Most people who have tinnitus (T) have a regular pattern to it. It may not be the same every day, but the signal (remember, T is not sound!) behaves in similar ways under certain conditions.
A typical pattern might be: “ I’m not usually aware of it, but if I listened out for it, I would become aware of a high-pitched ringing signal. This is more prominent (seems louder) when I’m in a noisy place. If I was stressed or working on a deadline, it would be much more prominent and I’d be aware of it more or less the whole time. When I get home, after half an hour relaxing with a cup of tea, it would fade into the background. Sometimes the ringing signal is there at night, and - rarely - I have a problem getting off to sleep”.
When you first got tinnitus, it was probably acknowledged by the doctor or audiologist. In rare cases, such as one-sided or pulsatile T, it will have needed to be investigated by a specialist doctor. For most people though, it’s just one of those things. They have T, nothing to worry about medically, they just have it. Once your doc or audiologist has confirmed it’s nothing to worry about, the best thing is to not dwell on it. You find your way of living with it. If you haven’t, talk to me about my Active Habituation tinnitus crash course.
When you have T, it will sometimes spike. This means it will temporarily become more prominent/intense. If you’re usually able to keep it in the background, you might find that it is suddenly in the foreground. You may even find that you’re having difficulty hearing the TV or friends because the T is competing for attention. These spikes can last for hours, days, a fortnight or even a month, depending on how long the underlying cause goes on for. If you don’t have any otological (ear) or neurological (nervous system/brain) red flags, then you must work to reduce/end the spike. When you succeed, the T will go back to your usual pattern.
These kinds of spike (more prominent T that still ebbs and flows, but is more intense than your normal pattern) are quite normal, and they are often related to stress. Many, many people had one during COVID lockdown. Job changes, house moves, personal relationships - these are all common triggers for a tinnitus spike. The best thing we can do is look for the cause of the stress and work on eliminating/reducing it. Do not fall into the trap of having big, negative thoughts about the T, do not feed the T by concentrating on it. If you do, you will be ensuring it spends more time in the foreground, and you’ll prolong the spike.
What is less common is a “turning on” of the tinnitus signal. Instead of ebbing and flowing, moving from background to foreground of your consciousness, it switches on and stays on. In my experience, this is the case with head injury and medication related T.
A significant, persistent change in the intensity or quality (e.g. pitch) of the T sometimes needs to be investigated. It’s quite tricky to work out when, so seek advice from your audiologist (if you have one) or your doctor if you’re unsure.
Just because your T didn’t need investigation in the past, it doesn’t mean you can’t develop a condition that does need investigating, during the course of your life. The following new symptoms, in addition to your changed T, need medical advice/attention:
Otological/Audiological
🚩Noticeable worsening of hearing ability, either all in one go or rapidly declining.
Pulsing pattern/rhythm of the tinnitus signal or a white noise (like water or wind rushing).
Vertigo (dizziness other than general lightheadedness). Swaying, feeling like you’re moving when your head/body is still.
Pain in/around the ear, heat in the skin/tissue.
Discharge from ears that isn’t earwax. Can be blood, clear fluid, yellow/straw colour, creamy, greenish.
Crackling/popping sounds in the ear.
Fullness sensation. This can be a sense of pressure, or it could be the sense that you have your fingers in your ears, blocking them.
Non-Otological
Head injury/neck injury
Balance/movement issues, such as veering off while walking.
Rhythmic pulsing sounds, either in time or not with your heartbeat.
Headache/pressure in the head.
Vision disturbances.
Medication side-effect, may need medication adjusting.
Psychiatric/Psychological
Hearing voices
Musical hallucinations
Depression/anxiety
Sleeplessness due to change in T
Hearing Aid Faults / Earwax / Hearing Changes
Silence is a common trigger for T. If you’re hearing less for any of these reasons it may cause your T to become more prominent.
Maintaining hearing aids is important. If the aids, tubes, vents, domes or ports are blocked it can cause the aid to be quiet, silent or distorted.
Hearing deterioration.
If you are prone to earwax buildup, consider arranging examination / wax removal.
Some of these symptoms are time related, so they do not need intervention if they don’t last longer than a week or 4 weeks. Your audiologist will advise if you need a medical referral. Your doctor will be able to advise if you need treatment or a referral due to your symptoms.
Tinnitus by its nature is changeable, you can expect to perceive multiple different pitches and intensities of T signals over your lifetime, as your hearing changes. So simply noticing
Hearing your own heartbeat is not necessarily cause for concern. If it’s after hard exercise and lasts only a few minutes, we don’t consider that to be pulsatile tinnitus.
2)
3) Ask your audiologist take a look in your ears to check for wax buildup.
4) If it’s been more than 18 months since your last test, and you think the aids/hearing aren’t as clear as they used to be, request a hearing reassessment.
If you have a volume control on the aids, you can try turning them up a notch or two. If you find doing this daily is helpful, definitely request a reassessment!
There’s more, but I’ll write an article and come back to post a link. Check with your doc though if you have any new health worries alongside this increase in T.
I’m in clinic on Tuesday if you need an audiologist and can’t get your usual one.
~Sally
Comments