T is for Tinnitus
Tinnitus, often called ringing in the ears, is a hearing condition where people hear noises, hisses or hums that are not present in the real world. Tinnitus can be constant or occasional, loud or soft, mild
or severe, and can be heard in one or both ears or in the head. Tinnitus can happen to people of any age or background. Approx. one in three people in Australia have experienced tinnitus at some
point in their life and about one in six live with constant tinnitus. About 2% of Australians (or 500,000 people) find their tinnitus very distressing.
T is for Trigger
Tinnitus is a symptom of other underlying conditions, such as hearing loss, noise exposure, ear injury, neck or jaw issues,
circulatory system disorders and more. Most commonly it starts because of a change in the ear.
This could be a temporary change like a build-up of wax or an ear infection, or a more permanent change like a hearing loss. But tinnitus is actually generated by the brain.
The nerves in the hearing pathway of the brain are “turned up”, so we are listening to sounds made by our own body. For some people, the impact of tinnitus can be greater than the impact of the underlying condition that causes it.
T is for Troublesome
Sometimes our brain decides that these tinnitus sounds are an important threat, so it highlights these messages in the brain’s emotional control centre. This means our
attention is drawn to the tinnitus and “fight or flight” response kicks in.
For some people, the impact of tinnitus on a person’s life can be devastating, increasing risk of depression, anxiety, and even suicidal thoughts. Some people fear that their tinnitus will get worse forever,
but that isn’t true.
There is help.
If you are in the need of urgent support contact Lifeline.
T is for Treatment
The more we understand our tinnitus, the more we can regain control and actively work towards reducing its impact on our life. The first step is to get in touch with your GP and audiologist who can check your hearing, help you understand your tinnitus and discuss a management plan.
You may also be referred to an Ear Nose and Throat (ENT) doctor to check if there are any medical causes for the tinnitus.
Your own experience of tinnitus will help your healthcare provider direct you to the best management options. If your tinnitus changes with neck movements, you might see a physiotherapist.
If you have jaw pain or clicking, you might see a dentist. If you have hearing loss, you may see an
audiologist to trial hearing aids.
For many people, seeing a psychologist or audiologist who specialises in Cognitive
Behaviour Therapy (CBT) could be the best option.
Tinnitus explained
Tinnitus, often called ringing in the ears, is a hearing condition where people hear noises, hisses or hums that are not present in the real world. Tinnitus can be constant or occasional, loud or soft, mild or severe, and can be heard in one or both ears or in the head. Tinnitus can happen to people of any age or background.
Approx. one in three people in Australia have experienced tinnitus at some point in their life and about one in six live with constant tinnitus. About 2% of Australians (or 500,000 people) find their tinnitus very distressing.
Want to support people living with tinnitus? Find out more at our Tinnitus Awareness initiative.
What causes tinnitus?
Why do some people hear tinnitus all the time, and others do not? For some there may be an easy explanation, such as a build-up of earwax, certain medicines, or exposure to loud sounds, but for others it can be a bit more complicated. For this reason, we advise seeing an audiologist to help you find out what is important to you. An audiologist can help you:
- Understand the experience
- Confirm the diagnosis
- Check your hearing
- Look for a related cause
- Discuss a management plan
Managing tinnitus
When it comes to managing tinnitus, it is important to look at the whole person. Tinnitus is a symptom of many small changes that have taken place in your body over time. For example, most people know that stress impacts their health, but did you know it can also impact your tinnitus? Or take your head and neck – your ears are surrounded by a web of muscles and ligaments, and how well they work can be related. For this reason, your audiologist may recommend management plans that treat you as a whole person, from talking to your GP about the medicines you take, seeking support from a psychologist, or even visiting your dentist to assess the health of your jaw. The goal of management is to help provide you with the support you need for the tinnitus and the impact it has on your life.
While exploring your tinnitus, friends and family can be very helpful. But it can be hard to find the words to describe something they can’t hear with you. If you are experiencing tinnitus, it may help to describe it using silence. Most people never stop to think about how important silence is for them, but it is there for us whenever we sleep, rest, or relax. Having tinnitus enter that space is a big change. For that reason, people with tinnitus may have difficulties with concentration, sleep patterns and even their mental health.
