Ringing or, as it is known in the literature, tinnitus, is the result of a process that negatively affects the functioning of our auditory system, especially at one point in our body. In other words, ringing is a continuous signal flow generated within the auditory system itself. When a sound is perceived in the brain, it cannot be precisely identified where its physical origin is. The cause of tinnitus that occurs in each patient is almost always different. The form and frequency of tinnitus experienced by each patient do not resemble those of another.
If the sound perceived in the brain is noticed only by the patient, it is called subjective tinnitus; additionally, if it is audible to others, it is called objective tinnitus. Objective tinnitus, which can be heard by others besides the patient, is quite rare. It is usually the result of turbulent flow caused by sudden dilation or constriction of blood vessels. Therefore, when a patient with tinnitus complaints is referred to the hearing aid center, and if the ringing is also audible from the outside, it should be initially considered as a possibility for possible treatment and directed to a specialist in the field. Such tinnitus falls within the domain of brain surgery or interventional radiology specialists. This referral will be a favorable approach both for the patient and the audiologist.
As mentioned earlier, the ringing perceived by each patient is based on different reasons. Therefore, questions like “Is there a cure for tinnitus?” cannot be considered a correct approach without understanding the underlying cause (etiology) of tinnitus. Similarly, discussing the treatment of tinnitus in general, like “Is there a treatment for headaches?” is not a correct approach. First, factors that could be causing it should be investigated by Ear, Nose, and Throat and Neurology specialists.
The statement often emphasized on social media, “There is no cure for tinnitus,” cannot be considered entirely accurate. In short, tinnitus is a symptom of various diseases; it is not a disease to be treated. With the reasons explained so far, it is said that it is not the right approach to approach tinnitus treatment without evaluating all the factors that may cause tinnitus. Thus, it can be said that patients with tinnitus should not apply to the hearing aid center without undergoing diagnostic tests by a specialist physician.
After this, let’s move on to patients with tinnitus who have been medically examined but have not found any underlying and treatable diseases such as Stapedial Otosclerosis, Meniere’s disease, Ototoxicity, Vestibular Schwannoma, etc. In other words, let’s talk about the subjective idiopathic tinnitus…
To explain this picture, it means tinnitus is only felt by the patient (subjective), that the cause has not been determined by medical methods (idiopathic). Of course, categorizing all tinnitus patients into this group would be misleading. What is important here is to distinguish the subjective tinnitus phenomenon with an unknown cause that has undergone medical examination and tests from other cases that can respond to medical treatment.
If patients with tinnitus of unknown cause additionaly have complaint of hearing loss as well, in this case, the use of a hearing aid is considered the most effective solution. If the main complaint that bothers the patient the most (hearing loss) is ahead of tinnitus and can be easily accepted, the option of a hearing aid will be acceptable. Because in cases of untreatable hearing loss, hearing aids become the only solution, while tinnitus patients are offered a wide range of treatment options by physicians: medication therapy, acoustic desensitization therapy, tinnitus retraining therapy, cognitive-behavioral therapy, repetitive transcranial magnetic stimulation, etc. These are some treatment schemes offered to the patient. Although they do not provide a definitive cure, they represent various options presented to the patient. However, it is known that almost no medication eliminates established tinnitus (lasting more than 5 years). Tinnitus that has settled in brain circuits for a long time can become permanent. Therefore, if results are desired, any treatment should be implemented as early as possible.
When the hearing aid is properly adjusted, it can alleviate depression-like complaints and sometimes even eliminate them. The power of masking tinnitus with low-frequency ambient sounds that directly access the cochlea from the vent opening of the mold will increase, and by giving more listening effort and selective attention to speech sounds, the patient’s response to tinnitus may weaken. When the device is worn, the patient with improved verbal communication skills will realize that the main communication problem is not tinnitus but hearing loss. Also, over time, awareness of tinnitus will decrease due to the presence of background noise and its increased audibility. In addition, with counseling provided to the patient, it will be understood that it is not tinnitus but the exaggerated weight and reaction attributed to this sound by the individual. According to the results of all research, it is the weight and reaction attributed to the tinnitus rather than the sound itself that makes tinnitus unbearable for patients.
Prof. Dr. Bulent Serbetcioglu
Which of the following is an incorrect practice when adjusting a hearing aid in a patient with hearing loss and bothersome tinnitus?
a) Internal noise suppressors should be turned off
b) DSL formulation may be preferred
c) Behind-the-ear device is preferred
d) A very narrow vent must be opened in the mold of the hearing aid.
e) Tinnitus maskers can be used
Correct answer: d. The wide vent lets ambient noise in the external ear canal and contributes to the habituation to tinnitus.