Can hearing aids help people with tinnitus?
Last updated on 17 August 2011
‘The prevalence of tinnitus has been estimated as 15% of the world population.’ Hearing loss is a risk factor for tinnitus, and the prevalence increases to 33% in individuals aged over 60 years.¹ Emotional factors are likely to affect the transmission and processing of sounds from the ear to the brainstem, as the auditory system has many connections with the limbic system² (centre in the cortex controlling our mood, behaviour, memory and sensory perception). Tinnitus will become louder or softer by activity in the limbic system depending on how much attention or focus the sound is given. Psychological factors such as stress, anger, lack of control, and anxiety will lead to an alteration in the processing pattern and a decreased sound tolerance level, which will in turn exacerbate the problem. There is a continuous vicious cycle of distress in the person suffering from tinnitus, which can influence a person’s ability to relax, socialise with friends, and continue with daily life activities including maintaining their profession and health.³
Tinnitus is very much an individual condition; each person will describe different sounds heard and perceive it in a dissimilar manner. Not all patients will choose to seek advice from health care professionals despite its obvious impact on psychological health. This may be due to the common notion that if a specific cause of tinnitus is not found, effective treatment is unavailable; the patient will therefore, have to live with their symptoms. However, research has shown that tinnitus does gradually get better, and tolerance of tinnitus increases with time with the help of a tinnitus management program.
Tinnitus and hearing loss
Another inadvertent health condition associated with the misconception that tinnitus cannot be treated is hearing loss. Tinnitus is commonly accompanied by hearing loss, yet people will often neglect their disability and continue with everyday life.
Hearing impairment, like tinnitus, can also cause psychological and social difficulties because it interferes with a person’s ability to communicate effectively. Communication plays a significant aspect in maintaining relationships and quality of life. People with a hearing loss perceive themselves as poor conversationalists. This often results in depression, loneliness, annoyance, anger, and social isolation. These social and emotional changes lead to long term lifestyle changes and diminished quality of life. People find it easier to withdraw from communication situations than face the embarrassment of frequently misunderstanding conversations or responding inappropriately. They can no longer do things they enjoy; they feel vulnerable, insecure, a decreased self-esteem, and do not successfully adjust to their new circumstances. Therefore, the individual with both untreated tinnitus and untreated hearing loss would be expected to experience a greater impact on their health and psychological well-being compared to individuals with only tinnitus or only hearing loss.³
At present, there is no medication available to cure tinnitus, although a lot of research is currently in process. The treatment plan is tailored to meet the individual’s requirements with the aim of aiding habituation of tinnitus rather than eliminating noises completely.
If you are experiencing troublesome tinnitus and would like an evaluation, the first step is to visit your GP. The GP will examine your ears to make sure the eardrum looks healthy. If the ear canals show excessive wax, or an ear infection, you will receive eardrops/antibiotics to treat this. A referral to the ENT specialist will be facilitated to carry out a hearing test, tympanometry, CT scan, and x-rays to ensure there are no underlying pathologies. The ENT specialist will make a referral to an Audiologist for other audiological measurements of tinnitus including pitch masking, loudness matching, and minimum masking level. In addition, you will receive tinnitus counselling and methods for treating tinnitus including hearing aid fitting if appropriate.
What is a hearing aid?
A hearing aid is a small electronic device that you wear in or behind your ear. Hearing aids are signal processors; they alter the signal input to improve it for the wearer by making sounds louder, which can help with hearing and speech comprehension. A hearing aid has three basic parts: a microphone, amplifier and speaker. The hearing aid receives sound through a microphone, which converts the sound waves to electrical signals and sends them to an amplifier. The amplifier increases the power of the signals and then sends them to the ear through a speaker. The electrical signals are then converted to neural signals by hair cells situated in the inner ear and sent to the brain via the auditory nerve.
Hearing aids for the treatment of tinnitus
There is evidence to suggest hearing aids can mask tinnitus sounds to help improve communication and reduce stress and anxiety levels, which normally exacerbate tinnitus. The loudness and prominence of tinnitus is decreased by activating the auditory system and amplifying background sound. The knowledge that you can mask tinnitus with a hearing aid is not an innovative concept, but previous hearing aids occluded the ear canal with a tight fitting ear mould. Patients reported a hollow reverberation amplifying chewing sounds and the sensation of tinnitus. A new type of hearing aid called the open-fit has been designed to successfully alleviate tinnitus symptoms by introducing a noise-reduction control. The slim tube connected to the hearing aid is cosmetically appealing, comfortable to wear, as well as eliminating external sound sources without interfering with the transmission of sounds from the outer ear to the inner ear.
Studies have shown robust evidence promoting hearing aid fitting as an effective treatment option of tinnitus control. The provision of hearing aids decreased the severity of tinnitus in 69% of bilaterally aided patients and 67% of unilateral aided patients.ª Similarly, research undertaken by Del Bo et al, (2006)º showed successful results for 22 patients fitted with open-fit hearing aids in alleviating symptomatic tinnitus perception. The participants in this study had a mild-moderate hearing loss predominately in the 2-6 kHz frequency range. The pitch of tinnitus is often detected in the 3-8 kHz range. In conjunction with hearing aid fitting, all patients had tinnitus retraining therapy, which proved to be effective at habituating sound perception, allowing the patient to ignore the presence of tinnitus over a period of six months.
How can hearing aids help?
If you have a hearing loss, a hearing aid can help with managing tinnitus by offering sound therapy in the following ways:
- increase the information available to the brain by amplifying background sounds making the tinnitus seem less audible.
- improve communication with others, therefore reducing stress levels.
- helping to compensate for your hearing loss.
- help you to habituate to tinnitus sounds.
One of the main reasons why open-fit hearing aids have been successful in tinnitus patients is because they do not significantly occlude the ear canal, which can aggravate tinnitus symptoms and, therefore, do not interfere with external sound transmission. They provide sufficient amplification in patients with a mild-moderate hearing loss, have an in-built noise reducing control, and are perceived as highly comfortable. In conclusion, the combination of using a hearing aid and employing counselling techniques will equip the patient with tinnitus and a mild-moderate hearing loss in the 2- 6 kHz region to habituate to their tinnitus and learn how to manage symptoms better.
¹ Pinto, P. C; Sanchez, T.G; & Tomita, S. (2010) 'The impact of gender, age and hearing loss on tinnitus severity.' Brazilian Journal of Otorhinolaryngology, 76(1): 18-24.
² Jastreboff, P.J; & Hazell, J.W.P. (1993) 'A neurophysiological approach to tinnitus: Clinical implications.' British Journal of Audiology, 27 (1): 7-17.
³ Kochkin, S; & Tyler, R. (2008) 'Tinnitus treatment and the effectiveness of hearing aids: Hearing care professional perceptions.' Hearing Review. Available from: http://www.hearingreview.com (accessed April 18, 2010).
ª Trotter, M.I; & Donaldson, I (2008) 'Hearing aids and tinnitus therapy: a 25-year experience.' The Journal of Larnygology and Otology, 122: 1052- 1056.
º Del Bo, L. et al (2006) 'Using open ear hearing aids in tinnitus therapy.' Hearing Review. Available from: http://www.hearingreview.com (accessed April 18, 2010).
Dr Sheena Ruparelia, BSc, MSc, CCC, AuD, Audiological Scientist at Hillingdon Hospital.
This article was originally published in Quiet, Summer 2010
There is evidence to suggest hearing aids can mask tinnitus sounds to help improve communication and reduce stress and anxiety levels