Whistling, humming, squealing, thumping and hissing - all unpleasant noises that one would like to avoid. But escape is not possible when the agonizing sounds come not from outside at all, but from within.
The feeling of being at the mercy of the noise, not knowing whether it will ever stop, is often the worst thing for those affected.
Complaints
Tinnitus (literally "ringing") is the name given to the phenomenon when the hearing itself seems to produce sounds that can distress a person day and night. 40% of all people suffer from the complaints in the course of their lives. 10-20 % are permanently affected.
Tinnitus is not a disease, but a symptom, similar to headaches or toothaches, and can have numerous causes. Tinnitus is not pathological in every case. In an anechoic room, virtually all people hear some whistling or hissing.
Even though tinnitus subsides without consequence in most people, others are very persistently affected. Medication does little to no good, and at some point the phrase, "You'll have to put up with it." comes up.
Is this true? What is behind tinnitus? And what can be done?
Trigger
Tinnitus does not usually come out of the blue. Typical triggers are persistent stress, infections, inflammations or a loud noise, such as the explosion of a firecracker. Often, several causes come together.
Hearing loss, a sudden onset of hearing loss, is also common. But there are many more clinical pictures that can lead to tinnitus:
- Bang trauma
- Hearing loss
- Noise-induced hearing loss
- Age-related hearing loss
- Tumors
- Poisoning
- Otosclerosis (calcification of the ossicles)
- Metabolic diseases
- Diseases of the cervical spine
- Kidney diseases
- Stress and tension
Frequency
Tinnitus is common. About one in four people suffer from it for a long time at least once in their lives.
Approximately 1 million people with tinnitus in Germany require therapy, with around 250-350,000 new cases every year.
Women are affected slightly more often than men.
Acute and chronic tinnitus
Short-term tinnitus is largely normal. Suddenly there is a beeping in the ear. Such events are not rare and usually disappear after a few minutes. Depending on the duration, one distinguishes between different forms:
- up to three months duration: acute tinnitus
- three to 6 (or 12) months duration: subacute tinnitus
- above that: chronic tinnitus
Tonal and non-tonal tinnitus
About half of those affected suffer from tonal tinnitus, the other half from non-tonal tinnitus.
Tonal means a whistling, ringing, buzzing, chirping, etc. The tones are usually very high in the range of 3000 Hz.
Non-tonal means a hiss, hum, buzz, crackle, pop, rumble, etc.
Objective or subjective tinnitus
A distinction is generally made between objective and subjective tinnitus. In the case of objective tinnitus, sounds are actually produced, e.g., by flowing blood, cracking when swallowing, or muscle activity. Such sounds can be registered by an examiner e.g. with a stethoscope or microphone from the outside.
In the case of subjective tinnitus, there is simply nothing at all. It hisses and whistles for no apparent reason. The noise is caused by disturbed stimulus processing.
Another classification concerns the degree of severity:
- Grade 1: compensated tinnitus without suffering,
- Grade 2: compensated tinnitus, which is perceived as disturbing in the case of stress and psychological strain,
- Grade 3: decompensated tinnitus with permanent impairment in private and professional life,
- Grade 4: tinnitus with complete decompensation in the private sphere or occupational disability.
Causes
Innocent inner ear
What happens in tinnitus at the neurophysiological level is not yet fully understood. For a long time, the main attention was focused on the ear itself. It was assumed that there was local damage to the ear. In desperate cases, therefore, the auditory nerve was cut in order to help the patients achieve the peace they longed for. The severely affected would rather be deaf than continue to endure the unbearable whistling.
But the successes failed to materialize. The noise persisted despite deafness. This made it clear that the problem was not in the inner ear, but in the subsequent processing of stimuli.
"Fibromyalgia of the Hearing."
In more recent times, theories on the origin of tinnitus have changed. They are very similar to the explanation of chronic pain. Similar to pain, hearing is only made possible by a mixture of excitation and inhibition. Impulses go from the ear toward the brain. Other signals go from the brain toward the ear and cause insignificant things to be inhibited.
The path from acoustic event to perception proceeds through three stages. First, a sound event is converted into an electric current in the inner ear.
Now this signal reaches the brainstem and thalamus and is analyzed there. It is compared with stored sounds and subjected to a kind of pattern recognition. At the same time, fibers go to the limbic system and the amygdala (tonsil nucleus), which cause emotional coloring. This emotional significance is very essential to perception. Insignificant things are blanked out, threatening, dangerous and unpleasant signals always have priority as warning signals. Only after that, in a third step, the conscious perception takes place.
Phantom perception
So if you slumber gently, your hearing does register the sounds of the street or the wind in the trees. The impulses are picked up and directed to the thalamus. Upon analysis, the upstream brain nuclei conclude that the signals have long been known, and the limbic system also shows no increased emotional interest. As a result, no arousal stimulus is sent to the conscious mind. Sleep is not disturbed. Not only at night, the vast majority of noises are thus constantly actively blocked out.
The situation is different with a quiet squeak, e.g. the opening of the bedroom door. This is also immediately identified and interpreted as threatening. With a jolt, the sleeper is awake and senses from the palpitations how much adrenaline has already been released. Similarly, young mothers are startled when their child whimpers softly.
Tinnitus is understood as a misperception or "phantom perception", similar to phantom pain. When it develops, causes in the inner ear, thalamus and consciousness are mixed.
In addition to loud signals (e.g., after an explosion), the emotional coloring of the signal is crucial. Threatening or frightening sounds are perceived much more intensely than soothing music. Attention is also essential. Those who pay attention to tinnitus involuntarily amplify it
Thus, tinnitus can be understood as a vicious circle. In the beginning, there is often an external cause that triggers the temporary whistling or humming. Anxiety and tension then intensify the problem. The more stress this causes a person, the more he pays attention to it, the less favorable the course.
This representation is certainly simplified. But recently it has become clear that tinnitus also belongs to the circle of central sensitization disorders, likefibromyalgia and otherfunctional disorders.
We have seen in recent years that breathing disorders are very common in tinnitus.