Noise damage is permanent and cumulative, so even if someone is only exposed to noise in their teens and twenties, it is still relevant. What was known about tinnitus in the 1960s was very little (hence the use of the term “nerve damage” which is incorrect), and even when I was in grad school in the 1990s we didn’t have much specific knowledge, because there is no way to see the inner workings of a live auditory system. Only with newer imaging techniques, like PET Scans and fMRI, can we get some insight into what is happening.
When evaluating a patient with tinnitus, we will ask them to describe the frequency, duration and perceived location of the sound. Tinnitus treatments these days regard it as a symptom akin to pain, and some places will use a scale from 1–10 to ask how bothersome it is to the patient. What you describe about your tinnitus and the other case history and test results help us to determine if your difficulties are most likely due to noise exposure, or if perhaps there is another factor contributing to your symptoms.
What recent research is suggesting about tinnitus in most cases (especially noise exposure) is that it is a by-product of hearing loss, similar to a phantom limb phenomenon – when someone loses an arm, but they still feel their fingers. When someone’s inner ear hair cells are damaged and no longer triggering the nerve as they used to (which is a sensory loss, rather than a nerve loss), the nerve fibers are still there and healthy and expecting to be busy, only there is no incoming sound stimulation so they are firing and creating their own noises.
For many people, correcting for the hearing loss is adequate to suppress the tinnitus. For others it is not enough, so some of the manufacturers have tinnitus maskers integrated into the hearing aids. For someone whose hearing loss started many years ago, they may not even notice the tinnitus much anymore… either because they’re so used to it, and/or because the nerve has atrophied from lack of sound stimulation from the inner ear. We now have diagnostic techniques to more clearly identify which components of the auditory system are working well and which aren’t, but in most cases, that is splitting hairs and the patients want to focus on relieving the symptoms.
Hearing aids are a rehabilitative process. You are learning to hear with assistance, like wearing eyeglasses or using a cane or orthotics. Those with good hearing don’t even notice most of the sounds around them because they expect those sounds to be there – they’ve been hearing them since before they were born. The ears are aware of our environment all around us, behind us, beyond what we can see, and through the walls that confine our vision. Our ears being constantly “on” is how we can sleep soundly at night, because unexpected sounds will awaken us. We all have heard that visually impaired people hear better – no; they only pay more attention to what they’re hearing and the learn to use auditory information consciously, when for those with decent sight the correlation of auditory and visual cues means we don’t have to think about it.
Wearing the hearing instruments during all one’s waking hours is the best way to retrain your brain to respond to the sounds around you more like someone who hears all those sounds naturally. This is why patient motivation is the key factor in success with hearing instruments. With the technology we have today, many of my patients notice how much easier it is to follow conversations and how natural it seems during the 1-hour hearing aid demonstration visit. It is best if a family member or close friend accompanies the patient to that visit so the patient can notice the difference in the sound of a familiar voice. We ask them to say things that the patient can’t anticipate the answer to.
You might want to check whether you have a University Medical Center near you, if it is affiliated with an Audiology Doctorate program as you may get some savings if you work with doctoral students who are being supervised. This way you can get state-of-the-art services, too. You can go to the website for the American Tinnitus Association for additional information. Let me know if you have any further questions!