Ringing in the ear: tinnitus and hearing loss

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Many people with hearing loss also have tinnitus, commonly known as ringing in the ear. This phrase is misleading, however, because some people hear ringing while others hear whistles, chirping, or a combination of sounds. Regardless of the particular sound, the distinguishing feature is that it doesn't have an external cause. People with tinnitus hear sounds that people around them don't hear. This isn't to say that tinnitus isn't real—researchers at the National Institute on Deafness and Other Communication Disorders have detected changes in brain activity that occur with tinnitus.

Get your copy of Hearing Loss

If you think you might need a hearing checkup, you probably do. This Special Health Report contains in-depth information on the causes, diagnosis, and treatment of hearing loss. You'll learn how to prevent hearing loss and preserve the hearing you have now. You'll also learn about the latest advances in hearing aid technology and find out which kind of hearing device may be best for you.

Strategies that can help

Some people with hearing loss and tinnitus find that both problems improve after they get a hearing aid or have a cochlear implant. Others find that their tinnitus symptoms improve somewhat when they cut down on caffeine and alcohol, reduce the amount of fat in their diets, and quit smoking. The following techniques may also help reduce your tinnitus symptoms:

When you're in a quiet room, put on music or use a "white noise" machine. Background noise tends to drown out tinnitus sounds.
Use the "tinnitus masker" on your hearing aid. This is a separate feature that is embedded into most hearing aids that allows you to choose a sound to "mask" the tinnitus sound you are hearing. How effective they are varies from person to person, but they usually do provide some level of relief for most people. Depending on the hearing aid, sounds that you could choose from may include spa music, chimes, white noise, and more. You can choose the pitch and loudness of the sound to suit your needs, and you can choose to turn it on or off.
Tinnitus retraining therapy is an effective method for treating tinnitus, especially in people with tinnitus and oversensitive hearing. It is a lengthy, expensive process, and can take 18 to 24 months. It relies on the principle of habituation, which occurs when your brain is exposed to a background sound, such as white noise, for long periods of time. After a while, the brain starts to filter out that particular background noise. Retraining therapy involves listening to a tone that is similar to the tinnitus sound for hours at a time. Eventually, your brain ignores the tone along with the tinnitus sound.
Reduce stress by whatever methods work for you. Try mindfulness meditation, which helps you learn not to focus on irritations such as the sound of tinnitus. Also try yoga, visualization, or other relaxation techniques.
Consider biofeedback or hypnosis. Ask your doctor to recommend qualified practitioners.

For more advice on tinnitus and other hearing ailments, buy Hearing Loss: A guide to prevention and treatment, a Special Health Report from Harvard Medical School.

Testing for hearing loss

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The human ear is the envy of even the most sophisticated acoustic engineer. Without a moment's thought or the slightest pause, you can hear the difference between a violin and a clarinet; you can tell whether a sound is coming from your left or your right, and if it's distant or near; and you can discriminate between words as similar as hear and fear, sound and pound.

Nearly everyone experiences trouble hearing from time to time. Common causes include a buildup of earwax or fluid in the ear, ear infections, or the change in air pressure when taking off in an airplane. A mild degree of permanent hearing loss is an inevitable part of the aging process. Unfortunately, major hearing loss that makes communication difficult also becomes more common with increasing age, particularly after age 65.

Testing — 1, 2, 3

How do you know if you need a hearing test? If you answer yes to any of the questions below, talk with your doctor about having your hearing tested:

Are you always turning up the volume on your TV or radio?
Do you shy away from social situations or meeting new people because you're worried about understanding them?
Do you get confused or feel "out of it" at restaurants or dinner parties?
Do you ask people to repeat themselves?
Do you miss telephone calls — or have trouble hearing on the phone when you do pick up the receiver?
Do the people in your world complain that you never listen to them (even when you're really trying)?

You can also ask a friend to test you by whispering a series of words or numbers. After all this, if you think you have a hearing problem, you should have a test.

What does a hearing test involve?

Thorough hearing evaluations start with a medical history and examination of your ears, nose, and throat, followed by a few simple office hearing tests. An audiogram is the next step.

For an audiogram, you sit in a soundproof booth wearing earphones that allow each ear to be tested separately. A series of tones at various frequencies are piped to your ear. An audiologist will ask you to indicate the softest tone you can hear in the low-, mid-, and high-frequency ranges. People with excellent hearing can generally hear tones as soft as 20 decibels (dB) or less. If you can't hear sounds softer than 45 to 60 dB, you have moderate hearing loss, and if you don't hear sound until it's ramped up to 76 to 90 dB, you have severe hearing loss.

Hearing tones is nice, but hearing and understanding words is crucial too. For this reason, the audiologist will also play tape-recorded words at various volumes to find your speech reception threshold, or the lowest dB level at which you can hear and repeat half of the words. Finally, you'll be tested with a series of similar-sounding words to evaluate your speech discrimination.

For more on diagnosing and treating hearing loss, buy Hearing Loss: A guide to prevention and treatment, a Special Health Report from Harvard Medical School.