Tinnitus refers to sounds that someone can hear that don’t come from their external environment. The sounds may originate inside a person’s ear or head and may be one type of sound in one ear, or as many as eight different sounds experienced in either ear at different times. Despite the general assumption that tinnitus is ‘ringing in the ears’, it actually encompasses different noises, most commonly:
Tinnitus is a condition that other people may not even be aware of, but for the person who has tinnitus it can be the source of irritation, stress and even depression, anxiety and mental ill health.
An estimated six million people in the UK – some ten percent of the population – are affected by some form of tinnitus. But for 600,000 people (one percent of the population) the condition is so bad it affects their daily lives and reduces their quality of life. It can affect a person’s ability to:
- hear clearly, especially in certain environments – or, conversely, over-sensitive hearing;
- to sleep.
Causes of tinnitus
Prolonged exposure to loud noise (e.g. listening to music or using a device with headphones at too high a volume) or a single loud blast of noise are common causes of tinnitus – some 60 per cent of sufferers have some level of noise-induced hearing loss. Loud noise can cause permanent damage to sound-sensitive cells in the cochlea, the spiral-shaped organ in the inner ear, and loud industries or noisy workplaces may increase the danger of developing the condition.
Tinnitus is also linked to:
- age-related hearing loss;
- Ménière’s disease – a condition that can cause hearing loss and vertigo, as well as tinnitus;
- Otosclerosis – the abnormal growth of bone in the middle ear;
- middle ear infection;
- a build-up of ear wax.
Tinnitus is rarely a sign of a serious condition, but for those people in whom the tinnitus is continuous and loud, and cannot be ignored, it can induce marked stress and even depression.
Stress does not directly cause tinnitus but for some people the onset of tinnitus occurs after a period of stress or following a stressful event.
Some cases of tinnitus, such as those caused by the build-up of ear wax or because of an ear infection, can be treated by a doctor. In other cases, there is no cure, and treatment is focused on developing coping mechanisms in order to live with the condition. Various therapies may be helpful.
- Sound therapy: Tinnitus often sounds louder at quiet times, such as when trying to sleep. Sound therapy focuses on creating alternative sounds as a distraction, thus masking the tinnitus, either through a sound generator fitted in or behind the ear or by playing music or the radio. Many people will go to sleep listening to the radio or music to distract them from the tinnitus sounds.
- Counselling: Talking to a counsellor can give comfort and reassurance in dealing with tinnitus and other issues that may be contributing to the problem. Medical counselling is sometimes offered in tinnitus clinics in hospitals by hearing therapists or specialised audiologists. It can give an understanding of tinnitus, help people who have the condition to accept it, and offer ideas on living with tinnitus.
- Cognitive Behaviour Therapy (CBT): This can help people manage problems such as tinnitus by reviewing and changing the way they think and behave. Often led by clinical psychologists or psychotherapists, CBT can help by teaching coping techniques for dealing with the unwanted noise and the negative emotions that come from it. Positive and practical solutions are key to CBT.
- Tinnitus Retraining Therapy (TRT): This attempts to address an individual’s heightened awareness of tinnitus sounds based on the theory that it is the part of the brain responsible for emotions (the limbic system) that exaggerates the importance and meaning of these noises. Through counselling and sound therapy, TRT aims to reduce a person’s awareness of tinnitus through a process of habituation.
Tinnitus and work
There is a significant link between loud or prolonged noise and tinnitus which means that some jobs carry a higher risk to workers. Carpenters, pilots, musicians and street workers are among those whose jobs put them at risk, as are people who work with chain saws, guns or other loud devices or who repeatedly listen to loud music.
In a survey, 42 percent of tinnitus sufferers believed that their condition had an adverse effect on their work, and loss of concentration, lack of sleep and anxiety can all make working more difficult. But tinnitus can also impact on working in other ways:
- Difficulty in hearing conversations in the office and in meetings, which can lead to misunderstandings with colleagues.
- Difficulty socialising after work.
- Problems hearing telephone conversations.
Employers have a duty of care to their workers and if noise in the workplace regularly reaches 80-85dB they should take steps to protect their staff, such as:
- trying to reduce the noise of machinery and considering noise levels when buying new equipment;
- providing protection from noise, such as ear plugs or guards;
- reorganising shift patterns to reduce the time workers are exposed to loud noise;
- educating staff about the dangers of noise and insisting that they use ear guards;
- set up a programme of health surveillance;
- offering regular hearing tests to your staff.
Employers also need to understand their responsibilities to staff with tinnitus or hearing loss under the Equality Act 2010 and will need to be prepared to make reasonable adjustments to support staff with hearing difficulties. People who have hearing loss or tinnitus are advised to inform their managers of their condition and discuss changes that could help, such as moving to a different workstation, changing meeting venues or reducing stress.
Fit for Work offers free, online work-related health advice and guidance to anyone looking for advice and support about an existing case of sickness absence, or about issues that may result in sickness absence. Visit the Fit for Work website or call the free telephone advice line on 0800 032 6235 (English) or 0800 032 6233 (Welsh). There is a separate service running in Scotland (0800 019 2211).