Instant Genius - Tinnitus: What causes the persistent ringing or buzzing of the ears and how can we treat it?

Episode Date: December 18, 2023

Many of us will have experienced a ringing or whining noise in our ears at some point, perhaps after going to a concert or working a long shift in a loud environment. But for some, the ringing sound never stops. These people have something know as tinnitus. In this episode we catch up with Dr Lucy Handscomb, a lecturer in audiology at University College London’s Ear Insitute. She tells us what’s going on in our bodies when we hear these mysterious sounds, the impact they can have on our lives and what we can do to lessen their effect. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Music just as the artist intended. Visit name audio. and welcome to Insted ingenious, a bite-sized masterclass in podcast form. I'm Jason Goodyear, commissioning editor, a BBC Science Focus magazine. Many of us will have experienced a ringing or winding noise in our ears at some point. Perhaps have to go into a concert or working a long shift in a loud environment. But for some, the ringing sound never stops. These people have something known as tinnitus.

In this episode, we catch up with Dr. Lucy Hanscom, a lecturer in audiology at University College London's Ear Institute. She tells us what's going on when we hear these mysterious sounds, the impact they can have on our lives, and what we can do to lessen their effect. So today we're talking about tinnitus. So a lot of people might have heard of this as a ringing in their ears, a sound in their ears.

But what exactly is tinnitus? What's the scientific definition? Titus is really a descriptive word. It comes from a Latin word, to nari, which means to ring. But actually, it's not only ringing. And it's a little bit misleading. Sometimes the description of tinnitus you see is ringing in the ears. And some people tell me, well, I haven't got tinnitus because mine isn't ringing.

But it can be all sorts of different sounds. It can be humming, buzzing, whistling, crackling. There are many, many different descriptions that people have for their tinnitus. Sometimes it's heard in the ears. Sometimes it might be heard in one ear and not the other. and sometimes people describe it as coming from the middle of the head. So rigging in the ears is only really part of the definition. So I think before we really get into the meat of this topic,

I think we should talk about the structure of the ear and how human hearing works. So could you break that down for me, please? Yeah, so there are basically three sections to the human ear. There's the outer ear, which consists of the bit you can see, the pinner on the sides of the head, and then the ear canal. The air canal is where you sometimes get wax building up.

Then at the bottom of the ear canal, you've got your eardrum, which is sort of stretched across the bottom of the ear canal, a bit like the skin of a drum. And that's the barrier between the outer ear and the middle ear. So the middle ear is a kind of a little space inside the skull. Inside it, you've got three tiny bones, which are actually the smallest bones in your body. They're known as the hammer, the anvil,

and the stirrup because of the shape that they are. In your middle ear, you've also got the eustacean tube, so that connects the middle ear to your nose and your throat. Beyond that, we've got the inner ear, and the main structure in the inner ear is called the cochlear. Cochlear means a snail shell, and it looks like a snail shell. So a very tiny, coiled-up snail shell,

and that's where you have the tiny little nerve endings. and the cochlear is attached to the hearing nerve that then goes on up to the brain. So you mentioned there that there are different ways of experiencing tinnitus. Different people get different sounds in different areas. So what can we say about that? Well, we don't really have a very good explanation for why some people hear certain sounds and other people hear others. Quite often the sound of tinnitus corresponds to the missing frequencies. in somebody's hearing. So if somebody has a high frequency hearing loss, for example,

then they will be more likely to have a high-pitched sound as their tenetious, whereas someone with a low-frequency hearing loss, which is less common, will be more likely to have a deeper sound as their tenetors. But other than that, there's no particular reason that we've established why some people hear of buzzing, some people hear of ringing, some people have a whistling and whatever else. Yeah, so as I've said to you earlier before we started, I actually have tinnitus. So how common is it? It's really common. It's actually quite difficult to answer the question precisely because of course many people aren't familiar with the word tinnitus. So the answers you get depend a little bit on how you define tinnitus if you're asking very large numbers of people whether they experience it. But our best guess from a number of surveys that have been done is about one in eight people have tinnitus. And by that, I mean, tinnitus that lasts for more than just a couple of minutes at a time and isn't only triggered by very loud noise. So if you think about

going to a disco and the kind of tinnitus you get after that, you know, that's almost everybody. But about one and eight people have tinnitus that arises in other situations, not just after very loud noise. So having said that, how do you diagnose it sort of clinically? Really, the diagnosis of tinnitus just relies on the description that the person gives, because we don't have any objective way of measuring tinnitus. Diagnosis just involves asking questions to the patient about what they're experiencing. So what do we know about what's going on sort of physiologically when someone has tinnitus? So there are still a few unanswered questions about what's going on physiologically and probably it's not exactly the same thing for every person who's experiencing tinnitus,

which is one of the things that makes Tinnage is quite a tricky problem. But what we think is happening is some kind of interference in the normal pattern of signals that the ear is sending to the brain. So I don't know if it would help if we went back and looked a little bit more at how the inner ear works. Yeah, sure. So the in area, the cochlear, has these tiny little nerve endings inside it, which are known as hair cells.

