Tinnitus, commonly referred to as ringing in the ears, is the perception of noise or ringing in one or both ears. The sound can be constant or intermittent, and often has no external source. Tinnitus affects around 15% to 20% of people, and the prevalence increases with age. There has been much debate over whether tinnitus tends to worsen as people get older. In this article, we will examine the evidence around this question.
What causes tinnitus?
Tinnitus can arise from various parts of the auditory system, including the inner ear, auditory nerve, brainstem, and cerebral cortex. Some of the main causes include:
- Age-related hearing loss (presbycusis) – As we age, cells in the inner ear start to deteriorate and die off. This leads to hearing loss and often tinnitus.
- Noise-induced hearing loss – Exposure to loud noises can damage the delicate hair cells in the cochlea part of the inner ear, causing hearing problems and tinnitus.
- Earwax blockage – Built-up earwax can press against the eardrum and interfere with vibration, sometimes producing tinnitus.
- Meniere’s disease – This inner ear disorder can cause pressure and fluid buildup, leading to tinnitus and vertigo spells.
- Head and neck injuries – Injuries to the head or neck can affect the auditory pathways and lead to tinnitus.
- Acoustic neuroma – This non-cancerous growth on the vestibulocochlear nerve can cause tinnitus symptoms.
- Medications – Some medicines, like aspirin, antibiotics, antidepressants and chemotherapy drugs can cause temporary tinnitus.
In many cases, the specific cause of tinnitus is unknown. However, these and other factors often increase the risk.
Prevalence of tinnitus by age group
Several studies have investigated the prevalence of tinnitus across different age groups. The trends show a clear increase in tinnitus with advancing age:
- Younger adults – Around 5% to 15% of adults aged 18 to 44 experience tinnitus.
- Middle-aged adults – The rate increases to 12% to 30% in adults aged 45 to 64.
- Older adults – Tinnitus affects 33% to 40% of adults aged 65 to 84.
- Elderly adults – Over 60% of adults aged 85 and above have tinnitus.
These statistics demonstrate that tinnitus becomes much more common as people get older.
Reasons for higher tinnitus prevalence in seniors
There are several reasons why seniors are more likely to develop tinnitus:
- Age-related hearing loss – This is the leading cause of tinnitus in the elderly. Gradual damage to the cochlea over time leads to hearing decline.
- Increased noise exposure – Older people have lived through times with less regulation of noise at work and recreationally.
- Medications – Elderly patients tend to be on more prescription drugs that list tinnitus as a side effect.
- Reduced blood flow – Vascular conditions like high blood pressure can reduce blood supply to the inner ear.
- Auditory nerve deterioration – The auditory nerve fibers gradually deteriorate with age, especially those attuned to high frequencies.
Severity of tinnitus by age
Not only is tinnitus more common among seniors, but the symptoms also tend to be more severe. A large European study evaluated tinnitus severity in different age groups using the Tinnitus Handicap Inventory (THI). The THI assesses functional, emotional and catastrophic impact of tinnitus symptoms.
THI scores by age
| Age Group | Mean THI Score |
|---|---|
| 18-30 years | 22 |
| 31-45 years | 28 |
| 46-60 years | 34 |
| Over 60 years | 40 |
Higher scores indicate worse tinnitus symptoms. The data shows that THI scores were lowest in young adults and steadily increased with each older age bracket. Seniors over 60 had almost double the handicap from tinnitus compared to those under 30.
Reasons tinnitus may worsen with age
There are several explanations for why tinnitus tends to become more debilitating in older people:
- Increased hearing difficulty – This makes tinnitus harder to ignore.
- Reduced cognitive function – The ability to filter out and habituate to tinnitus declines.
- Higher chance of depression – Tinnitus can exacerbate depression which further amplifies symptoms.
- Less social engagement – With reduced social contact, tinnitus is more noticeable.
- Sleep disturbances – Tinnitus disrupts sleep more easily in the elderly.
Longitudinal changes in tinnitus
While the aforementioned studies compared difference age groups, longitudinal studies follow people over time to see how tinnitus changes within individuals.
A few longitudinal studies have shown tinnitus generally increases in prevalence and severity over time:
- A Swedish study followed 70 year olds over 5 years. Tinnitus prevalence increased from 30% to 39% in that relatively short time.
- In a UK study, tinnitus handicap scores increased steadily each year over 4 years in adults over 50 years old.
- An American study found tinnitus grew gradually louder in 50% of elderly patients monitored over 10 years.
However, a long-term study of noise exposed workers found their tinnitus did not worsen significantly over a 12 year period. More longitudinal research is still needed, but initial evidence points to gradual worsening of tinnitus in many seniors.
Treatments to prevent tinnitus worsening
While there is no cure for tinnitus, several management options may help limit worsening of symptoms as you age:
Hearing aids
Hearing aids amplify ambient sounds which helps mask tinnitus. They also prevent strains on auditory processing that exacerbate tinnitus. Using properly fitted hearing aids can stabilize or even reduce tinnitus perception.
Sound therapy
Listening to soothing background sounds like rainfall or music can distract the brain from tinnitus. This helps break the cycle of conscious awareness of symptoms. Sound generators, apps, CDs and bedside sound machines can provide continuous sound therapy.
Counseling
Cognitive behavioral therapy (CBT) helps develop coping techniques for tinnitus. Changing reactions and thought patterns around tinnitus can help improve ability to manage symptoms. Counseling often includes education, relaxation exercises and addressing anxiety/depression.
TRT (tinnitus retraining therapy)
This combines sound therapy with directive counseling to help habituate the signal between ear and brain. It retrains the auditory system to subconsciously reduce perception of tinnitus.
Medications
There are no drugs to treat tinnitus itself. However, medications may be used to manage comorbidities like anxiety, depression and insomnia that commonly accompany tinnitus. This helps prevent worsening of tinnitus severity.
The impact of untreated tinnitus
Neglecting to address tinnitus symptoms can lead to significant life impairment over time. Common effects of severe, untreated tinnitus include:
- Sleep disturbances like insomnia
- Inability to concentrate or focus
- Irritability, anxiety and depression
- Reduced social activity and isolation
- Work or school impairment
- Reduced quality of life and life satisfaction
Seeking treatment for tinnitus, especially as it worsens, can help limit these negative effects and preserve normal daily functioning.
Does tinnitus eventually go away?
In most cases, tinnitus is a permanent condition. The auditory system has likely undergone permanent changes that maintain perception of phantom sounds. However, this does not mean tinnitus cannot be managed.
For some people, symptoms may seem to resolve over time:
- If tinnitus results from short-term inflammation, medication or earwax, it may go away once the underlying cause is treated.
- Masking techniques, habituation and neural remapping can make tinnitus less noticeable, as if it disappeared.
- Severely reduced hearing in advanced age may diminish awareness of tinnitus.
But for many seniors, bothersome tinnitus symptoms tend to persist and require active management. Consulting an audiologist can help develop an effective, multi-faceted treatment plan.
Conclusion
In summary, research clearly shows that both the likelihood and severity of tinnitus increase significantly as we age. Contributing factors include age-related hearing loss, noise exposure, vascular issues and neurological changes.
While no cure exists, proactively managing tinnitus with sound therapy, counseling, medications and hearing aids can help stabilize symptoms. Allowing tinnitus to worsen untreated can lead to sleeping difficulties, anxiety, depression and reduced quality of life.
Tinnitus is a complex condition with many causes and contributing factors. Working closely with healthcare providers can help identify the best individualized management approach to help limit worsening tinnitus as you grow older. Consistent tinnitus monitoring and treatment adjustment are key to maximizing outcomes.