If you are experiencing tinnitus for the first time, it may be helpful to know that you are not alone. Some people fear that their tinnitus will get worse forever, but that isn’t true. Tinnitus is a symptom, not a disease, one that changes over time in response to many factors, including our health. Working with your audiologist you can slowly understand the things that make your tinnitus better, or worse, as you work towards management. The more we understand our tinnitus, the more we can regain control and actively work towards reducing its impact on our life.
In some cases, the impacts of tinnitus may lead you to feel you can no longer cope. If you feel in need of urgent assistance, please call Beyond Blue 1300 224 636 or Life Line 13 11 14. While the information provided will not be specific to tinnitus, their expertise in all areas of mental health will ensure you are supported at times of greatest need.
All other, non-urgent persistent matters should be discussed with your audiologist or medical practitioner.
Tinnitus and stress
It is likely your tinnitus will fluctuate with changes in your overall levels of stress. Through self-awareness you can recognise the signs of stress and act to prevent it from affecting your awareness of tinnitus.
Few of us can escape periods of stress in our lives. Stress can come in many forms; it may be physical, such as neck pain from sitting at the computer, or emotional, such as the loss of a job or relationship. It is important to recognise the impact of these events on how our whole body functions.
For those with tinnitus, increased periods of stress may lead to increased awareness of tinnitus. Likewise, increased awareness of tinnitus can lead to increased stress or may lead to someone experiencing tinnitus for the first time. Whichever is the case for you, feel comforted by the knowledge this need not be permanent. By developing ways to manage stress, you can learn to live well with tinnitus once again.
Racing heart
Sweating
Reduced concentration
Nausea
Changes in appetite
Recognising signs of stress
While some level of stress can be useful for motivating us to act and protecting us from danger, in excess or for prolonged periods, stress can be detrimental. Stress can look like different things for different people. Here are some common signs of stress to be aware of.
If you can recognise you are overly stressed or are likely to be, you may be able to act early and minimise the impact on your tinnitus.
Poor sleep
Increased irritability
Lack of motivation
Increased negative thoughts
Strategies
Talk to someone
Connection is vital. Understanding from a family member, friend or peer group can help you through challenging times. Additionally, a counsellor or psychologist can help you recognise and manage the major sources of stress for you.
minimise stressors
Minimise or remove yourself from the stressor, in other words, reduce the number of social engagements, remove yourself from excessive noise or take regular breaks from the computer screen.
Be kind to yourself
With heightened stress levels, it is important to take care of yourself. Prioritise your time to only focus on important tasks, take a walk, exercise, listen to music or sounds that relax you, have a massage and ensure you are getting adequate sleep.
Healthy diet
Eat a healthy diet and as such avoid excessive intake of salt, sugar coffee, tea and alcohol. While research has not found a strong correlation between tinnitus and particular foods or fluids, excess of anything is discouraged.
Seek assistance
Talk to an audiologist or general practitioner for further assistance. If previously you have been prescribed tinnitus management strategies, you may be advised to start these once again. If it you are using noise therapy, use of hearing aids, relaxation strategies etc, continuation or adjustment of these approaches may be advised so you can reduce the impact of your tinnitus. Talk to an audiologist and be connected with the most suitable option for you.
Urgent support
In some cases, the impacts of tinnitus may lead you to feel you can no longer cope. If you are in need of urgent assistance, please call Beyond Blue 1300 224 636 or Life Line 13 11 14. While the information provided will not be specific to tinnitus, their expertise in all areas of mental health will ensure you are supported at times of greatest need. All other, non-urgent persistent matters should be discussed with your audiologist or medical practitioner.
“I was fitted with a pair of hearing aids, introduced sound therapy into my life on a daily basis, cut down on caffeine, and started feeling mentally robust again. I started feeling I was getting control of my life and of my tinnitus.”
PROVIDING SUPPORT
If someone you know is suffering from increased awareness of tinnitus, patience, empathy and compassion can help enormously. Recognising their need for assistance; be it quiet, time alone, use of a noisemaker/masking device, assistance to make clinic appointments, help to reduce their workload and/or commitments, can be greatly beneficial. Engage in positive conversation and ask how you can assist and support them during challenging times.
