The Phantom Sound

Have you ever experienced hearing sounds in your ears which you are so sure that nobody else is hearing it as well? It could be a ringing, buzzing, hissing, chirping, whispering, blowing of the wind sound, or to quote a patient, dengar orang mengaji dalam telinga (hearing someone recite the Quran). That last part was quite random, but for the other sounds, they are quite common complaints. In fact, my niece and partner are experiencing the ringing sounds.

This hearing symptom is called tinnitus. Tinnitus is sound heard in the ears which are not externally stimulated. It is a phantom auditory perception. Almost everyone has tinnitus; but it could either be normal tinnitus or pathological tinnitus.

Normal tinnitus is experienced by most people. It occurs less than 5 minutes, less than once a week and is not associated with hearing loss.

On the other hand, pathological tinnitus occurs more than 5 minutes, more than once a week and usually heard by people with hearing loss. The severity ranges from acceptable to unacceptable. By acceptable means that the sounds do not disturb you from doing tasks, while unacceptable means the sounds affect you to a point you have to stop doing whatever you are doing whenever it occurs. In this case, it is very frustrating for that person.

The duration of the tinnitus could be temporary, occurring only at a certain position and situation (e.g. when you're lying on your bed, preparing to sleep; when you're in a very noisy place). It could also be permanent, meaning it's there 24/7.

The causes of tinnitus varies: it could be due to noise exposure, Meniere's Disease, medication, food intake, lots of ear wax and idiopathic (unknown), even.

Usually, if the sounds heard are high pitched in nature, it is usually associated with high frequency hearing loss, while low pitch tinnitus relates to low frequency hearing loss. That's why if you are experiencing this symptom, it is advisable to immediately have your hearing assessed, as to ensure that your hearing is not affected and is not the cause of the tinnitus.

Referring to the pamphlet my coursemates did for our Audiology Seminar, there are several approaches for tinnitus management and treatment. They are:

1. Tinnitus Retraining Therapy (TRT) that includes directive/retraining counseling and sound therapy;

2. Masking of tinnitus using hearing aids (for those with hearing loss, of course), tinnitus maskers (apparently downloadable), tinnitus instruments;

3. Medication such as anti-depressant, anti-convulsant (tegretol, phenytoin, mysoline, depakene), anti-histamine (meclizine), vasodilators (gingko biloba, niacin);

4. Psychological treatment of cognitive therapy, cognitive restructuring, attention diversion techniques, imagery training, relaxation training, hypnosis;

5. Other treatments: TinniTool (developed in Switzerland, see picture below); Neuromonic; biofeedback; and electrical stimulation.



One particular treatment I would like to stress on would be the Sound Therapy as it is an easy, self-practised approach. The therapy facilitates tinnitus habituation by weakening the tinnitus signal. Patient is instructed to avoid silence and to enrich the background noise by listening to music, using table-top sound machines or wearable sound generators.

For the medication part, it is strongly advised to get them as medically consulted.

*Compliments to Chan Soon Chien, Suriya Mohamad, Tan Ping Meng and Ong Chun Suan @ the Purple Phantom :)