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Tinnitus Explained

Tinnitus is an arousal-reactive symptom. The arousal component is the onset of tinnitus and the reactive component is how it is processed in the brain. The onset of tinnitus on the most basic level, is often due to an abnormality that occurs with the sensory organ within the inner ear called the cochlea. Additionally, the central nervous system responds to this abnormality and is a full participant of the arousal component. The reactive component is how we psychologically respond to the tinnitus.

The obvious question is why do some develop stress and anxiety from having tinnitus and others do not? It is estimated that 50 million Americans report having tinnitus. Of this, 16 million are affected enough to seek medical attention or actively surf the internet searching for a cure and 2 million are signigicantly impacted to the point that it negatively disrupts their daily lives. Fortunately, for the other 32 million, tinnitus is not an issue. So let's explore the factors that separate these three groups. These factors include auditory, attentional and psychological.

Tinnitus is most often triggered by an insult within the inner ear region of the auditory system causing hearing loss. Some common triggers are:
  • Noise exposure/trauma
  • Ototoxic drugs
  • Aging auditory system
  • Head trauma
  • Lyme disease
  • TMJ

Within the inner ear(s) there is a structure called the cochlea. This structure, which looks like a snail, houses thousands of hair like cells called cilia which reside along a membrane inside. These cells have a tonotopic arrangement meaning that where they reside along the membrane will determine their frequency or pitch, much like keys of a piano. When damaged, these cells will no longer send input to the auditory center in the brain, called the auditory cortex, which is accustomed to receiving it. Because of this, the auditory cortex will over compensate for this lack of input leading to an over-excitation of unaffected neurons. In others words, the brain is trying to reproduce these diminished or lost signals. This is thought to be the geneses of tinnitus.
Have you ever been in a group of people having an interesting conversation with a friend and, even though there are other conversations going on around you, your brain is able to filter out the surrounding conversations. Suddenly, someone in the other conversation mentions your name or something of interest to you, you will immediately turn your focus to the other conversation. This demonstrates how the subcortical awareness pathways, or subconscious, filters and categorizes all the sounds in our everyday life. Those that are categorized as important are sent to the brain for processing and those that aren't are filtered out. When tinnitus is categorized within the subconscious realm as harmful, irritating, and disrupting it's labeled as important and allowed to continue on the way to the brain for processing.
If we feel that something in our lives is harmful, irritating or disturbing, as with tinnitus, it will affect our emotion. It may cause anger, fear, depression, helplessness and even guilt. This has a direct impact on the limbic system which is our emotional response area of the brain. When there is a negative reaction in our emotion of fear, anger and so on, the limbic system activates the Autonomic Nervous System which is where our fight or flight responses occur. The brain is alerted that something is wrong and begins activating physiological components of our body. Heart rate increases, breathing quickens, and adrenaline increases. When our brain determines that it is the tinnitus that is causing this neurological disturbance it reactivates the limbic system as a negative emotion and the whole process is repeated. This is known as the vicious cycle of tinnitus.

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