Does the Cause of Tinnitus Influence Its Severity, Impact, or Progression?

[Scruffiey]

I know tinnitus is completely subjective, so this is a rather tricky one to answer, but is there a general sense of an established difference in tinnitus depending on the cause?

For example, some people experience sudden sensorineural hearing loss and permanently lose, say, 60 dB along with all their high frequencies in one cruel twist of fate. They must surely develop intense tinnitus. I assume a significant amount of damage must occur to the hair cells, nerves, and synapses for that to happen.

Then there is someone with a "perfect" audiogram (yes, I know it is not entirely reliable) and a bit of hidden hearing loss, who ends up with the typical "eeee" sound for the rest of their life after a one-time loud event or concert that does not affect their peers at all.

Another person might lose 30 dB across a couple of frequencies over several decades from long term noise exposure, but then one day tinnitus appears suddenly, like the final straw that breaks the camel's back. Are they now as vulnerable as the people who had a single loud event?

Of course, we are all different, and our ears vary in what they can handle. Some people never develop tinnitus, while others get it but are somehow not bothered by it. I ask because I have noticed that people with sudden sensorineural hearing loss often seem to come to terms with their tinnitus more easily. It feels like a cruel twist of luck, and yet they seem to cope. I assume they still face the same kinds of issues as anyone else with tinnitus and are just as vulnerable to further worsening.

I have also noticed that many of the worst noxacusis sufferers seem to have nearly perfect audiograms and only experienced a few particularly bad exposures. But then why do we not see more military veterans, who often have large dips in their hearing, also suffering from severe tinnitus and noxacusis?

Just curious if there is any kind of consensus.

 

[RingerBell]

If I had to guess, I would say that single severe noise traumas such as explosions, other intense impulse noises, or loud concerts that leave hearing temporarily muffled, or sudden sensorineural hearing loss (SSHL) with large dips and no recovery, are the most likely situations in which a person develops tinnitus.

However, among people who have a faulty gating mechanism and are therefore capable of developing tinnitus, genetics still play a role. For example, resilience in how their hearing can withstand noise and recover from it is one factor. Another factor is how reactive or sensitive the brain is, including how much hearing loss is needed before the brain begins to compensate with tinnitus, and how strong that compensating signal needs to be. The list of factors that influence whether the brain creates tinnitus is probably very long and still partly unknown.

It was mentioned in one of the Tinnitus Talk podcasts or Tinnitus Quest interviews, by one of the researchers, that in cases of age-related or other gradually acquired hearing loss, a stressful event could change the brain's state enough to trigger tinnitus, even if there had been no recent change in hearing.

So I do not think there is a real consensus. But one thing does seem fairly clear. People tend to develop tinnitus in very different ways, at different ages, with varying degrees of hearing loss, and even when they have consistently protected their ears. If someone does not have a suppression mechanism for the phantom signal and is therefore capable of developing tinnitus, there is a high chance that the brain will eventually produce it.

Since we cannot predict everything that will happen in life, it seems to me that the question is not so much if someone will develop tinnitus, but when.

 

[Scruffiey]

If I had to guess, I would say that single severe noise traumas such as explosions, other intense impulse noises, or loud concerts that leave hearing temporarily muffled, or sudden sensorineural hearing loss (SSHL) with large dips and no recovery, are the most likely situations in which a person develops tinnitus.

However, among people who have a faulty gating mechanism and are therefore capable of developing tinnitus, genetics still play a role. For example, resilience in how their hearing can withstand noise and recover from it is one factor. Another factor is how reactive or sensitive the brain is, including how much hearing loss is needed before the brain begins to compensate with tinnitus, and how strong that compensating signal needs to be. The list of factors that influence whether the brain creates tinnitus is probably very long and still partly unknown.

It was mentioned in one of the Tinnitus Talk podcasts or Tinnitus Quest interviews, by one of the researchers, that in cases of age-related or other gradually acquired hearing loss, a stressful event could change the brain's state enough to trigger tinnitus, even if there had been no recent change in hearing.

So I do not think there is a real consensus. But one thing does seem fairly clear. People tend to develop tinnitus in very different ways, at different ages, with varying degrees of hearing loss, and even when they have consistently protected their ears. If someone does not have a suppression mechanism for the phantom signal and is therefore capable of developing tinnitus, there is a high chance that the brain will eventually produce it.

Since we cannot predict everything that will happen in life, it seems to me that the question is not so much if someone will develop tinnitus, but when.

Interesting…

I suppose I ask because I've been trying to figure out my tinnitus. I went to several concerts when I was younger and never experienced even a hint of it. Years ago, I was exposed to a small explosion, probably similar to a gunshot. I recovered quickly, with only about 30 seconds of faint ringing. But now, I see that one ear has a significant 30 decibel dip compared to the other, which is nearly spotless aside from some age related hearing loss. Why would that be?

Looking back at how my tinnitus developed, from a slight ring to an enormous and catastrophic siren, along with several completely dead frequencies when I tested with a tone generator, then gradually settled into a more moderate tinnitus, I wonder if I actually experienced Sudden Sensorineural Hearing Loss and just recovered partially. And why does the drone-like tone in that frequency dip come and go?

At the same time, I had also been under enormous stress for the past few years, and it was reaching a breaking point. Maybe my auditory gating mechanism simply failed.

I know there is no real answer, and none of this changes much for me right now. But as I look toward future treatments, and since I am naturally curious, I wanted to hear what others think about this.