock, but you will not hear” it – unless you wish to and actually concentrate on it, i.e. re-activate a conscious formof processing.

This method of neural date processing “is part of our nature. It makes sense; because hearing your self swallow constitutes no survival advantage. What we must hear is the equally loud sound of a branch cracking under a predator’s foot! First and foremost, to successfully survive, our sense danger. Hearing is a deeply emotional process, even anatomically: parts of the auditory neural chain communicate with the so-called “Limbic System”, an anatomical structure within the brain which “houses” our feelings. To summarize the above, the brain has to evaluate information as part of a ‘Darwinian struggle”. If we do not know a signal and, in particular, if a new signal comes suddenly, we usually react with fear and tension – in physiological preparation for flight. That’s exactly how tinnitus works.

Its one set is usually sudden and typically in a particular stress- or strain Situation (almost 80% of people report that this is how their tinnitus, started). Your brain dies not know how to value this sound; your environment cannot perceive it and reacts with disbelief. A typical reaction of yours is fear and apprehension “whether something serious is happening”, soon in combination with an element of range, because tinnitus is taking away your “right of silence”.

Consequently, as a plain sensory and usually harmless impression, tinnitus already has stamped negative. You start to consciously listen for your tinnitus, whether it is still there” or whether it has become louder”. You consult your doctor, friends, and would-be specialists. Perhaps you get answer like “there’s nothing you can do about it”, this may be the coming of a heart attack or stroke “and the like. Such answer are typical, unfortunately,- and they can be devastating, They leave you rather hopeless and with no problem solving strategy.
Constant strain without a solution strain without strategy is negative stress. This will naturally increase your awareness of this sound in your ear. The loop close.
There are many hints that in most cases tinnitus does actually begin in the inner ear, i.e. has a cochlear” cause. Indeed, with the excess of sound impressions that reach our ear every minute, there must be some occasional mal-information, which is carried via the auditory pathway to the brain and triggers a loop as above. If the mal-information was only brief, this loop should quickly terminate or-as we say - “run dead”. If some mal-information with a high level of alertness perpetuates, it will constantly re- trigger the sensorineural loop as above, until by way of internal feed back mechanisms, it will become a phenomenon solely located within the brain. We speak of a “centralized sound”.

In this context it may be of interest that, after a while, all of us without exception will experience tinnitus when locked up in a sound-tight chamber. We may thus conclude that tinnitus is a actually the manifestation of some from of basic activity of our auditory system, which we normally don’t notice, because its level its level is too low. Only when it manages to get hold of our “auditory awarenss:, does tinnitus become a problem. Tinnitus is frequently compared to phantom pain, i.e. a quality of pain that some one might develop after amputation, and which is usually projected in to the limb, which was taken off. We feel that arachnophobia (fear of spiders) also makes a good comparison.

Most of us will have difficulty to develop an understanding of phantom pain, but we all have an idea about what arachnophobia might be like. Typically, arachnophobia is in no way related to the “objective” stimulus (i.e. the size of the spider, which without doubt poses no danger to us); arachnophobia is usually learned at an early age (typically as a result of peer/brother/sister teasing) and tends to augment with time. Just like tinnitus, fear of spiders is not rare. Only for a few unfortunate, it goes as far as to dominate their life and keep them from going places and doing things they would have otherwise done. In the true sense of the world, tinnitus is not a disease, but rather a symptom. By itself this symptom has no value indicative of any disease.

Acute tinnitus as described in the introduction, is currently associated with some from of reduced blood Circulation. Because of the implications, in the view of many (but not all) doctors, this necessitates quick medical action with the goal to raise tissue oxygen supply.
For chronic tinnitus, the answer is a decisive no. Tinnitus is neither a forerunner of stroke not a heart attack and the like. No. Very often, tinnitus and partial hearing loss go together. In such cases, tinnitus will often improve With the fitting of a hearing aid. When selecting a particular type of aid, it may make sense to choose a combination device (hearing aid + tinnitus control instrument TCI). As part of the diagnostic procedure for acute tinnitus, your doctor will check for acoustic neuroma, a rare and benign tumor affecting the acoustic nerve. Afterwards, you can forget about this worry. Tinnitus is no indication of arteriosclerosis. It happens, but rarely. The honest answer must thus be probably not. You can, however, learn to adapt well without letting tinnitus dominate your life. Remember that 80% of people with tinnitus are very well habituated to it and report no reduction in their quality of life. This is being discussed however; there is no proof.
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