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Excerpts From The Tinnitus Handbook
A Self-Help Guide by Bill Habets

What is Tinnitus?

It's not all that easy to come up with a totally satisfactory definition of tinnitus because almost invariably there will be some exceptions to almost anything you might state categorically to describe it. To illustrate this point, there is even some confusion about whether "tinnitus" is a disorder in its own right or merely a label that conveniently identifies a number of broadly similar symptoms.

For example, the authors of one standard medical dictionary plainly see tinnitus primarily as a symptom when they defined it as "any noise (buzzing, ringing, etc.) in the ear." That definition is fine as far as it goes, but totally ignores the fact that for many sufferers tinnitus is seen as a disorder or a condition that is the cause of their symptoms.

It follows from this that the word tinnitus, depending upon the context within which it is used, can have a curious dual meaning, so at times possibly denoting two quite different things:

1) Tinnitus can simply mean, as suggested by the dictionary quoted above, "a noise heard in the ear," or

2) The word can describe a disorder of hearing whose main symptom is that the sufferer experiences sounds for which there is no matching source in the environment. But, as we shall see later, this already broad definition still isn't quite wide enough because it doesn't include that form of tinnitus in which the sufferer hears non-environmental sounds that in fact have origins in his or her own body. What's more, this definition also fails to include those situations where the tinnitus noises are doubtlessly the symptoms of some other clearly defined disorder. It also needs to be pointed out that the noises of tinnitus are by no means always heard in the ear; many sufferers describe their symptoms as "sensing noise" somewhere in their head.

While it would be useful if there were one word to denote tinnitus as a symptom and another to indicate it as a disorder, that unfortunately is not the case.

Incidentally, for most people affected by tinnitus, there is little doubt as to exactly what the word means to them: it is the disorder, condition, ailment, call it what you like, that afflicts them, and the symptoms this produces usually are simply described by them as "noises" rather than tinnitus.

A Very Ancient Problem

The term tinnitus is derived from the Latin word tinnire, which means a ringing or tinkling sound. Because many forms of tinnitus are the result of overexposure to very loud, high noise levels over lengthy periods. It is assumed by some that the complaint is a malady of modern times and perhaps didn't exist in earlier days when life was allegedly simpler and probably less noisy. It's a nice theory, but one that's not borne out by the facts, as references to tinnitus are found in the earliest medical writings dating back to the dawning of civilization in early Mesopotamia and Egypt. In more recent times, tinnitus is frequently mentioned in the medical literature of the day, suggesting that it was just as common a complaint then as it is now.

It is hard to say whether tinnitus is on the increase, although there is plenty of evidence to suggest that there are more recorded cases of it today than ever before, this leaving open the question as to just how many instances of tinnitus might have gone unrecorded in the recent past. Most experts, however, agree that it is likely that more people than ever before have tinnitus today or are at greater risk of eventually developing it. This increase is being brought about by several different factors, including:

Many cases of tinnitus can be traced back to previous exposure to sounds that were loud enough to cause hearing loss, this loss usually taking place almost imperceptibly over many years, if not decades. While modern technology has brought us the benefits of an endless variety of home entertainment in the form of television, tapes, records and videos, it has also enabled us to listen to these things at volume levels high enough to ultimately damage hearing. What's more, for many, listening to very loud music is not just an occasional pastime, but also something they choose to be exposed to for many hours everyday.
There is little doubt that, mainly because of increased road traffic, our towns and cities have generally become noisier places, the cumulative effect of this noise pollution taking a toll on the hearing of the inhabitants. There is also some evidence to suggest that tinnitus stemming from working or having previously worked in noisy environments may be on the increase despite various regulations meant to control noise levels in the workplace.
Even medical advances in other fields may have contributed to increasing the risk of tinnitus. Several drugs used to treat quite ordinary conditions have been found to be able to trigger the problem in susceptible people.
Another reason why a larger percentage of the population today may have tinnitus is because, on the average, we live longer than our ancestors. A very common form of tinnitus is the one that is associated with a kind of hearing loss that occurs mainly as part of the ageing process. As more people live longer, greater numbers reach the age when tinnitus is likely to become noticeable.

Incidence and Prevalence

When considering how widespread tinnitus is, there are two separate aspects to take into account: its prevalence and incidence. These are two words that are sometimes carelessly used as meaning the same thing, but which have quite different definitions:

Prevalence - also known as the prevalence rate - is a measurement based on the number of people affected by the condition in a given population.
Incidence - also known as the incidence rate or inception rate - is a measurement, usually obtained by statistical methods, of the number of new episodes of an illness or disorder arising in a given population over a specific period of time. Incidence is most often expressed as so many people affected or episodes of the disorder per 1,000 individuals at risk. In tinnitus, or course, there will almost invariably only be one episode per individual affected, unlike other ailments, such as influenza which someone may have more than once within the time period being studied.

While there is unanimous agreement amongst experts that tinnitus is extremely common, there is still discrepancy between statistics from various sources. However, the following figures are generally accepted as reflecting most accurately the magnitude of the problem:

The British Tinnitus Association says that "more than four million British adults have tinnitus, as do a large number of children, almost certainly from birth." While no exact figures are available for the number of children affected, one estimate extrapolated from other statistics puts this as high as possibly a million.
A fairly old study - but one with an interesting point of reference - was carried out by random sampling between 1957 and 1959: nearly 40 percent of those older than 55 years of age have a history of tinnitus as did more than 20 percent of people between the ages of 18 and 24. However, these very high figures need to be discounted somewhat because they also include instances where the tinnitus lasted only a very short time and didn't recur thereafter.
A more recent research project, also based on random sampling, by the Institute of Hearing suggested that a more realistic prevalence figure was 17 percent of the UK population, including only those cases where the symptoms were constant or present most of the time and excluding those where the noises were only heard temporarily. Incidentally, the same study also found that people in manual occupations were twice as likely to have tinnitus than those doing non-manual work.
The British Tinnitus Association has calculated that, on the average, "every day some 200 people in the UK experience the onset of permanent noises in their heads heard only by themselves.

Even more revealing of the massive effect that tinnitus has on the everyday lives of those afflicted by it are figures showing how much it effects them. In a recently published document, the British Tinnitus Association said that of the four million plus adult sufferers in the United Kingdom:

More than 200,000 of them experienced symptoms so severe that they were unable to lead a normal life.
About 437,000 were afflicted to the extent that they described the quality of their life as being "severely affected."
More than 655,000 said that they were "severely annoyed" by their tinnitus.
Nearly 1.1 million described their tinnitus as "moderately annoying."

The sufferers falling into the four categories above add up to about 2.5 million, leaving a further 1.5 million adult sufferers with tinnitus who say their symptoms cause them relatively little discomfort, annoyance or interference with daily life.

While statistics are undoubtedly open to interpretation or liable to slight error, there is little doubt that tinnitus is a health problem of massive proportions, affecting perhaps as much as a quarter of the population at one time or another.