Tinnitus is a debilitating and somewhat mysterious condition which affects one in eight people in the UK, often causing profound stress, sleep difficulties, anxiety and compromising hearing. Vicky Powell looks at what is being done to tackle tinnitus, how employers can protect their workers against developing these “phantom” symptoms and what sufferers themselves can do to find some relief.
What is tinnitus?
The British Tinnitus Association (BTA) describes tinnitus as “the perception of noises which have no external source”. The symptoms may be felt as ringing, buzzing, hissing, clicking, whistling, whooshing sounds, etc and may be constant or intermittent, varying in volume from person to person. Tinnitus is thought to affect 15 to 20% of people.
According to the Association, the noise may be in one or both ears, or it may feel like it is in the head. It may be low, medium or high pitched and can be heard as a single noise or as multiple components.
Occasionally people have tinnitus that can seem like a familiar tune or song, known as musical tinnitus or musical hallucination. Others have tinnitus which has a beat in time with their heartbeat — known as pulsatile tinnitus.
The symptoms are usually caused by an underlying condition with strong links to hearing loss in general.
Is tinnitus caused by exposure to noise?
Research conducted by the Health and Safety Executive (HSE) has indicated that the prevalence of tinnitus in workers exposed to noise at work is significantly greater than in workers not exposed to noise.
Therefore, jobs at particular risk of tinnitus are those characterised by loud or prolonged noise. For example, carpenters, construction and manufacturing workers, airport staff, musicians, call centre personnel and street workers could be among those at risk, as are people who work with chain saws, guns or other loud equipment as well as those who are exposed to loud music at work.
However, causes can also be completely unrelated to noise at work and linked to non-work-related hearing loss as well as ear infections or various illnesses such as diabetes, thyroid disorders, multiple sclerosis, anxiety, depression and Ménière's disease.
According to the NHS, tinnitus can also be caused as a side effect of some chemotherapy medicines, antibiotics, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin.
The BTA has produced a video which offers an excellent insight into what living with tinnitus is like, thanks to electronic recreations of the noises that various people experience.
What can employers do?
In the context of tinnitus, the Government’s Fit for Work occupational health advice service (tel: 0800 032 6235) has reminded employers that they have a duty of care to their workers and if noise in the workplace regularly reaches 80 to 85 decibels they should take steps to protect their staff, such as:
trying to reduce the noise of machinery and considering noise levels when buying new equipment
providing protection from noise, such as ear plugs or guards
reorganising shift patterns to reduce the time workers are exposed to loud noise
educating staff about the dangers of noise and insisting that they use ear guards
setting up a programme of health surveillance
offering regular hearing tests to staff.
The Control of Noise at Work Regulations 2005 apply to all industry sectors in Britain and aim to ensure that workers' hearing is protected from excessive noise, which could cause them to lose their hearing and/or to suffer from tinnitus. See the Noise topic for information and guidance.
The HSE warns that many thousands of people are exposed to loud noise at work that may be a risk to their hearing.
In addition, ototoxic chemicals — substances which can harm hearing, even in the absence of noise levels — also carry risks which can be under-acknowledged, but are associated with often life-changing effects related to hearing loss. See our feature The life-changing risks of ototoxic chemicals.
Living and working with tinnitus
In a survey, 42% of tinnitus sufferers believed that their condition had an adverse effect on their work, and loss of concentration, lack of sleep and anxiety associated with the condition can all make working more difficult. However, tinnitus can also impact on working in other ways including, for example, difficulties:
hearing conversations in the office and in meetings
socialising or chatting with colleagues
in hearing telephone conversations.
Employers also need to understand their responsibilities to staff with tinnitus or hearing loss under the Equality Act 2010 and will need to be prepared to make reasonable adjustments to support staff with hearing difficulties.
It is recommended by Fit for Work advisors that people who have hearing loss or tinnitus inform their managers of their condition and discuss changes that could help, such as moving to a different workstation, changing meeting venues or reducing stress.
Also helpful is an online resource, developed by the BTA, called Take on Tinnitus. It has been designed primarily for people who have just begun to experience tinnitus. However, it is also a valuable resource for those who have experienced the condition longer term.
Treatments for tinnitus
The Fit for Work advice points out that some cases of tinnitus, such as those caused by the build-up of ear wax or because of an ear infection, can be treated by a doctor. In other cases, there is no cure, and treatment is focused on developing coping mechanisms in order to live with the condition. Various therapies may be helpful including the following.
Sound therapy: Tinnitus often sounds louder at quiet times, such as when trying to sleep. Sound therapy focuses on creating alternative sounds as a distraction, thus masking the tinnitus, either through a sound generator fitted in or behind the ear or by playing music or the radio. Many people will go to sleep listening to the radio or music to distract them from the tinnitus sounds.
Tinnitus counselling: Talking to a counsellor at an NHS tinnitus clinic in a hospital can give comfort and reassurance in dealing with tinnitus and other issues that may be contributing to the problem.
Cognitive Behaviour Therapy (CBT): CBT can help people manage their tinnitus by reviewing and changing the way they think and behave. Often led by clinical psychologists or psychotherapists, CBT therapists can teach coping techniques for dealing with the unwanted noise and the negative emotions that come from it.
Tinnitus Retraining Therapy (TRT): This attempts to address an individual’s heightened awareness of tinnitus sounds based on the theory that it is the part of the brain responsible for emotions (the limbic system) that exaggerates the importance and meaning of these noises. Through counselling and sound therapy, TRT aims to reduce a person’s awareness of tinnitus through a process of habituation.
A wide range of treatments and a number of specific medications, including antidepressants, amitriptyline and melatonin for example, have been reviewed by the BTA and evaluated using an extremely helpful traffic light system, based on their safety and efficacy.
The Association also runs a helpline (on tel: 0800 018 0527) and a webchat service via its website.
In addition, there is a network of tinnitus support groups around the country, listed via the Association’s website, where people can develop and learn about new coping skills and gain inspiration and encouragement from others.
Research to resolve a medical enigma
In 2020, Tinnitus Awareness Week is taking place from Monday 3 to Sunday 9 February, focused around the theme of tinnitus research.
The BTA has recently partnered with scientists and academics from the Nottingham Biomedical Research Centre and the Universities of Nottingham and Newcastle to conduct innovative research, using imaging data from thousands of brain scans held in the UK Biobank, a major national and global health resource. It is thought that chronic tinnitus may be associated with changes in the structure of the brain, and that reversing these changes might prove effective in the treatment of the condition.
Commenting on the research, David Stockdale, Chief Executive of the BTA said, “We are excited to be working with world class organisations as we push on in search of a cure for tinnitus. The research teams we are partnering with have a proven track record in innovative, patient-focused research making our partnership a powerful combination. Working as one team we hope to unlock the full potential of the UK Biobank data, giving new insight into the mechanisms behind tinnitus.”
It is estimated that tinnitus affects approximately six million people in the UK at present, and many people elsewhere around the world, potentially causing stress, sleep difficulty, anxiety and compromising hearing.
As research efforts continue, it is hoped that soon a cure for this enigmatic and distressing medical problem will be found.