Tinnitus is a condition affecting many millions of people worldwide. Depending on the studies you read, at any one time between 5% and 40% of people could be affected by it. A significant proportion of these people will describe their tinnitus as bothersome, affecting their quality of life.
Tinnitus is defined as any sound that is heard by a person when there is no external source for the noise. The way someone describes the sound can be very individual and varied. This includes buzzing, ringing, whooshing and the wind blowing. The volume can change throughout the day, as can the type of sound being heard. People will sometimes describe both a high pitch and low pitch ringing tone that can be present at the same time or separately.
Normally it is impossible for another person to hear the noise the tinnitus sufferer describes. However, there are two types of tinnitus where this is not the case. The first is a rare form of ‘clicking’ tinnitus which is caused by a constant twitching of the tiny muscles in the ear or throat.
The second is Pulsatile tinnitus where the noise happens in time with the heartbeat and is usually the result of hearing the blood rush past your ears through the large blood vessels in the neck. Patients suffering this type of tinnitus often complain of a whooshing or rushing sound. This type could possibly be heard by a doctor placing a stethoscope over the area of the neck where the carotid pulse is usually felt.
Tinnitus is normally diagnosed and treated by an ENT doctor, (Ear, Nose, and Throat). In any consultation with a patient about tinnitus I will first ask to know about any other problems with the ears. This includes asking about any previous infections, whether they suffer from dizziness or hearing loss and also if there have been any more significant ear conditions in the past, perhaps even requiring surgery. However, as most forms of tinnitus cannot be heard by your doctor, or anyone else – the diagnosis is predominantly done by listening to a description of your symptoms.
How Can Tinnitus Affect Your Life?
Tinnitus can often have an intrusive impact on day to day life. One of the key times is in the evening approaching bedtime when the level of background noise is reduced, and the tinnitus becomes more noticeable.
This is when many people find the tinnitus more of an intrusion in their life and some find it hard to fall asleep.
Fortunately, very few people are woken up by the noise, although if awake in the middle of the night for another reason, the tinnitus could then prevent them from falling asleep again.
During the day tinnitus can still cause problems, in particular when the sufferer is trying to concentrate on doing a piece of work or reading.
The constant noise can affect the person’s ability to focus on the task which leads to frustration.
Occasionally to the extent that all they can hear is the tinnitus, making other activities impossible.
It is a common finding that stress, anxiety, and tiredness will make the tinnitus seem louder which can then become self-perpetuating and lead to a difficult situation.
In some cases, these factors are the underlying cause so that when they are addressed, the tinnitus is no longer noticeable. Also, any other illness can lead to worsening tinnitus making the person feel even worse.
What Causes Tinnitus?
Developing tinnitus can be a very scary time for someone who has never had it before. It can often seem very loud, affecting every aspect of their life and they worry that it may never go away. As a Consultant Ear Nose and Throat Surgeon, I am also often asked whether it could be a brain tumor and whether they should have a scan. My answer to that would be that a scan is only recommended if the tinnitus is purely on one side and usually only if accompanied by significant hearing loss on that side.
Thankfully, in the vast majority of cases, the scan shows everything to be normal, but it is, of course, reassuring to be able to definitively rule out a brain tumor involving the inner ear and the hearing center of the brain.
I also aim to reassure, particularly new sufferers, that the natural course of tinnitus is for it to become far less intrusive with time, until it fades into the background so that most people are no longer bothered by it. This is due to a combination of finding ways to get used to it but also the tinnitus itself becoming quieter.
Explaining the causes of tinnitus can also be therapeutic for sufferers. But the truth is we don’t fully understand why tinnitus happens. We do know that it is due to a malfunction in either the cochlea of the inner ear or somewhere along the pathway between the hearing nerve and the hearing center at the back of the brain.
It is also more common that people with tinnitus often experience some hearing loss and it is thought to be part of a ‘wear and tear’ process. However, tinnitus can happen to anyone and it can occur in those with otherwise perfectly normal hearing.
