Introduction: The world is full of sounds, and our ears are designed to listen and process these stimuli 24 hours a day, even while we sleep. In this article, we will explore fundamental reflections on tinnitus, also known as ringing in the ears, and its management. We will examine its association with noise exposure, hearing loss, and presbycusis, as well as the importance of consulting an experienced audiologist on the subject. We will also address the nature of tinnitus as a benign bodily perception and its relationship with the emotional reaction to the fear of silence.
Tinnitus and its association with noise exposure and hearing loss: Tinnitus is the correct term to describe the perception of sound in the ears or the entire head without a known sound source. It is closely related to noise exposure, the presence of hearing loss, and therefore, presbycusis in a high proportion of cases (1). These factors can trigger or worsen tinnitus perception, highlighting the importance of taking preventive measures to protect our hearing and reduce the risk of developing this condition.
The myth that tinnitus has no solution: It is concerning that some professionals repeat as a mantra that tinnitus has no solution since this statement is based on incorrect information and spreads unfounded beliefs (2). It is important to seek advice from well-informed and up-to-date audiologists, as there are management and treatment options that can alleviate symptoms and improve the quality of life for people experiencing tinnitus.
The benign bodily perception of tinnitus: It is essential to understand that tinnitus itself is a benign bodily perception (3). Although it can be bothersome and uncomfortable, it does not represent a direct threat to life or hearing health. This perspective helps reduce the fear and distress associated with tinnitus, allowing individuals to approach it in a more positive manner. The patient experiencing tinnitus should address the issue by consulting with a professional who has proven experience in managing this symptom. However, it should not become a constant concern or obsession, as tinnitus is also associated with anxiety, stress, fear, depression, and reinforcing emotional responses.
Tinnitus as a brain and nervous system phenomenon: Tinnitus originates in the brain and the nervous system, and its true nature lies in how auditory information is processed (4). It is important to recognize that tinnitus is an abnormal response in the central auditory system and not a condition within the ears themselves.
The importance of an audiologist specialized in tinnitus management: When perceiving noise in the ears, the audiologist with demonstrated experience in tinnitus management is the first professional to consult (5). These professionals are highly qualified to conduct auditory tests, such as tinnitus pitch matching, as well as administer questionnaires to assess the impact of tinnitus on quality of life. Additionally, they are capable of referring patients to other specialists, such as physicians and psychologists, for comprehensive interdisciplinary care. The audiologist also provides counseling and debunks myths related to tinnitus. Anyone perceiving noise in their ears should undergo auditory tests with an audiologist. With these results, they can provide more information during their visit to the physician. In most cases of tinnitus, there are no detectable pathologies visible to the naked eye, making it more difficult for a physician to make a diagnosis without data on the individual's hearing health. Ideally, it is recommended to seek a specialized audiology center, where there is an interdisciplinary team consisting of at least an audiologist, a physician, and a psychologist.
Focus on the emotional reaction to tinnitus: The treatment of tinnitus focuses on addressing the emotional reaction that arises from this auditory perception, rather than trying to eliminate the noise itself (6). Cognitive-behavioral therapies and other psychological interventions can help reduce the anxiety and stress associated with tinnitus, thus improving the quality of life for affected individuals.
The impossibility of masking tinnitus: It is important to note that completely masking tinnitus is impossible; however, perception suppression techniques can be employed to reduce its impact (7). The goal is not to imprison tinnitus but to provide tools so that it does not become the constant center of attention for the individual. Complete masking of tinnitus is impossible since tinnitus is not a physical sound. It is not a measurable energy that can be countered. It is a subjective perception. Therefore, there is no physically viable way to neutralize it with opposing external energy. However, its perception can be suppressed through distracting stimuli that act on the auditory system, auditory pathways, and the cerebral cortex.
Hypervigilance and obsession with tinnitus: Most people do not perceive their tinnitus during the day because their brain's attention is distracted by external sounds and daily activities (8). This demonstrates that tinnitus is associated with hypervigilance and an obsession with constantly monitoring the auditory phenomenon.
Conclusion: Tinnitus is a complex condition that requires a multidisciplinary approach. Consulting an audiologist with experience in tinnitus management is the first step to receiving proper evaluation and care. By focusing on the emotional reaction to tinnitus and employing evidence-based management strategies, it is possible to improve the quality of life for those living with this condition. While absolute silence may be a myth, we can find ways to live in harmony with our auditory perception.
References:
Shargorodsky J, Curhan GC, Farwell WR. Prevalence and characteristics of tinnitus among US adults. Am J Med. 2010;123(8):711-718. doi:10.1016/j.amjmed.2010.02.015
Martinez-Devesa P, Perera R, Theodoulou M, Waddell A. Cognitive behavioural therapy for tinnitus. Cochrane Database Syst Rev. 2010;(9):CD005233. doi:10.1002/14651858.CD005233.pub3
Baguley D, McFerran D, Hall D. Tinnitus. Lancet. 2013;382(9904):1600-1607. doi:10.1016/S0140-6736(13)60142-7
Eggermont JJ, Roberts LE. The neuroscience of tinnitus. Trends Neurosci. 2004;27(11):676-682. doi:10.1016/j.tins.2004.08.010
Martines F, Bentivegna D, Martines E, Sciacca V, Martinciglio G. Characteristics of tinnitus with or without hearing loss: Clinical observations in Sicilian tinnitus patients. Auris Nasus Larynx. 2010;37(6):685-693.
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