Tinnitus in children
Just as adults can experience tinnitus (noises in our ears or head unrelated to an external source) so too can children. If children are worried by their tinnitus, support is available and beneficial.
Children as young as three can reliably describe tinnitus, if they experience it, and asking will not make their tinnitus worse. Asking a child if they hear any noises that they think mummy or daddy can’t hear in a non-leading manner will give them the opportunity to explain what they hear, have their experience validated and to be supported.
Children often describe tinnitus in ways that reflect sounds within their environment or experience, such as buzzy bees, growling tigers, choo choo trains or wind in the leaves.
How a child experiences their tinnitus can be influenced by how they perceive it (scary or just normal), their developmental age and the aspects of their lives that are affected.
If a child experiences tinnitus and is worried by it, it may affect their emotional and mental wellbeing. Children who experience tinnitus may have difficulty falling asleep, may prefer to sleep with a radio or the television playing and they may become more irritable, frustrated or emotional.
Some children describe having difficulty concentrating at school or not liking being in either very noisy or very quiet environments. Others may also stop participating in activities that they previously enjoyed or avoid new activities.
Some children with tinnitus appear to have trouble listening, following instructions or participating in conversations and may have difficulty on hearing tests. When children are troubled by a condition such as tinnitus their parents and family can also be affected.
What to do
If your child does experience tinnitus and is bothered by it, it is important to listen to their description and reassure them. It is also important to see your doctor and an audiologist who understands tinnitus in children. They can perform a hearing test, to check there are no underlying hearing or ear health issues that need to be addressed, and organise specialist referrals, where required. If no further referrals are needed, they can work with you and your child to develop strategies that will help them habituate to their tinnitus (reduce their awareness and distress). Strategies can include tinnitus education, sound enrichment, emotional support and relaxation strategies.
As with adults, children’s experiences of tinnitus and associated distress can increase during times of stress, such as family breakdowns, times of transition or bullying. Understanding this pattern can help to reduce fear and worry. Seeking help from your child’s doctor, audiologist and/or psychologist may assist in recognising and managing these periods.
Caring for a child who is distressed by their tinnitus can be worrying and in rare cases either you or your child may feel as you are having trouble coping. If either you or your child is in need of urgent assistance please call Kids Help Line 1800 551 800 or Life Line 13 11 14. While the nature of their advice will not be specific to tinnitus, their expertise in all areas of mental health will ensure that you are your child are supported at times of greatest need. This service also offers a range of resources and webchat support options for children and their carers. All other non-urgent persistent matters should be discussed with your audiologist or medical practitioner.
Sound sensitivities in children
Does your child become overwhelmed, cover their ears, cry, scream or behave oddly near loud noises? This can be a normal phase for young children; however, if the behaviour persists, they may be experiencing a sound intolerance or hyperacusis.
Hyperacuis is a term used to describe when everyday sounds seem uncomfortably loud or when a person has heightened sensitivity to particular sounds (misophonia and phonophobia also fall within this definition). For children who experience hyperacusis, and their families, it can be a very troubling condition.
Children with hyperacusis may have difficulty remaining in situations that are loud, such as noisy classrooms, or they may have difficulty listening to everyday loud sounds, such as hand dryers, vacuum cleaners, blenders and traffic.
Children with hyperacusis can be fearful of certain noises, and try to avoid them, or become visibly distressed. Curiously, not all sounds of the same volume will cause the same distress.
The mechanisms responsible for hyperacusis and sound sensitivity are not yet fully understood. Hyperacusis is seen to occur more commonly in children with conditions such as adhesive otitis (glue ear), autism spectrum disorder (ASD), Williams’ syndrome, epilepsy, attention deficit hyperactivity disorder (ADHD), tinnitus and hearing loss, and following head injuries.
For some children, their hyperacusis stems from having been surprised by, or had a bad experience with, a noise – such as balloon popping or someone shouting. When we experience a fright or unpleasant experience it triggers a stress response – increasing our heart rate, blood pressure and breathing.
This is the body’s natural defence mechanism to help us to avoid danger. However, when certain sounds are associated with danger it can change how we react to those sounds. Children with hyperacusis can be worried that the sound will hurt them and try to avoid it to protect themselves.