They're not really hairs, but they look like hairs when you see them under a microscope. There are many thousands of them. When a sound comes into your inner ear, it activates the hair cells. They start to move around. And as they do that, they generate electrical signals, which are then passed along your hearing nerve and into the brain. Now, different groups of hair cells are responsible for different types of sound. So high-pitched sounds will activate certain hair cells, low-pitched sounds will activate others. And this is going on all the time. So your brain is, is kind of receiving sound in the form of a very complex electrical code that it then has the decipher. Now, if there's some damage in the hearing system, really at any part along the hearing pathway, that can cause some disturbance or interference in the normal pattern of signals that the ear is sending to the brain. And the brain picks up that interference as a sound. The way I sort of think of it is it's a bit like when you have a piece of electrical machinery that's not quite functioning properly, it's faulty, and you get a background hum or a buzz or something like that.

And our ears are a little bit like that. If they're not functioning perfectly, you'd often get an internal sound as a sort of side effect of that. So you mentioned that most people have perhaps experienced it now and then, but what makes it stick around in some people, you know, more than others? Tinnitus is very often related to hearing damage. But it seems that the hearing damage needs only to be very minor in order for tinnitus to be caused. And there are quite a lot of people who describe having tinnitus, and when you test their hearing, they don't have any measurable degree of hearing loss. But some research that was carried out a little while ago suggests that if you test those people at much higher frequencies than you would normally test hearing,

their hearing is a little bit less good than average. So there's an indication that most tinnitus is caused by some damage within the hearing system that might only be a very tiny about of damage or it might be much more extensive and people with a significant hearing loss that very commonly experienced tinnitus as well. So talking about that damage, as I said, I have it because I think I got it

because I used to play in rock bands very loud and I used to stand next to the drums and it was really loud and it's especially my right here so that's why I think I've got it. Is something like that likely to cause it? Because I know a lot of orchestral players get it too. Is it just a case of just the raw volume?

Music over a certain volume, and indeed any sound over a certain volume, can cause damage to the delicate nerve endings that we talked about in the inner part of the ear. And that's really one of the most common causes of tinnitus. So like you, a lot of people develop tinnitus. after prolonged noise exposure or regular noise exposure. And it is, as you say, quite a common problem amongst musicians of all types. So what do we know about, because it's not a real sound, right?

It's like a perception of a sound. What do we know about what's going on there? Well, that's where we still have quite a lot of unanswered questions, really. And one of the mysteries about tinnitus is that there are quite a lot of people out there who have some damage to the hearing system, sometimes quite significant, who don't have tinnitus at all. And it's really hard to explain why people with the same amount of damage or the same type of damage within the hearing system, why some of them have tinnitus and other people don't. So we don't really fully understand why it is that the brain sometimes perceives its

sound when there's something wrong within the hearing system and it sometimes doesn't. But the way in which we perceive sound is very complex and depends on a lot of factors. One of the things we know, which is quite relevant to our understanding of tinnitus, is that if you put people into a soundproof room, like an anechoic chamber, people who don't have tinnitus normally, just get them to listen very carefully and then ask them what they heard. A large number of people, most people will come out saying they could hear some kind of buzzing or humming or whistling sounds that people just when they have tinnitus. So that suggests that we do all actually have the capability of hearing internal noises, but most of the time, most people aren't hearing that, presumably because the

hearing system is occupied with other things and we're surrounded by other sounds, and even in quite quiet environments, is really completely silent. So having said that, how do you go about researching tinnitus? Well, a lot of tinnitus research involves asking people lots of questions about their tinnitus. And that's certainly the type of research I'm involved in. A lot of it is questionnaire-based. So we try to get a better understanding of what people are experiencing when they have tinnitus, when it's worse, what kinds of things affect it, what helps them to manage it better and so on. There is another whole branch of tinnitus research, which is looking at it from a much more physiological point of view. And some of the research that goes on within hearing institutes is looking in detail

at the hair cells and the structure of the cochlear, trying to get better understanding of what's going on and the differences that damage to the inner ear can make to a person's ability to hear tinnitus or not. It's peak pollination season and my business is scaling fast. To keep the nectar flowing, I need a phone plan with top priority data speed. That's why I chose GoogleFi Wireless. My connections stay strong even when the hive is buzzing. Plus, unlimited plans started $35 a month. Now that's a deal that doesn't stay.

