Tinnitus, commonly described as ringing, buzzing, or hissing in the ears, is a fascinating and often perplexing condition, especially for those who have noticed a sudden shift in their hearing. The experience varies widely, ranging from chronic tinnitus, where the symptoms persist over time, to acute tinnitus, where they last only for days or weeks. Understanding the nuances of tinnitus can be challenging even for those who live with it daily. This is particularly true for a specific kind of tinnitus known as idiopathic tinnitus, which presents its own unique set of mysteries and complexities.
Idiopathic tinnitus, also known as primary tinnitus, is a type of tinnitus characterized by the absence of a discernible underlying cause. It earned the label “primary” because individuals diagnosed with this condition will not exhibit any other identifiable factors or triggers for the ringing in their ears. This implies that no associated underlying conditions or comorbidities are typically associated with this form of subjective tinnitus, also referred to as subjective idiopathic tinnitus.
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"As a recent graduate who’s achieved stage four habituation, I cannot thank Treble Health enough for getting me to the finish line."
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Patients with tinnitus are often also plagued by other inner and middle ear issues or even symptoms of pulsatile tinnitus, a form of objective tinnitus with a clear, identifiable physical root. This is not the case in an idiopathic diagnosis, as tinnitus symptoms are considered an isolated and primary diagnosis.
Primary Tinnitus Versus Secondary Tinnitus
Primary tinnitus and secondary tinnitus are the two main tinnitus types used to classify symptoms. Primary tinnitus is idiopathic, meaning that it develops without a specific or identifiable cause, though it can be associated with sensorineural hearing loss (also referred to as sensorineural tinnitus). There is no cure for tinnitus, which means that primary tinnitus patients are encouraged to manage the condition of the auditory system, rather than seek out a traditional cure. This can include mental health intervention, sound masking, and more, to help alleviate both mild and severe tinnitus symptoms within idiopathic subjective tinnitus.
Secondary tinnitus is so named because it comes from a secondary source, meaning that it comes from another condition and has an underlying cause. A common example of secondary tinnitus is any tinnitus that occurs following exposure to loud noise; the mechanisms behind hearing damage or interruption that occurs following an exposure to loud noises explains the onset of tinnitus. Meniere’s Disease, vascular abnormalities, and acoustic neuroma are all additional potential causes for tinnitus onset in secondary tinnitus. Tinnitus treatments for this patient population typically involve treating the underlying condition first and foremost, and typically requires a medical referral to ensure proper diagnosis and targeted treatment.
How Are Causes Of Tinnitus Identified?
To accurately identify the causes of tinnitus, there are a standard series of steps and diagnostic procedures used by hearing health professionals. A physical examination is typically the first step, as a systematic review of health can rule out (or pinpoint) any additional issues leading to tinnitus onset. In a physical exam, conditions like cholesteatoma, fluid in the middle ear, and excessive earwax can all be identified and a treatment plan can be developed. After this examination, various diagnostic tests can be used. The most common ones include an audiogram to assess hearing levels within the auditory system, tympanometry to evaluate the health of the middle ear, and an auditory brainstem response to evaluate the functional ability of the auditory nerve and auditory system pathways to the brain.
After these tests have been completed, if tinnitus roots and potential tinnitus treatments cannot be developed, additional imaging practices such as an MRI (Magnetic Resonance Imaging), CT (Computed Tomography) scan, and MRA (Magnetic Resonance Angiography) can be used. These tests can provide a more detailed view of the ear’s anatomy and surrounding structures to identify any abnormalities that could explain the cause of tinnitus onset, and subsequently guide tinnitus treatment.
How Is Idiopathic Tinnitus Managed?
Managing short-term or chronic idiopathic tinnitus requires a multi-faceted approach. Remember: primary tinnitus has no cure, making it impossible to determine expected tinnitus duration once interventions have been put in place. The goal, then, is to alleviate symptoms and improve quality of life. The most recent research suggests that successful management encompasses several different strategies used in tandem.
Education and counseling are both considered important in providing tinnitus patients with a greater understanding of their condition, while equipping them with effective and healthy coping mechanisms. This can also help address some of the mental health concerns that arise with tinnitus and hearing loss.
Sound therapy is another important step in managing tinnitus patients’ symptoms, as sound therapy uses external noise to mask tinnitus. Masking helps diminish the prominence of tinnitus sounds in a patient’s perception, thereby reducing the sensation of severe tinnitus and giving patients a sense of tinnitus control. This helps reduce tinnitus distress and can help with some of the depressive symptoms associated with this diagnosis, by lessening the overall perception of ringing, buzzing, or hissing within the auditory system.
Cognitive behavioural therapy (CBT) is another common tool in the arsenal of tinnitus treatment, as this therapeutic intervention helps reduce negative thought patterns and emotional responses. This can help patients with tinnitus develop a healthier relationship with their symptoms, and eventually reduce the impact of chronic subjective tinnitus, even in those with high tinnitus severity index scores.
By combining these approaches, hearing health professionals like audiologists deliver the cornerstone of idiopathic tinnitus management, thereby reducing its impact on the individual, providing broad symptom relief, and delivering mental health management and emotional support. While tinnitus is not a “curable” condition, by effectively treating tinnitus symptoms, hearing health professionals can help patients improve their quality of life and develop a healthy relationship with their experience of tinnitus.
Treating Idiopathic Tinnitus With Treble Health
If you are looking to start tinnitus treatment, the Treble Health team is ready to help you. Our audiologists have decades of experience working with tinnitus patients at top practices around the country, and can work with you to create a personalized treatment plan that best addresses your specific needs. If you have any questions regarding your personal case, whether that be causes, treatment options, or something else completely, we recommend scheduling a complimentary telehealth consultation with our team. This is a free, 20-minute Zoom call with an audiologist on our team, where you can have all of your questions answered and learn which treatment options would best suit your needs. To get started, click here.
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