What to do
If your child experiences hyperacusis or sound intolerance, support and reassure them. It is important to show your child you understand their distress. Try not to focus on these sounds in a negative way. Do not promote avoidance – or use earmuffs, noise-cancelling headphones or ear plugs – as this reinforces the sensitivity to sound. It is essential for your child to hear normal sounds for their ears and brain to regain normal sound processing. Explain what the sound is and identify where it comes from, to provide gentle, supported exposure. Help your child develop tolerance by letting them have some control over the sound and reward positive interaction. If your child becomes distressed, do not force them to remain in the situation. Instead, allow them to remove themselves. This process takes time. Teaching your child relaxation strategies and informing carers and school, so that they can offer support, is essential.
Talking to your child health nurse or doctor is important. An audiologist can undertake a hearing test to check that there are no underlying hearing or ear health issues that need to be addressed and organise specialist referrals, if required. Working with an audiologist or psychologist can help your family to develop strategies to manage and reduce your child’s hyperacusis or sound intolerance.
Support services
Caring for a child who is distressed by hyperacusis can be worrying and, in rare cases, either you or your child may feel as you are having trouble coping. If either you or your child is in need of urgent assistance please call Kids Help Line 1800 551 800 or Life Line 13 11 14. While the nature of their advice will not be specific to hearing conditions, their expertise in all areas of mental health will ensure that you are your child are supported at times of greatest need. This service also offers a range of resources and webchat support options for children and their carers. All other non-urgent persistent matters should be discussed with your audiologist or medical practitioner.
Food, drink and tinnitus
Can the food, drink or tobacco products you consume have an affect on your tinnitus?
A number of people with tinnitus associate fluctuations of their tinnitus with having certain foods, drinks or tobacco. However, an equivalent number of people find that these same substances will actually improve their tinnitus!
“It sounds strange, but I’ve found my regular morning coffee ritual really helps to quiet my tinnitus.”
Foods
Information on the internet suggests that many foods can trigger or exacerbate tinnitus. There is some weak evidence that dietary factors can have an influence on Ménière’s disease, but this is generally with regard to the dizziness of Ménière’s rather than the tinnitus and is beyond the scope of this fact sheet. For all other types of tinnitus there is no robust research to link foods to tinnitus. Certainly, there does not seem to be any foodstuff that definitely causes or exacerbates tinnitus in every person. Whatever reaction someone with tinnitus might notice is likely to be a personal idiosyncratic reaction.
Unfortunately, there is no simple test for such reactions. As with other types of food intolerance, the only way to investigate this is to perform a trial elimination diet. If a food is thought to exacerbate tinnitus it should be cut out of the diet for 2–6 weeks and then reintroduced to see if the symptom is affected. There are some problems associated with this approach.
Firstly, the act of going on an elimination diet can encourage people to monitor their tinnitus, particularly during the reintroduction phase, which can make the tinnitus seem louder. Secondly, it is important to maintain a healthy balanced diet and excluding food groups can be dangerous. We strongly recommend that anyone contemplating an elimination diet should discuss it with their GP and/or a dietician before proceeding. Finally, cutting foods out of the diet means withdrawing something that might have been pleasurable previously. Removing items of food that were previously enjoyed can add to the overall burden of tinnitus.
Drinks
People with tinnitus are frequently told to avoid drinks that contain caffeine, such as coffee and tea. There is no scientific rationale for this advice. A properly conducted scientific study showed that caffeine was not associated with tinnitus causation. Moreover, the researchers found that withdrawing someone from their usual intake of caffeine did produce side effects, particularly headaches and nausea, and this could potentially worsen pre-existing tinnitus. The sensible advice regarding tea or coffee drinking therefore seems to be to stay on a fairly constant intake and not vary this too much from day to day.
It is often recommended that people with tinnitus should abstain from alcohol, with red wine frequently coming in for special criticism. Once again, there seems little hard evidence to justify these statements. The majority of the evidence that is available suggests that alcohol is more frequently helpful rather than harmful with respect to tinnitus. There have, however, been some pieces of research that have identified particular groups of people, such as teenagers, for whom alcohol does seem to be associated with increased levels of tinnitus.
