Tinnitus
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Why Your Hearing Could Be Worse Than You Think

Tinnitus, or that sound of ringing in the ears, affects 1 in 5 Americans

Limited exposure to loud noise, coupled with wearing earplugs, can reduce the likelihood of developing tinnitus and hearing loss.

There have been many times I’ve come away from a concert or Fourth of July fireworks with my ears buzzing. I usually chalk it up to a great time, maybe the liquor, or both. When I finally go to sleep in a daze, thinking about how good the show was, it’s easy not to give a second thought to the background noise still reverberating in my head hours later. The next day, I’d wake up and the noise would be gone—and I’ve always taken that temporary quality for granted. 

For more than 50 million Americans, the ringing, hissing or humming background noise won’t stop after a few hours. It continues for days, weeks, months and, for some 2 million people, it never goes away at all, impairing their day-to-day life. Prolonged exposure to loud noises increases the risk of developing the constant perceived ringing, but any damage can cause symptoms.

The receptive issue—that ringing sound—is often diagnosed as tinnitus, says Santa Cruz Ear Nose and Throat Doctor Daniel Spilman. It’s common for patients to come in complaining about ongoing ringing, Spilman says. He and his two partners generally see a few people per day about tinnitus, which adds up to about 10% of their clients. The doctors start by asking patients to rank the ringing and discomfort they are experiencing. 

“What it comes down to is, if you hear ringing, does it bother you? The levels of bothersomeness start with, ‘Well I notice it a little bit, but it doesn’t bother me,’ then moves up to, ‘I notice it when I’m trying to fall asleep and it’s irritating,’ to, ‘Well, I hear it all the time and sometimes I can’t hear people over it, I can’t concentrate or get work done. It’s driving me crazy,’” Spilman says. “Obviously that last group is a pretty miserable group. Most people don’t fall into that group. Most people are in the mild level of symptoms, where they notice it and it occasionally irritates or distracts them.”

Repeated, loud noise exposure can lead to permanent damage to the inner ear, but Spilman says that alcohol coupled with loud noise can also exacerbate the issue—not ideal for those that frequent concerts, or on the Fourth of July. “There are tiny hairs in there that pick up the vibrations of sound, but when you hit them with a high enough pulse of energy, you actually kill them,” he says. “Not every time, but repeatedly the tiny hairs die off and you have spots in your ear that aren’t picking up sound anymore.”

Spilman says that one theory for the symptoms of tinnitus is that when the brain sends signals to the ear, it doesn’t receive anything back from particular spots. The perceived, ongoing, ringing may come from that signal. But tinnitus doesn’t always stay forever. It can fade away, or it can come and go. Regardless, Spilman says the best thing to do after loud noise exposure is give the ears a break to prevent permanent injury. 

People who develop tinnitus are often exposed to sounds louder than noisy traffic—particularly those who work in construction, with firearms or in the music industry. But tinnitus can happen to anyone, regardless of workplace or background. Prevention mostly involves hearing protection. Over-the-ear headphones and earplugs are the best preventative measures to take for long periods of loud noise, but they aren’t always used since standard noise-reduction earplugs can degrade the quality of music. 

While basic foam ear plugs are the go-to inexpensive solution to protect hearing, they block out  sound rather than filtering it. This is probably why many people choose not to wear ear plugs, because they can “spoil the experience.” There are plenty of cheap, hi-fidelity ear plug options that don’t block sound altogether, but just let less sound through. Although they’re more expensive than foam ear plugs, they’re still available at around a $10 starting price. 

Beyond preventative measures, there aren’t many fixed one-time solutions for those experiencing tinnitus. One of the first steps is called masking, or playing loud background music or white noise to cover up or “mask” the noise. For people with more hearing loss, hearing aids, counseling and biofeedback can help teach the brain to ignore certain signals. Not all services are covered by general health insurance, though, especially for more extreme cases. 

Many seek therapy or support groups for tinnitus, and there are research links between tinnitus and anxiety, depression, self-harm, or even suicide. It’s the most common disability for veterans. Around 1.5 million vets live with tinnitus, and in 2012, the country spent $1.2 billion on tinnitus-related compensation to veterans, according to the American Tinnitus association.

“You’re cured if it never comes back, right? But it’s not like we can do an X-ray and it’s gone,” Spilman says. “When you get it and you have good hearing, there is a very good chance that you will resolve it—especially if you don’t injure your ears again. Once you have hearing damage, you’ll probably be living with it, but it’s still very common that it fades away and disappears. Even if that happens, is it cured? We don’t know, it could come back.” 

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