For some it’s a high-pitched mosquito whine; for others it’s a low bass hum. It might come and go with periods of stress, or it might be the permanent, irritating background track to daily life and nightly sleep. Whatever form it takes, tinnitus – hearing sounds like ringing, buzzing or hissing when no external noise is there – can be extremely distressing because it’s quite literally in your head; there is no escaping it.
Given that at least one-quarter of the population report experiencing tinnitus at some stage in their life, it’s surprising how little is understood about why. Laird looks for other symptoms such as headaches and vision changes that could point to neurological conditions such as migraines or stroke. If the tinnitus is only in one ear or the sound pulses with the heartbeat, that could suggest an acoustic neuroma – a tumour on the nerve that leads from the inner ear to the brain.
She also does full hearing assessment, because hearing loss is a common cause of tinnitus, particularly after exposure to loud noise. But for many people, tinnitus is unexplainable; an irritating noise that starts and persists without any clear physiological explanation. But far from being “all in the mind”, tinnitus is very real, and for a small number of people – around 2% – it’s extremely distressing.
Cognitive behavioural therapy, or CBT, for tinnitus has good evidence supporting it, and has been endorsed by numerous audiology and hearing organisations. It works by challenging and resetting thoughts, behaviours and emotions around tinnitus. Sieradzki starts by explaining to patients that tinnitus happens when the brain classifies an otherwise benign sound as harmful.
That leads to a stress response, which in turn increases the perception of threat. A similar therapeutic approach is what’s called acceptance and commitment therapy, or ACT, which focuses more on changing a person’s relationship with their tinnitus. Tinnitus is often associated with stress and anxiety.
Dr Peter Selvaratnam, a physiotherapist and associate professor at the University of Melbourne, focuses on the neck and jaw in his work with tinnitus patients, because one thing many stressed people do is clench and grind their teeth. That clenching and bruxism – grinding – can lead to increased neural activity that can both cause tinnitus and be caused by it. He uses a variety of techniques to address the bruxism, including getting patients to focus on changing the position of their tongue so it’s behind their top teeth, working with acupressure points around the jaw, head and neck to release tension, as well as breathing and mindfulness techniques to address the underlying stress and anxiety.
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