As with foods, a trial withdrawal and reintroduction would seem to be the sensible way for an individual to establish whether alcohol is related to the level of tinnitus. A word of caution needs to be sounded here: some people find that alcohol actually helps their tinnitus. We should all keep our alcohol consumption within safe limits and people with tinnitus are no exception to this rule. The Australian government advises that people should not have more than 10 standard drinks a week and no more than 4 standard drinks on any one day. The guidelines are the same for men and women.
Tobacco
It has been known for some time that tobacco smoking can contribute to inner ear hearing loss. The position with regard to tinnitus was less clear, though recent research suggests that smokers have a small increased risk of developing tinnitus.
Drugs and tinnitus
Many people with tinnitus worry that certain drugs or medicines may have caused their tinnitus. A search on the internet would seem to reinforce that view as there are numerous reports of tinnitus being associated with medication. In fact, when these claims are subjected to proper scientific scrutiny, the number of drugs that genuinely cause tinnitus is extremely small, and these are outlined below. For most drugs, there is no scientific evidence to either support or refute claims that they cause tinnitus.
For the majority of the most commonly prescribed drugs the number of people who report tinnitus while taking the drug is tiny, usually less than one in 1000 people. Tinnitus is a relatively rarely reported adverse reaction in most cases compared to the total number of adverse reactions.
This applies to most drugs for high blood pressure, cholesterol-lowering drugs (statins), drugs given for anxiety and most antidepressants. Even those drugs that do cause tinnitus tend to result in temporary tinnitus: once the drug is discontinued the tinnitus usually disappears. Also, where drugs do cause tinnitus, the effect is usually dose dependent. In other words, the normal dose that a doctor would prescribe does not cause tinnitus. It is only unusually large doses that result in tinnitus.
Why so many adverse reports, but so few confirmed cases?
The reasons for this apparent contradiction are interesting. Firstly, tinnitus is common and taking medication for one condition or another is also common. It is therefore inevitable that there should be some coincidences and some people will develop their tinnitus while taking certain drugs just by chance. They may then blame the drug even though it is blameless. If the patient reports this to their general practitioner the doctor has a duty to fill in a report for the Theraputic Goods Administration (TGA).
The information is then stored so that other doctors can access it to advise their patients. Thus a small number of reports of tinnitus can label a drug as a “tinnitus causer” even though the tinnitus may have been coincidental to taking the medication.There is another way that drugs may get accused of causing tinnitus: drugs are administered to treat medical conditions or illnesses. Having the illness that requires treatment is a stressful event. Stress is a well recognised trigger for tinnitus and it may well be that it is the stress of the illness rather than the drug used to treat the illness that triggers the tinnitus.
Specific drugs and tinnitus
Nonetheless, there are a small number of drugs that do cause tinnitus. Many of these drugs are only given for serious illnesses where there is no alternative: no one should alter their medication without first discussing it with the prescribing doctor.
Aspirin
Aspirin in large doses has long been recognised as being able to cause tinnitus and indeed researchers use this property to deliberately produce tinnitus in animal experiments. In the normal small doses used to treat headaches or flu it is very unlikely that aspirin will cause tinnitus. Similarly the tiny doses of aspirin that many middle aged and elderly people take to prevent heart attacks or strokes are extremely unlikely to result in tinnitus. A very small number of people are unusually sensitive to aspirin and develop reversible tinnitus at very low doses. Clearly, such people should avoid aspirin and contact their doctor for advice regarding alternative drugs.
Aspirin used to be used in much larger doses to treat some rheumatological conditions and when given at these very high doses tinnitus sometimes did occur. However, this effect was generally reversible: once the aspirin was stopped or the dosage reduced, the tinnitus disappeared. Such large doses of aspirin are almost never used nowadays as there are more effective, modern drugs available to treat these conditions.
Quinine
Quinine and some of the other antimalarial drugs can occasionally cause damage to the ear when given in high or prolonged doses, such as in the treatment of malaria. However, taken in low doses this does not usually happen. In the rare cases where people on these low doses of quinine do report tinnitus it is temporary and stops as soon as they discontinue the medication.
Aminoglycoside antibiotics
There is a small group of very specialised, powerful antibiotics that can be ototoxic – in other words they can damage the inner ear. This damage can cause hearing loss and a small number of the affected people develop tinnitus as a consequence of this hearing loss. This group is known as the aminoglycoside antibiotics and includes streptomycin and gentamicin.
