Tinnitus

By Dr. Hamid Djalilian

NeuroMed specializes in the medical management of tinnitus, a treatment approach that involves structured neurologic rehabilitation. We use medications, nutraceuticals, brain therapies, and lifestyle changes to actively rewire the brain so that the experience of tinnitus fades into the background. 

Too often, people with chronic tinnitus are told that “nothing can be done.” This is absolutely not the case. I have successfully treated thousands of patients using the Integrative Neurosensory Rehabilitation protocol that is now available through NeuroMed. 

While tinnitus originates in the hearing apparatus, the annoyance we experience with chronic tinnitus occurs in various different parts of the brain. Tinnitus is not an ear problem, it's a brain problem. This means that tinnitus can be successfully managed with applied neuroscience.

What is tinnitus?

Tinnitus is often experienced as a ringing or buzzing sound in the ear. It can affect people of all ages and can be temporary or chronic, depending on how long the symptoms last. 

This condition originates when your brain's hearing system registers signals that are not there. It usually indicates that there has been some damage to the auditory system, although people can experience tinnitus even in the absence of hearing loss.

The ringing or buzzing noise can affect one or both ears, be intermittent or continuous, and may vary in loudness.

Understanding How Hearing Happens

Our hearing system is divided into three main sections: the outer ear, the middle ear, and the inner ear.

The act of hearing happens when sound waves traveling through air are converted to electrochemical signals and sent to the brain. These sound waves enter the body through the outer ear and reach the eardrum through the ear canal. 

Vibrations of the eardrum are then amplified by the middle ear bones and forwarded to the cochlea, a snail-shaped structure of the inner ear. Hair cells within the cochlea then convert the vibrations into electrical signals in the form of nerve impulses. These nerve impulses then travel to the auditory cortex, the hearing part of the brain. 

To summarize the sequence: Sound hits the ear drum > Vibrations are transmitted through the bones of hearing to the cochlea > Vibrations are translated into electrical signals by cochlear hair cells > Nerve impulses leave the inner ear and travel to the auditory cortex. 

But this is not all that goes into hearing! There are multiple collateral connections that influence our perception of sound in other parts of the brain. Neural networks that attach the auditory cortex to multiple other parts of the brain are essential in the process of hearing. 

Fear, Attention, and Tinnitus

Hearing is more than auditory signals from the ear. For instance, certain sounds can trigger the fear and annoyance center of our brains. This is an evolved response to warn us of danger, such as the sound of a predator or of a baby crying. These neural networks are ancient and they are the real culprit when it comes to tinnitus. 

The annoyance center allows us to cue in to signals that would otherwise be faint. A famous tinnitus professor gave this analogy at a lecture. He had a neighbor who had a small dog that was constantly barking with a high pitched bark and it drove him crazy. It became so intrusive that it would interupt his attention when watching TV or while trying to study.

One night, he had friends over for dinner and the dog was barking as usual. He said to his friends, "I'm so sorry for all of that noise coming from next door", to which his guests replied, "what noise?". His brain had developed a neural network between the auditory cortex and his annoyance center, such that he became cued in to the sound, even if it was faint. His guests, on the other hand, did not have this conditioning and didn't even notice it!

On a related note, the attention center of the brain is connected with the auditory cortex, allowing us to essentially tune out sounds that are irrelevant. When people live near rivers or waterfalls, they stop "hearing" the waterfall in the sense that it's tuned out as irrelevant. The signal is still coming in to the ear, its just ignored. An analogy would be the feeling of your shirt on your shoulders. If you pay attention, you can feel the fabric on your skin. However, for most of the day, you never even register this sensation. The signal is coming in, but its ignored. 

All of this is to say that the presence of sensory information is not what is relevant. Instead, what makes sensory information important (or salient) is the neural networks ascribed to it by the attention center of the brain. 

Tinnitus typically starts with some sort of cochlear hair cell damage. When this happens, instead of going silent, the hearing nerve sends a steady low-grade signal to the auditory cortex corresponding to the pitch of the damaged hair cells. But this itself is not what makes tinnitus problematic. Instead, the neural networks that connect the auditory cortex with other parts of the brain, in particular the fear and attention centers, is what makes tinnitus severe and burdensome. Again, tinnitus is not a hearing problem, it's a brain problem. 

Common Causes for Tinnitus

Tinnitus is often related to some kind of hearing loss, but there are a variety of other causes.

Sensorineural Hearing Loss

Sensorineural hearing loss happens when the hearing organ of the inner ear or the hearing nerves become damaged. The most common causes involve induced hearing loss due to physical trauma and the normal aging process that weakens our hearing system.