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Hilton, for the stay. This podcast is sponsored by name, audio, and trocal. With over 100 years of combined expertise, Name and Focal have been bringing music to listeners just as the artist intended. Since day one, this mantra has shaped every innovation in hi-fi design, technology and acoustic engineering, balancing craftsmanship and tradition with pioneering thinking. Name Audio pushes cutting-edge technology to ensure digital precision whilst sustaining Pratt, pace, rhythm and timing, the elusive quality that makes music feel alive and gives it a most

texture. Today, in partnership with French acoustic specialist focal, name audio creates systems that deliver exceptional sound and unforgettable listening experiences at home. Try it for yourself at a focal powered by name boutique. Visit focal powered by name.com for more information. So have there been any sort of neural imaging studies? There have been some studies which have shown differences in brain activity between people who are hearing tinnitus and people who aren't hearing tinnitus. There's quite an interesting group of people who have what we call gaze evoked tinnitus, which is quite rare, but it basically means if they flick their eyes in one direction, their tinnitus starts, if they move their eyes in the other direction,

their tinnitus stops so they can actually switch their tinnitus on and off, and it's under their control, which is a very unusual situation. So obviously, researchers like those people, and they can put them into brain scanners and get them to turn their tinnitus on and off and then see different patterns in brain activity, depending on whether the tinnitus is present or absent. So you mentioned earlier musicians, you know, in my own experience of sort of teenage exuberance or something. Who's most at risk of developing it? You know, I'm thinking about genetic risk factors and things like that? So certainly noise exposure is one of the biggest causes of tinnitus.

So people who work in the music industry or the ledger industry are at risk of tinnitus. Similarly, people working in kind of heavy industry, but that seems to be a bit less of a problem now because there's much more regulation over ear protection. So it was longer ago, it was more people who worked in mining and in factories and that kind of thing. but there are much stricter rules now about protecting your ears. But not everybody who has tinnitus had noise exposure. So many people develop tinnitus when they haven't been exposed to very much noise at all. It can be related to any type of hearing loss at all,

including hearing loss, which is related to ageing, which is the most common type of hearing loss and affects most of us by the time we get to about 70 years old. So can hearing impaired people experience to Nittis? Oh yes, very much so. It's very common amongst people with hearing impairment. Yeah. So I think recently you mentioned there, we've mentioned music,

we've mentioned, you know, perhaps somebody who's working in a heavy industry. More and more now, lots of us are listening to music or other things on headphones. How worried should we be about that when we're using headphones? I tend to say to people there's nothing evil about headphones per se, but we need to be aware of the volume and we need to be aware of the duration of exposure. So it's an equation really. You can tolerate fairly loud sound for short periods of time

without it doing too much damage. You can tolerate moderate levels of sound for longer periods of time. What we need to be careful of is having headphones turned up loud for quite long periods of time. And I think where some of the danger lies is when people are using headphones in background noise. So when they're commuting, for example, you tend to turn the volume up so you can hear over the noise of the train or whatever transport you're on. And then you've got quite loud and

potentially damaging volumes going into your ears. So we do need to be limited about both the amount of time we use headphones and the maximum volume we turn them up to. So is Tinnitus linked to any other medical conditions. So the strongest connection is certainly a link to hearing loss. As we said, so a lot of people with hearing loss also have tinnitus. In terms of other conditions, there's not really a strong link between tinnitus and many of the sort of more common medical conditions. So what sort of things, mental health conditions, can it perhaps be linked to? Tinnitus can be associated with mental health problems like depression and anxiety. People who have one of those conditions more likely to have tinnitus are more likely to be bothered by tinnitus than people who don't.

And then we get a kind of chicken and egg situation because, of course, if somebody is anxious and they develop tinnitus, they're likely to experience an increase in their anxiety. And if you're feeling anxious or stress, that's one of the things that can make. Tinich is much worse and more difficult to cope with. So it's a really important factor. So let's have a look at treatments then. Say I've got tinnitus and it's really irritating me. It's ruining, well, not ruining. It's impacting my quality of life. What can I do about it? How can we treat it? The most effective treatment we have for tinnitus at the moment is CBT or cognitive behavioral therapy. And this is really linked to what we were just saying about the psychological

impacts of tinnitus. Even if someone doesn't have pre-existing anxiety or pre-existing depression, they may well find that the tinnitus makes them feel stressed, anxious, depressed, angry, irritated. There are many kind of emotions triggered by tinnitus. And lots of negative thoughts that go along with it. So cognitive behavioural therapy is about managing those difficult thoughts that go with tinnitus and managing the emotional response. People don't get rid of their tinnitus through using CBT, but they do find that it becomes a lot less distressing and a lot easier to live with. Having said that, does it ever just go away? Sometimes it does. Sometimes it goes away for no apparent reason. there are quite a lot of people who have tinnitus temporarily, which might be related to something like an ear infection or a sinus problem or something like that.