These drugs are not available as tablets, syrups or other oral preparations and are generally given by injection in hospital for severe, life-threatening infections. Damage to the ear only occurs when the amount of the drug in the blood stream exceeds certain levels. For this reason the level is closely monitored by regular blood tests. However, there are certain conditions such as renal failure when the level of the drug can rise unpredictably and allow dangerous levels to be reached. In these rare circumstances, tinnitus can occur.
Aminoglycosides are also a component of some ear drops. These ear drops are only available on prescription: the ear drops that can be purchased at a pharmacy without a prescription in Australia do not contain aminoglycosides. Although there is a theoretical risk, aminoglycoside ear drops do not generally cause ear damage and ear specialists are happy to prescribe them in reasonably short courses. However, any patient who is worried about taking such drops should discuss the matter with their doctor.
Cytotoxic drugs
The other main group of drugs that can damage the inner ear are the cytotoxic drugs used in treating cancer. Despite the power of such drugs, damage to the ear is surprisingly uncommon. The main group of cytotoxic drugs that can damage the ear is the group containing platinum, including cisplatin and, to a lesser extent, carboplatin and oxaliplatin.
The specialist doctors who prescribe such drugs are very well aware of their potential side effects and usually discuss the matter in great detail prior to treatment. Also, where possible, patients receiving such drugs will have their hearing tested on a regular basis to identify any ear damage at an early stage, before any serious deterioration occurs.
Loop diuretics
Some other drugs that are occasionally ototoxic are a group of drugs called loop diuretics, which are used to increase the production of urine in the treatment of high blood pressure, heart failure and some kidney disorders. Ototoxicity only occurs with large doses and the relatively small dose given for mild or moderate hypertension (high blood pressure) does not cause damage to the ear. Even with large doses, such diuretics probably only cause permanent damage when used in combination with other ototoxic drugs.
Idiosyncratic drug reactions
Although the vast majority of drugs do not cause tinnitus, there is a small group of patients who will have an unexpected – or idiosyncratic – reaction to their medication. Anyone who suspects this should discuss the matter with their doctor. There may well be a suitable alternative medication or a different dosage regime that may help.
Recreational drugs
Although Soundfair cannot condone the use of such substances, there is no evidence that marijuana, cocaine or heroin usage increases the risk of developing tinnitus. Indeed, there has been discussion among some patient groups as to whether marijuana could help tinnitus. Although there is not much research on this topic, the evidence that is available suggests that it is not helpful. The use of hallucinogenic drugs and inhalants (solvents) does seem to be associated with increased risk of developing tinnitus.
Tinnitus and disorders of the tMJ and neck
Learn more about the jaw joint – temporo-mandibular joint or TMJ – and how problems with it or the neck may affect tinnitus.
Introduction
There is a close relationship between certain problems with the jaw joint (also called the temporo-mandibular joint or TMJ) and tinnitus.
Scientific studies have shown that people with TMJ problems are more likely to suffer from tinnitus. Similarly, some individuals who have sustained an injury to their neck may also suffer from tinnitus. Some people with either TMJ problems or neck problems are able to alter the intensity of their tinnitus by moving their mouth, jaw, face and neck. Successful treatment of the underlying problem can be associated with an improvement of tinnitus symptoms.
What is the TMJ?
There are assistive listening devices (often called ALDs) such as headphones that connect directly to your television for personal volume control. If you wear a hearing aid that is fitted with a telecoil, you can make use of audio-induction loop systems that are often installed in auditoriums. These systems enable the wireless audio signal to be delivered directly to your hearing aid for better clarity of sound.
There are still other devices that are used with your hearing aids to make listening in noisy environments a little easier. Your audiologist can help you to decide what might work best for you, depending on your hearing condition, your hobbies and lifestyle, whether you use hearing aids or not, and – of course – your own personal preference.
Symptoms of TMJ problems
The usual symptoms of TMJ problems are pain, which may be felt as earache, clunking of the jaw, or limitation of movement, causing difficulty in opening the mouth. Other symptoms that may arise are swelling of the joint, headaches, neck pain and tinnitus. Some people notice that when stressed, they grind their teeth – particularly at night – and this can put pressure on the TMJ.
How does the TMJ affect tinnitus?
