What’s That Sound in My Ear?

Stephen is a 53-year-old man who was in a car accident 20 years ago. At the time, he detected a faint yet perceivable ringing in his head, but it never bothered him because he was able to shift his attention to other activities and put the sound in the background. About five months ago, the ringing increased, seemingly “out of nowhere,” and he was no longer able to ignore it. 

Amanda, a 19-year-old college student, plays bass guitar in an alternative rock band. She occasionally wears foam hearing protection when she performs but doesn’t like the way the music sounds when she does. At night when she goes to sleep, Amanda detects a soft hissing in her left ear. 

What is tinnitus?

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Tinnitus is the perception of sound when there is no external sound present.  Some people may describe it as ringing, buzzing, roaring, clicking, whooshing, and even musical; however, it can manifest as any sound. It may be heard in one or both ears, or even from the center of the head. The noise can be constant, intermittent or pulsating, and it can fluctuate in loudness and pitch. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that 10 percent of the population – that’s over 25 million Americans – have reported tinnitus lasting more than five minutes in the past year. About 25 percent of those people find it so debilitating that they may need to seek treatment for it. 

Causes of tinnitus

What causes tinnitus? Most of the time, it can be difficult to pinpoint the exact cause, as it may be a symptom of one of roughly 200 health disorders. The most common cause is hearing loss; however, not everyone with tinnitus also has hearing loss. Other sources include noise exposure, ear infections, wax buildup in the ear canal, head or neck trauma, hormone changes, medications that have caused ear damage, or a disorder of the temporomandibular joint (TMJ), the hinge that lets you move your jaw up and down and sideways. Pulsatile tinnitus, a type of tinnitus that steadily pulses in time with your heartbeat, may be caused by issues in blood flow to the head or neck. 

Is it objective or subjective?

There are two types of tinnitus: objective and subjective. With objective tinnitus, the sound can be heard when an audiologist is positioned close to the ear. This accounts for approximately one percent of the tinnitus population. Subjective tinnitus is when the sound can only be heard by the person reporting it. 

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There are assessments available that measure the perceived volume and pitch of tinnitus and its effect on someone’s life.  The results can then be compared to measurements taken after treatment to detect any changes in the tinnitus. This assessment is also a great way to let the patient know that the sound is real and put it in perspective with other known sounds.

Management of tinnitus

If a known problem, such as an ear infection or a TMJ disorder, is causing your tinnitus, treatment of this issue may relieve the sound. If there is no known cause, there are several other ways to manage it and make you less aware of it. 

• The simplest way to cope is to avoid being in a totally quiet environment. Maskers – such as fans, white noise machines, air filters or background music – can help minimize the perception of tinnitus. These tools can be especially useful if tinnitus is affecting your sleep. 

• Changes in your diet may be helpful as well. Limiting sodium, caffeine, alcohol and nicotine may suppress the tinnitus
by increasing blood flow to your ears. 

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• Relaxation therapy is a positive way to reduce stress, which in turn can reduce the tinnitus. Examples of this include acupuncture, yoga and meditation.  

For people who are unable to improve their quality of life with the tools above, the usage of sound therapy may be necessary. This may come in the form of hearing aids or a sound therapy device specific for treatment of tinnitus. An audiologist will work with you to determine the best form of sound therapy treatment. 

Lastly, counseling by a cognitive behavioral therapist with a focus on tinnitus management may be an appropriate form of treatment. This is a good option for people struggling to cope with it. 

Help for Stephen and Amanda

In Stephen’s case, since his hearing was normal, I recommended a sound therapy device for him to wear during the day when the tinnitus flares up and at night to help him fall asleep. These sounds allow him to decrease his awareness of the tinnitus even when he is not using the device. I also recommended that he meet with a cognitive behavioral therapist who can help limit the negative associations he has towards the tinnitus.

As for Amanda, I found out that she stands on the right side of the stage when performing, which primarily exposes her left ear to the loud noise. I recommended custom musician earplugs with filters to lower the music volume but prevent distortion. Since her tinnitus is noticeable only at night, I suggested that she use a fan at night to create low background noise that can help reduce her tinnitus perception. 

If you are suffering from tinnitus or have difficulty hearing, call the Donald R. Reed Speech and Hearing Center at 914-366-3010 to schedule an evaluation with an audiologist and learn about your treatment options. 

Jessica LaCorte, AuD, CCC-A, F-AAA, is Coordinator of Audiology Services at the Donald R. Reed Speech and Hearing Center
at Phelps. In addition to providing direct clinical services, Dr. LaCorte oversees the Phelps Balance Center. Her focus is on pediatric and adult audiological evaluations, vestibular (balance) evaluations, treatment of patients suffering from tinnitus and hearing aid dispensing. 

Dr. LaCorte obtained her BA degree at the University of Maryland and her Doctor of Audiology from The Graduate Center, CUNY. She worked at Columbia University Medical Center during her residency and interned at The Ear Institute at the New York Eye and Ear Infirmary and Weill Cornell Medical College. She also aided in research studies at the National Institute on Deafness and Other Communication Disorders at the National Institutes of Health in Bethesda, MD. Dr. LaCorte, a licensed audiologist and hearing aid dispenser in New York State, is a Fellow of the American Academy of Audiology and has a Certificate of Clinical Competence in Audiology. She can be reached at 914-366-3010.


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