A theory I find a very plausible explanation for tinnitus and frequently tell patients is that tinnitus is related to the microscopic hair cells in the cochlea. These hair cells are bathed in a specialized fluid. In normal circumstances, when sound hits the ear it displaces the fluid causing the hair cells to move. This sends a signal to the brain and the person ‘hears’ the sound.
It is thought that in some people the hair cells move spontaneously, in the absence of sound. This sends a signal to the brain, so the person hears a noise, thus creating tinnitus. Research into what causes these cells to move spontaneously may help us develop more effective treatments in the future.
An obvious and common question I get is how do I treat or address tinnitus? Below I have summarised some of the information I would give out in a consultation.
The first stage in managing tinnitus is to try, where possible to address the causes of stress, anxiety, tiredness, and any other external pressures.
Relaxation is incredibly important and having a focused massage on the head and neck can lead to great improvement in symptoms. Some people believe that acupuncture from a specialist can also be helpful. While some patients see good results from this, it is not effective for everyone.
It is important to remove from your diet anything that seems to exacerbate the tinnitus. Common substances that can worsen the condition are caffeine, alcohol, and chocolate.
Cutting these out may reduce the noise level of the sound you are hearing and lessen its impact on your daily life.
3) White Noise
To target the noise specifically, having the radio or music on in the background can mask the tinnitus allowing the person to either work or fall asleep.
Some companies now play ‘white noise’ in working areas as this helps to remove distractions, has a calming effect and can lead to more productivity.
4) Tinnitus Therapy
There are now a number of tinnitus apps to download which play a wide range of sounds, including white noise. You can experiment with these to find the sound which suits you best. If the tinnitus is associated with hearing loss, then wearing a hearing aid can help as it will raise the background level of noise and help to drown out the tinnitus.
For those who are still having difficulty despite these measures, tinnitus therapy can be a very effective treatment. This can be in the form of group sessions or 1 to 1. Where I work in the UK, at the Royal National Throat, Nose and Ear Hospital, we have a fantastic team of therapists in the audiology department who help those with more troublesome tinnitus.
One of the more advanced treatments they offer is cognitive behavioral therapy. This is a fantastic treatment that allows the sufferer to gain some level of control over the noise and push it away to the back of their mind, so they notice it far less and life can return to normal.
A useful resource with information about many of the treatments I have mentioned is the British tinnitus association website www.tinnitus.org.
You can find on the internet any number of potential remedies, promising to treat tinnitus. None of these, such as herbal compounds and other supplements have any strong scientific evidence to support their effectiveness. There is some weak evidence as to the efficacy of to Ginkgo Biloba and Ginkgo-soft-laser treatment (1),(2).
However, the many studies that have evaluated the efficacy of Ginkgo biloba in the treatment of patients with tinnitus present a contrasting view of it. Some of the studies reported that Ginkgo biloba is effective in the treatment of tinnitus effective* (3-8) whereas others show it to be an ineffective herbal medicine (9-13).
A large literature review noted that even if Ginkgo was only mildly effective it at least prevents patients from choosing and searching for other ineffective or potentially dangerous alternate treatments (14)
Overall it would seem that there is not enough evidence to suggest that Ginkgo Biloba or any other herbal treatment is effective in treating tinnitus.
Whereas the actions and the treatments I have suggested above, such as dietary improvements and CBT therapy, are safe effective and recommended. I would recommend, as with many complex conditions, forming a comprehensive strategy and combining a number of approaches. This is the most likely way to lead to the best outcome.
To Summarise: How To Manage Tinnitus
So, start by analysing your life in general. Are there are any sources of anxiety or stress that can be addressed? Can you improve your work/life balance and sleep patterns? A positive outcome with any of these can lead to huge improvements.
Next look at masking techniques to take your mind off the noise. Use a source of background noise, perhaps through a tinnitus app, to drown out the tinnitus. If you have hearing loss, wear a hearing aid which will have the same effect by raising the background level of noise.
