Managing Tinnitus: An Audiologist’s Perspective

One of the most famous cases of tinnitus goes back to 1888 when Vincent Van Gogh cut his ear off. Although this did not solve his problem, today we have a much greater understanding of the effects that tinnitus has on mental health, relationships, sleep, and overall quality of life. 

Tinnitus is the awareness of a sound in your head or ears. The sound is usually ringing or buzzing; it may be constant or intermittent; and it varies in intensity. Like a headache, tinnitus is a symptom of an underlying condition. According to the American Tinnitus Association, 50 million Americans experience tinnitus. 

While there are several types and a wide range of presentations, management of tinnitus is most successful with a multidisciplinary approach. Although there is no cure for tinnitus, I asked my colleague Dr. Drew Price, Au.D., FAAA, a local audiologist at Sound Relief Healing Center, about her take on managing symptoms. 

How did you become interested in audiology?

Dr. Price: I was destined to become an audiologist! My mom was an audiologist and worked in private practice, nursing homes, and the school system. She and my Dad met in an audiology program, but he went on to become a pastor and never practiced. My 7th grade science fair project was testing my classmates' hearing; it was in my blood! I chose to specialize in tinnitus treatment after watching my Dad suffer from tinnitus for years. There would be nights where he seemed sad, exhausted, and simply defeated because of his tinnitus. I knew there had to be a better way than just living with it, like many doctors recommend to patients, or simply trying traditional hearing aids. Research shows that, for the majority of people suffering from tinnitus, they will need more treatment than traditional hearing aids alone. 

What causes tinnitus? 

Dr. Price: The main underlying cause of tinnitus is hearing loss, meaning tinnitus is a symptom of missing input in the auditory system and not a disease process itself. Tinnitus originating from hearing loss is most often caused by age-related hearing loss and loud sound exposure. Medications can also cause hearing loss, which in turn leads to tinnitus, as well as some diseases (i.e. diabetes, cardiovascular disease, high or low blood pressure, etc.). A common misconception about hearing loss is that damage in the auditory system can only be present if a person also has communication difficulties. Tinnitus and communication difficulties are both symptoms of hearing loss; you can have hearing loss and no communication difficulties just as you can have communication difficulties without tinnitus. It's all about how each specific person's brain processes the missing input in the auditory system.  

Tinnitus can also originate from the somatosensory system, but purely somatic tinnitus is significantly less common. Typically, we'll see hearing loss as the main cause of tinnitus and somatic tinnitus as a secondary cause. With either clinical presentation, we refer to physical therapists or dentists for these symptoms, depending on the patient and symptoms. 

Lastly, major injuries, especially head injuries, and chronic pain can cause tinnitus or amplify it. For example, I have many patients who had non-bothersome tinnitus prior to a car accident, but the injuries (minor and major) sustained in the accident led to an increase in tinnitus. Patients can also have multiple sources of tinnitus. These patients require a multidisciplinary approach to treatment. 

How does the musculoskeletal system affect tinnitus?

Dr. Price: The musculoskeletal system can cause or amplify tinnitus, a phenomenon known as somatic tinnitus. Somatic tinnitus is defined as sensory input from muscles or structures outside of the ear that cause or change tinnitus. The most common presentations of somatic tinnitus are with cervical tinnitus and tinnitus resulting from temporomandibular joint dysfunction (TMD or TMJD). 

How can audiologists and physical therapists work together to manage tinnitus?

Dr. Price: Audiologists and physical therapists, when working together as a team in a multidisciplinary approach, can help patients significantly reduce tinnitus disturbance, overall health, and quality of life.

Physical therapists can help patients experiencing somatic tinnitus and can achieve less tinnitus disturbance by treating physical tension or movements that amplify tinnitus. Treatment for TMD may be indicated, as well as addressing muscular tension/dysfunction in the head and neck area. Even balance issues may arise if someone is also dealing with dizziness or vertigo. Because of this, I often refer to physical therapy. 

Audiologists can help patients with hearing loss. A patient can have very mild hearing loss that they don't notice in conversational speech, but the brain notices the missing input and amplifies tinnitus. That is why PTs should always refer to audiology for a hearing test if a patient presents with tinnitus. 

Tinnitus is perceived and amplified in the limbic system –– ‘the emotional brain’ –– which can cause physical stress on the body. Audiologists use sound therapy known as Tinnitus Retraining Therapy (TRT) to alter the nervous systems response to tinnitus. This process is a form of habituation therapy to help those with tinnitus get relief from their symptoms. Treatment involves ear-level sound therapy plus ‘directive counseling.’ Directive counseling consists of working with an audiologist to help patients become experts on tinnitus. We help patients discover why their tinnitus is there, what triggers tinnitus to increase or spike, and help them develop skills and strategies to manage those spikes. Through this process, we help patients rewire their brains to filter tinnitus, rather than amplifying it. Using sound therapy in conjunction with physical therapy helps keep the body and emotional brain calm, keeps the person focused on their daily tasks, and also helps with sleep disturbances caused by tinnitus.

Thank you Dr. Drew Price for taking the time to answer these questions and for your commitment to helping this population.

Disclaimer:  The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.

To learn more about ways to help tinnitus, check out our TMJ dysfunction page.

Dr. Tia Totura

Physical Therapist | Doctor of Physical Therapy
Tia Totura is a Doctor of Physical Therapy (DPT) who specializes in sports, general orthopedics, TMJ disorders and headaches. She works at Activcore in Denver, Colorado, located just one mile from the popular Cherry Creek Shopping District. As a former Division I swimmer and captain of the Women's Swimming and Diving Team at the University of Denver, Tia has a special interest in treating swimmers and other overhead athletes.
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