Tinnitus - don't take no for an answer

We all know the expression 'it made my ears ring' but for one in 10 people ringing (or similar sounds) in the ears are a permanent fact of life. This week is Tinnitus Awareness Week, and Patient.info has teamed up with the British Tinnitus Association, or BTA to help raise awareness of the condition and what can be done about it.

Tinnitus is defined as a sound you can hear that comes from inside your head - not because you're imagining it but because your hearing nerves are being stimulated. Different people experience different sounds, including buzzing, ringing, hissing or whistling. About one in 10 adults suffer from it, and for many it's only a minor inconvenience. But about one in 100 people is severely affected by tinnitus, and it can have a huge effect on your quality of life and mental wellbeing.

The first thing to be clear on is that tinnitus doesn't mean you're going mad. Tinnitus sometimes has a clear cause - ear infection or hard ear wax - that can be treated. It's more likely if you've been exposed to loud noise for long periods - it's never too early to start protecting your ears and heavy metal should be played at a light metal volume! It can be linked to a condition called Meniere's disease which causes attacks of vertigo, hearing loss and tinnitus. Some medicines, including cancer drugs, aspirin, loop diuretics and non-steroidal anti-inflammatory drugs can also lead to tinnitus. Tinnitus can come on after a head injury or meningitis, and can be a complication of multiple sclerosis.

Occasionally, a tumour on the hearing nerve - called an acoustic neuroma - can bring on tinnitus. This is almost always one-sided, and is often accompanied by hearing loss on the same side. If you have one-sided tinnitus, you should always be referred to a specialist to rule this out.

Often, there is no cause found for tinnitus. But the single most common reason identified is hearing loss. It's not exactly clear why this happens - possibly your auditory system is trying to replace lost sound - and some people get severe tinnitus with only minor hearing loss, while others have severe hearing loss but no tinnitus at all. But we do know that wearing a hearing aid often helps tinnitus as well as improving hearing and quality of life.

These days, there's a choice of hearing aid clinics in many parts of the country, with hearing centres at high street stores such as Specsavers and Boots often commissioned to provide the same NHS services as hospital clinics. If you're over 55, you may be able to pop in for a free hearing screening test - and if a problem with hearing is found, your GP can refer you for quick and easy assessment and fitting.

The second thing to be clear on is that you don't just have to grin and bear it. While there's no cure for tinnitus, in many people it gets less troublesome over time. Tinnitus is always worse in quiet environments, and you may find that simply keeping some background noise from a radio is enough to stop it bothering you. Some hearing aids come with a tinnitus programme, which provides additional 'white' or 'pink' noise - continuous quiet soothing 'whooshing' sound. The BTA advises that they have heard from some people who've done really well with these, but they feel more evidence is needed to show people really do better with these rather than with hearing aids alone. It's also possible to get background noise generators, which produce a variety of soft, nature-related noise like waves on a beach or rustling leaves.

If your tinnitus is having a significant impact on your quality of life, speak to your GP about referral to a tinnitus clinic. These are usually headed up by an audiologist rather than an ENT surgeon. You may have to go through the ENT clinic first to be referred on to the audiologist. These clinics tend to be much more effective than standard ENT clinics for treating tinnitus, largely because they're run by a specialist team who really understand the impact tinnitus can have, and can offer tinnitus counselling. The best evidence for effective treatment for tinnitus includes cognitive behavioural therapy, or CBT. CBT is based on the principle that your thoughts affect your behaviour. It aims to help you to challenge the unhelpful 'negative automatic thoughts' that can lead to a vicious cycle of anxiety and sometimes depression as a result of tinnitus.

In the past, people with severe tinnitus were sometimes sent for 'tinnitus retraining' - a method of adapting the way your brain responds to tinnitus. However, these retraining clinics are rarely available on the NHS and aren't widely used any more. Instead, a combination of CBT, relaxation and sound therapy, ideally via a tinnitus clinic, is usually recommended.

So if you have tinnitus that's having a significant effect on your life, don't put off speaking to your GP about it. The earlier you get the treatment you need, the more effective it's likely to be. Most people won't need it, but if you're one of the one in 100, early referral is likely to mean getting your life back sooner.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

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