Finally, group therapy or individual cognitive behavioral therapy can provide a fantastic solution to those who don’t succeed with the above strategies.
I would always recommend seeking the advice of an ENT specialist if you have any concerns about your condition, however by following some of the above strategies, many people will successfully be able to treat it themselves.
Jonathan Joseph (University College Hospitals NHS Foundation Trust)
- Consultant Ear Nose and Throat Surgeon
- Royal National Throat, Nose and Ear Hospital
- Fellow of the Royal College of Surgeons of the UK and Ireland
- Super specialist in nasal and sinus disease and facial plastic surgery
- Super specialist in paediatric ENT disorders
- Published expert in the psychological impact of nasal disease
- Olivier J, Plath P. Combined low power laser therapy and extracts of Ginkgo biloba in a blind trial of treatment for tinnitus. Laser Therapy. 1993;5(3):137-9.
- Plath P, Olivier J. Results of combined low-power laser therapy and extracts of Ginkgo biloba in cases of sensorineural hearing loss and tinnitus. Adv Oto-Rhino-Laryng: Karger Publishers; 1995. p. 101-4.
- Jastreboff P, Zhou S, Jastreboff M, Kwapisz U, Gryczynska U. Attenuation of Salicylate-lnduced Tinnitus by Ginkgo biloba Extract in Rats. Audiol Neurootol. 1997;2(4):197-212.
- Krauss P, Tziridis K, Buerbank S, Schilling A, Schulze H. Therapeutic Value of Ginkgo biloba Extract EGb 761® in an Animal Model (Meriones unguiculatus) for noise trauma induced hearing loss and tinnitus. PloS one. 2016;11(6):e0157574.
- Meyer B. Multicenter randomized double-blind drug vs. placebo study of the treatment of tinnitus with Ginkgo biloba extract. Presse Med. 1986;15(31):1562-4.
- Orhan I, Aydın S, Altın G, Yılmaz F. An efficacy comparison of betahistin, trimetazidine and ginkgo biloba extract in patients with tinnitus. Kulak Burun Bogaz Ihtis Derg. 2013;23(3):143-7.
- Tasca I, Di Lieto C, Compadretti GC, Gabrielli S. Effectiveness of ginkgo biloba (Brenstar (c)) in the treatment of tinnitus and vertigo. Prog Nutr. 2012;14(4):277-83.
- Tziridis K, Korn S, Ahlf S, Schulze H. Protective effects of Ginkgo biloba extract EGb 761 against noise trauma-induced hearing loss and tinnitus development. Neural plasticity. 2014;2014(2):27.
- Canis M, Olzowy B, Welz C, Suckfüll M, Stelter K. Simvastatin and Ginkgo biloba in the treatment of subacute tinnitus: A retrospective study of 94 patients. Am J Otolaryng. 2011;32(1):19-23.
- Holgers KM, Axelsson A, Pringle I. Ginkgo biloba extract for the treatment of tinnitus: Original Paper. Audiology. 1994;33(2):85-92.
- Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: Double blind, placebo controlled trial. Bmj. 2001;322(7278):73.
- Han S-S, Nam E-C, Won JY, Lee KU, Chun W, Choi HK, et al. Clonazepam quiets tinnitus: A randomised crossover study with Ginkgo biloba. J Neurol Neurosurg Psychiatry. 2012;83(8):821-7.
- Rejali D, Sivakumar A, Balaji N. Ginkgo biloba does not benefit patients with tinnitus: A randomized placebo‐controlled double‐blind trial and meta‐analysis of randomized trials. Clin Otolaryngol Allied Sci. 2004;29(3):226-31.
- Von Boetticher A. Ginkgo biloba extract in the treatment of tinnitus: A systematic review. Neuropsychiatr Dis Treat. 2011;7(1):441-7.
About Jonathan Joseph
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