Genetic factors also play a role in the speed at which hearing may be lost. Some people are born with sensorineural hearing loss due to hereditary causes. 

Although rare, infections and autoimmune conditions can also lead to the development of sensorineural hearing loss.

Conductive Hearing Loss

Conductive hearing loss is a condition caused by the interruption of sound transmission from the outer ear to the inner ear. This may occur as a result of a wax blockage in the ear canal or may be related to direct damage to the hearing bones. 

Usually, conductive hearing loss can be reversed with a procedure to correct the blockage.

Ménière’s Disease

Ménière’s disease (MD) is often characterized by symptoms like:

  • Episodic vertigo
  • Hearing loss
  • Pressure in the ear
  • Tinnitus

We now understand that MD is related to a migraine-like phenomenon in the brain. Controlling the underlying migraine process can cause resolution of Meniere’s vertigo, ear pressure, and buzzing. Dr. Djalilian has successfully treated hundreds of MD patients using the INR protocol

Benign Tumors of the Hearing Nerve

Acoustic neuromas, or vestibular schwannomas, are benign tumors that appear within the nerves in charge of balance and orientation. Although it is unclear why these tumors occur, it is often related to a genetic problem that targets the nerve coverings. 

These tumors are benign and slow growing. In fact, even when they are discovered, the usual course of action is to monitor them on an annual basis with MRI imaging

When they do require treatment, it can involve targeted radiation or a surgical procedure to remove the tumor. Tinnitus is not uncommon in patients with these tumors, but fortunately, there is hope to reduce the loudness of the tinnitus using the INR protocol. 

Certain Medications

Medications rarely cause hearing damage, but when they do, they could potentially lead to complete deafness. In these cases, chemotherapy, antibiotics, and certain diuretics are the usual culprits.

Hyperacusis

Hyperacusis refers to the brain's hypersensitivity to sound that causes a louder perception of noise. For example, patients with this condition tend to be sensitive to high-pitched voices or the sound of utensils when they knock on one another. 

It is common for patients dealing with hyperacusis to also suffer from tinnitus and atypical migraines. Treatment of the underlying migraine can result in the alleviation of hyperacusis.

When Tinnitus Becomes a Problem

A mild buzzing or ringing noise in quiet environments characterizes is very common, occuring in up to 10% of the U.S. population. When these sounds increase their intensity and frequency, they can significantly affect all aspects of a person's life. Reduced quality of life, tinnitus-related fear, and constant awareness are reported as common problems.

Here are some of the domains where severe tinnitus has an impact on one's life:

  • Intrusive: Persistent unpleasant awareness of the tinnitus, making it hard to ignore. 
  • Loss of Control: A feeling of lost of control and an inability to cope with tinnitus. 
  • Cognitive Issues: Disrupted ability to concentrate or do mental tasks efficiently. 
  • Sleep: Interference with the ability to get fitful sleep. 
  • Relaxation: Inability to relax and enjoy "peace and quiet".
  • Social Impact: Relationships are negatively affected and the desire to be social decreases. 
  • Mood: Increased incidence of anxiety and depression. 

Tinnitus Diagnostic Testing

Tinnitus is mainly diagnosed by your personal history. Your provider will conduct a thorough examination of your tinnitus history, looking for features like intensity, frequency, and factors that make it better or worse. While some report constant tinnitus, most people can identify patterns where the tinnitus intensity fluctuates.

Another component of your work up is evaluation of any prior hearing tests. If you have not had a hearing test, you can still start treatment, but we will want you to get tested at a local facility (many places will perform these free of charge in the hopes of selling you hearing aids). In general, people with tinnitus should get a hearing test every year. 

Depending on your case, we may also recommend that you get an MRI of your hearing nerve to provide a precise diagnosis.

Integrative Care for Chronic Tinnitus

Chronic tinnitus can affect nearly every aspect of your life. It is not just a hearing issue, it is a brain issue. Because of this, proper tinnitus care requires an integrative medicine approach to be successful. 

Integrative medicine at NeuroMed Virtual Clinic may use a combination of prescription medications, natural supplements, dietary and lifestyle changes, and behavioral therapy to treat tinnitus. Alleviating your tinnitus symptoms is a process that involves the retraining of your brain, which necessarily takes time and effort. 

Our team will guide you through this journey toward tinnitus freedom and optimal health with compassionate and efficient care.

Treatment for Tinnitus in California & Beyond

Our integrative approach combines traditional and alternative medicine with wellness coaching and lifestyle therapy. Through this holistic perspective, we work to alleviate your tinnitus symptoms and help you regain your well-being. 

To schedule an appointment at NeuroMed Virtual Clinic,  call us at 1-888-226-6330 or request an appointment online.

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