There are three main theories behind why problems with the TMJ may cause tinnitus, or make it worse. Firstly, the chewing muscles are near to some of the muscles that insert into the middle ear and so may have an effect on hearing, and so may promote tinnitus. Secondly, there can be a direct connection between the ligaments that attach to the jaw and one of the hearing bones that sits in the middle ear. Thirdly, the nerve supply from the TMJ has been shown to have connections with the parts of the brain that are involved with both hearing and the interpretation of sound. The general discomfort associated with TMJ problems can also aggravate any pre-existing tinnitus.
How can TMJ problems be diagnosed?
Your dentist can often diagnose TMJ problems on clinical examination. If necessary, the dentist will refer you for further tests. Disorders of the TMJ may be investigated with magnetic resonance imaging (MRI) scans and even, on occasion, by arthroscopy, which is a small procedure where a tiny camera is inserted into the joint.
What can be done about it?
A variety of treatments are available to treat TMJ disorders. If your tinnitus is related to your TMJ problem, the tinnitus may improve as the TMJ problems get resolved.
There are some simple measures that can help TMJ problems, such as a change to a soft diet, jaw muscle exercises or the use of anti-inflammatory medicines and painkillers. For people who grind their teeth or clench their jaw, a bite-appliance may be made that corrects the way in which the jaw works and reduces the stresses and loads on it. This can be disposed of when normal function is restored. In exceptional cases a specialist dentist, known as a maxillo-facial surgeon, may be required to perform surgery on the TMJ.
Tinnitus and COVID-19
In Australia, and around the world, many people have reported the onset of tinnitus or the worsening of their tinnitus during the Covid-19 pandemic.
A recent study conducted by the UK’s University of Manchester and Manchester Biomedical Research Centre, published in the International Journal of Audiology, estimated that 7.6% of people infected with Covid-19 experience hearing loss, 14.8% experience tinnitus and 7.2% experience vertigo. However, the authors note that this research, which lacked control groups, was not of the highest quality. Ideally, studies compare two groups, looking for a difference. For example, a study might look at people who were hospitalised for any reason (the control group) as well as people hospitalised for COVID-19 and see if the patients with coronavirus were more likely to have tinnitus.
There are also factors connected to Covid-19 that can indirectly affect the experience of tinnitus. Covid-19 is a respiratory infection and a common symptom is a sensation of blocked ears and nose. This can cause the onset or worsening of tinnitus in some people. Generally, once the respiratory symptoms are resolved, the tinnitus also eases. It is important to note that fear, concern and anxiety associated with having a Covid test or contracting the disease may also increase tinnitus in some people.
Quinine medications when used as a treatment, rather than the low levels used to prevent malaria or night cramps, can cause damage to the ear and carry a risk of tinnitus cause/aggravation. Importantly, do not change the medication you have been prescribed without first consulting your doctor. For more details about an adverse reaction to medication and the risk of causing/aggravating tinnitus, please refer to our “Drugs and tinnitus” fact sheet.
Sometimes, the neurological effects of post-Covid syndromes (often called “long Covid”) can heighten the awareness of tinnitus. Although this a very new area of study, research is currently being undertaken to understand more about long Covid and its symptoms.
Covid-19 vaccines
Data from the UK shows that tinnitus as a side effect of Covid-19 vaccination is rare, with one in 8000 people reporting experiencing tinnitus following Covid-19 vaccination. As with any spike in tinnitus following a known potential trigger, such as a new medication or vaccine, it can be difficult to know whether there has been a direct cause and effect between the two or whether the spike in tinnitus is connected to anxiety. Frustratingly, self-monitoring tinnitus – to check if the vaccine has affected it – can, by creating an awareness feedback loop, itself cause an increase in tinnitus. For people with pre-existing tinnitus, making an informed decision about vaccination and having the correct mindset is important. In the trials prior to their release, no mention was made of the onset of tinnitus or worsening tinnitus for any of the available vaccines.
Tinnitus during the pandemic
It is well recognised that there is a strong association between Covid-19 and tinnitus because of a variety of environmental stressors and behaviour changes associated with the pandemic, rather than directly attributable to the virus itself. There is a strong link between stress and tinnitus and, for many people, life changes during the pandemic, such as working from home or missing social connection, have increased their stress levels.
