Jude Liptak, Au.D., is a board-certified doctor of audiology and director of the Colonial Center For Hearing, located in McLaws Circle of Williamsburg.

A Ringing in the Ear: Diagnosing Tinnitus and Hyperacusis Part One in a Series Jude Liptak, Au.D. Published: July 2006 Many patients describe the sensation of “ringing in the ear” even when no external sound is present. This sensation, known as tinnitus, doesn’t always sound the same for everyone; sounds can range from a ringing to whistling to hissing to roaring; some people even hear multiple sounds at the same time. Sometimes the sound is in the patient’s ears, other times it’s in his or her head. Some people even say a sound originates from a certain point in space in front or behind them. The majority of the population has tinnitus (albeit briefly) at some stage in life. An estimated 17 percent of the population has problem tinnitus, one percent has tinnitus severe enough to cause annoyance, and about one-half of a percent have tinnitus that results in an inability to lead a normal life. In our area, tinnitus is more prevalent as a result of noise-induced hearing loss from our local industries (military, ship building). For most people tinnitus is only a nuisance. For some, it can be a chronic condition resulting in loss of concentration, sleep problems and even depression. Tinnitus has many causes (e.g., exposure to loud sounds, circulation problems, side effects to certain drugs) but it’s usually the result of damage to the inner ear. Occasionally, tinnitus is caused by hearing loss. Those who may be at risk for tinnitus are urged to have their hearing tested on a regular basis. There are three stages of tinnitus: generation, detection, and perception/evaluation. Generation usually occurs within the inner ear (cochlea) or the auditory nerve (the site for noise-induced damage). The change in nerve activity is detected by the brain and then perceived as sound. Tinnitus becomes a problem when this new background sound is evaluated and is determined as a “threat” by the emotional and reflex centers of the brain. Clinical evidence indicates that tinnitus is generated in the area of the cochlea where an area of damaged hair cells (cilia) border a normally functioning area. In these areas, some sensory cells can function normally while others are damaged. This results in altered activity within the ear. Does tinnitus indicate hearing loss? In most cases, tinnitus is associated with hearing loss. Sometimes only tinnitus is noticed and there is no hearing loss at all (because the tinnitus is linked to the body’s circulation). Although, if you have both tinnitus and hearing loss, the prevalence of tinnitus does not guarantee that you will lose your hearing ability. What can make tinnitus worse? Stress almost universally makes tinnitus worse because it tends to increase the volume control setting of the brain as the result of a survival-style reflex. But what makes tinnitus worse for some people may have no effect on another person’s condition. There is no concrete rule as to whether any of the aggravators named below will have an effect on an individual’s tinnitus. Common aggravators of tinnitus include: · Stress · Loud sounds · Aspirin · Caffeine · Nicotine · Alcohol Approximately 40 percent of tinnitus sufferers experience some discomfort with moderately loud sounds. A far smaller percentage experiences discomfort with normal everyday sounds. These people have a condition known as hyperacusis, or an extreme oversensitivity to sound. Normally the ear can tolerate most sounds in our environment. In ears with hearing loss, though, the ear’s ability to adapt to loud sounds is disrupted. In a phenomenon called recruitment, quiet sounds are no longer heard, yet loud sounds become uncomfortable. Hyperacusis is often accompanied by tinnitus, and it can occur among individuals with perfect hearing. Many people with hyperacusis resort to wearing earplugs, even during normal conversation; however, wearing earplugs when not exposed to loud sounds is actually detrimental for these people. Reduced stimulation of the hearing system can result in increased sensitivity and it can actually amplify the effects of tinnitus. Now that we’ve covered the basics about tinnitus and hyperacusis, stay tuned for next month’s installment in which I’ll address various treatment options for these two conditions.

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