And whence that problem clears up, the tinnitus also goes away. I have also come across people who have had tinnitus for several years and who've reported that it's stopped one day. And we don't really know why. It's a bit mysterious like that. But for the majority of people, once they've had it for a matter of months, it tends to persist. The better news is it doesn't tend to be such a big problem as time goes on. There's a general course of tinnitus as it becomes less problematic over time rather than getting worse. Yeah, having said that, one issue that I have, my tinnitus flares up is trouble sleeping.

Do you have any advice for people that are suffering from a similar problem? Yeah, so that's one of the most common problems related to tinnitus. So if you get people to list, some researchers have done this, there's got people to list in order the problems they have related to their tinnatures. Then sleeping problems quite often come at the very top of the list. So that's quite a common experience. One thing that can help and a lot of people get benefit from is using low-level sound in the background at night time.

There's lots of apps you can get now that play you the sound of seashores, waterfalls, rain, that kind of thing. And the idea is to have it on just a low-level when you're in bed at night. so it's giving your brain something else to listen to. The problem at night time is often because your surroundings are very quiet. You've got nothing else to listen to. The auditory brain kind of latches onto the tinnitus and it seems much more prominent and more irritating. So an alternative sound can be helpful and I usually suggest to people they just leave it on through the night. So if you wake up at 3 o'clock in the morning, you're not having to kind of fumble around and switch it back on

again, it's just there in the background. We also look quite a lot at general sleep tactics, because often if a problem with sleep has arisen because of the tinnitus, people will be in quite poor sleep habits. So we sometimes need to look at the whole picture, say what time people are going to bed, what they're doing when they can't get to sleep, how much time they're lying in bed, tossing and turning, and we might need to look at all of those things rather than just focus on sound. So this in a way might be common sense, but if somebody's listening to this and they don't have to knit us and think, oh, God, I don't want to get to knitters, how can you minimize your risk of getting it? Well, the biggest thing that we have control over is noise exposure. So being careful around noise. If you're going to gigs or discos take some earplugs with you. And there's lots of really effective earplugs you can get now, which I have. have music filters in them. So the music will sound the same, but just quieter. It doesn't distort

where you're listening to. So protecting your ears from noise, and I definitely wouldn't say, don't expose yourself to noise, but I would say make sure you take ear protection with you. And there's lots of good stuff out there that you can do. Other than that, there's not a great deal that we can control when it comes to whether we develop tenetis or not. All of us are susceptible to developing hearing loss as life goes on and all of us have a chance of developing tinnitus. I think what probably can be quite helpful is just being informed about what tinnitus is and the kinds of things that can make it worse and the kind of things that people find helpful because one of the difficulties I noticed with tinnitus patients is that if they first experienced

tinnitus, they've never come across it before, they've never even heard of it. It can be a very sort of frightening, isolating experience. And if stress and anxiety go up in the early days with tinnitus, it can be really hard to cope with. So looking forwards then, are there any sort of new treatments in development? Are you optimistic? We'll be able to develop treatments at some point. There are quite a lot of research projects going on, looking at tinnitus from many different angles. And I do think it's possible that there might be some kind of drug treatment developed eventually. There are a few research projects which are looking at drugs that might be able to restore the inner ear when it becomes damaged. And those could have a two-prong effect.

They could help people hear better. They could also help to reduce tinnitus or perhaps even eliminate tinnitus. I think it's not beyond the bounds of possibility that there will be ways of stopping tinnitus altogether in the future. There might also be devices developed, which will be able to give people more help with reducing their tinnitus than we've got available at the moment. I think it's unlikely there's going to be one solution that suits everybody because tinnitus is a problem that varies a lot between people and its pattern seems to be different from one person to another. So I think what's very unlikely is that there will be one single solution that's recommended to everybody who has tinnitus and that works for everybody. Often dealing with stress

can be a really important key to helping people manage tinnitus better. And that might be through looking at things like relaxation exercises. And it might be also to do with looking at the sources of stress in your life and seeing what you can reduce or what you can do differently. It's a really big factor and even people who aren't bothered by tinnitus normally will say that when they're stressed, the tinnitus gets worse and bothers them more. So I think that's really important and something that anybody with tinnitus can do is have a look at their stressors and see if there's anything they can do about those. There have been some groups run with people who have tinnitus, teaching them the principles of mindful meditation. And the results of that have been pretty positive.

So again, like CBT, it doesn't take into a diso way. People are still able to hear it, but they feel better equipped to live with it. They feel that they pay less attention to it, and it's easier just to put it in the background. Thank you for listening to this episode of Instant Genius, brought to you from the team behind BBC Science Focus. That was audiologist Dr Lucy Hanscom. The current issue of BBC Science Focus magazine is out now. Pick up a copy wherever you buy your favourite magazines or downloaders on your preferred app store. You can also find us online at sciencefocus.com.

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