Published in InterAction 60, Summer 2007
We regret that our medical advisers cannot respond to individual enquiries.
Dear Doctor: Tinnitus
I have had M.E. for just over five years and one of the symptoms is tinnitus. I had seen my doctor about this problem (prior to a firm diagnosis of M.E. being made) and he prescribed two doses of decongestants. Unfortunately they never worked and I have just had to live with tinnitus – it is wearing and frustrating when you cannot hear the TV properly. I have noticed that I rely on watching someone’s mouth if they are speaking and this has helped. I was advised by my specialist that tinnitus is something you just have to learn to live with. Is this really true?
I am now suffering from my second severe relapse, which is very worrying because I am housebound with new symptoms I have never had before. These are severe balance problems and tinnitus. I have a constant whistling and a wind rushing sound in one ear. I cannot balance properly for long and my legs feel very weak/wobbly. I don’t feel that it’s dizziness like vertigo, but more like the ground is coming up in front of me. Because the tinnitus started first, my doctor says he is sure it is M.E., but is willing to send me to an Ear/Nose/Throat specialist to double check. He has not been able to offer me any treatment. Will these symptoms eventually subside?
Jane Ninnis, Hearing Therapist at Royal Cornwall Hospital replied:
Tinnitus is the name used for any noise heard in the head or ears when there is no external source of the sound. Tinnitus sounds vary a great deal e.g. ringing, whistling, buzzing or humming. Tinnitus often appears to be louder when there is little or no background noise. This is why many people find it hard to get to sleep at night time.
Often people are told that there is nothing that can be done to help people with their tinnitus, which is not the case. Many Audiology/Hearing Therapy departments in local hospitals have specially trained staff to help people with tinnitus. Some people with tinnitus also have a slight hearing loss so a hearing test is carried out, but there is no test for tinnitus itself because it’s an internal noise. If hearing loss is detected then a hearing aid may be suggested, as by amplifying external sounds the individual is usually much less aware of their tinnitus. If people have normal hearing then a white noise generator may be suggested to provide the brain with a different noise as a distraction.
It is also important that people understand a bit more about what causes their tinnitus e.g. hearing loss, exposure to loud sounds or certain medications. Often stress, tiredness or ill health can exacerbate tinnitus.
Most people find it helpful to have other sounds in the background e.g. TV or radio. At night time, an under-pillow speaker can be connected to a radio/CD player or environmental sound (e.g. rain, sea waves, wind) generator. Learning and using relaxation methods can be very beneficial (contact the British Tinnitus Association (BTA) or the Action on Hearing Loss (formerly the Royal National Insititute for Deaf People) for details of pillow speakers, sound generators, relaxation CDs and other resources.
Talking to other people with tinnitus can also be helpful and the BTA have a network of such groups.
If you have another condition such as M.E. then you may be less able to do things to distract you from your tinnitus but do try background sounds and finding out a bit more about it.
You may find that if you have a good day with your M.E., you are able to do a bit more and are less aware of your tinnitus; conversely you may be more aware of it on bad days. Most people over time find that they do get used to their tinnitus and it is less intrusive; they feel in control of it rather than the other way around.
Professor Tony Pinching commented:
Although tinnitus is not as common as other symptoms in people with CFS/M.E., when it does happen, it can cause significant disruption, not least due to its persistence. Jane Ninnis outlines the key issues, which you will find helpful. Different factors will play a part in each person’s experience, and these may be important clues in working out how to manage it.
One of the letters suggests that it came on at the same time as a balance problem, and I have noted that combination in several patients. Illnesses that affect the inner ear (which is where both hearing and balance sensors are), may not only affect the balance mechanism (causing a sense of vertigo, tumbling, or being off balance) but may also cause tinnitus and/or hearing loss. People with M.E./CFS may be less able to adapt to these symptoms because of its effect on the nervous system.
Viral labyrinthitis is a common infection that affects the inner ear. This is quite a common triggering infection for M.E./CFS, or a relapse. It may leave a slight defect in balance or hearing sensor function afterwards, which could show up as vertigo/tumbling or tinnitus; this is more likely for a person with M.E./CFS
People with M.E./CFS are often sensitive to light, noise, smell or touch. This is probably because its effect on the nervous system reduces the brain’s ability to suppress unwanted sensations (which is normally going on all the time to prevent sensory overload). Tinnitus may sometimes be due to a similar effect.
Nasal congestion is common in M.E./CFS and occasionally leads to tinnitus. However, the sounds are more variable as the congestion varies.
Some medications (such as aspirin) can cause tinnitus, usually only at high doses. Patients with M.E./CFS may be more sensitive to medication, so side effects like this could happen at lower doses than usual. If in doubt, it is worth discussing this possibility with your doctor. Carefully reducing the dose of such medication may be worth trying.
Jane outlines some of the specific approaches that may be helpful in making it easier for you to live with tinnitus. If appropriate, you could discuss referral to a local hearing therapy department.
The British Tinnitus Association said:
What is tinnitus?
Tinnitus is the name given to the condition of noises ‘in the ears’ and/or ‘in the head’ with no external source. The noise/s may be heard in one ear, both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high-pitched. There may be a single noise or two or more components. The noise may be continuous or it may come and go.
What causes it?
Tinnitus is not a disease or an illness, it is a symptom generated within a person’s own auditory pathways. Although it is often assumed that tinnitus occurs as a result of disease of the ears, this is often not the cause. The precise cause of tinnitus is still not fully understood but is usually associated with some hearing deficits.
Who gets tinnitus?
Experiences of tinnitus are very common in all age groups, especially following exposure to loud noise; however it is unusual for it to be a major problem. There is a widely held misconception that tinnitus is confined to the elderly, but various studies have shown that it can occur at any age, even in quite young children. Mild tinnitus is common – about 10 per cent of the population have it all the time and, in up to one per cent of adults, this may affect the quality of their life.
If you think you have tinnitus:
- See your doctor. Tinnitus is rarely an indication of a serious disorder, but it is wise to see your doctor if you think you might have it. Should something treatable be causing it, you might be referred to a specialist.
- Try not to worry. The noises may seem worse if you are anxious or stressed. When tinnitus starts, particularly if it’s sudden, you may naturally be frightened and your concentration or your sleep may be disturbed. You may get angry and frustrated because no one else understands, or you may live alone and not have anyone to talk to about it.
- Find out more. You will probably feel better when you find out more about the condition – that it’s very common and you’re not alone.
- Occupy yourself. Many people say that they notice tinnitus less when they are doing something. Keeping your mind occupied helps (but don’t overdo things). If the noises seem louder at quiet times, particularly during the night, it may help to have soothing music or some other environmental or natural sound quietly on in the background. Practising relaxation and taking time out for yourself can also be a great help.
- Support groups. If you would like to talk to someone about any problems you have, the BTA can put you in touch with a support group near you. Many groups are run by people who are living with tinnitus – personal contact and shared experiences are very useful.
View a pdf of this article.