Tinnitus is the perception of a phantom noise in your ear. It’s characterized by the perception of noise in the ear without any external source. The noise and the intensity of the tinnitus noise vary for each tinnitus patient.
Tinnitus can be temporary or permanent, and it can be mild or intense. It can also come with other symptoms like headaches, vertigo, loss of balance, difficulty sleeping, or reduced concentration. Tinnitus is grouped into various subtypes to help us understand it better, including subjective and objective tinnitus, somatic tinnitus, pulsatile tinnitus, and low-frequency tinnitus.
Low-frequency tinnitus is one of the most confusing types because people with low-frequency tinnitus are usually unable to tell if the sound they hear is generated internally or externally.
We’ll extensively examine low-frequency tinnitus, its causes, and possible treatments below.
What Is Tinnitus?
Tinnitus is often considered a symptom rather than a disease itself. This is because tinnitus is usually a sign that something else is wrong with your ears, body parts related to your ears, or body parts close to your ears.
Common causes of tinnitus include exposure to loud noise, ototoxic medications, autoimmune inner ear disease, earwax blockage, aging, head injury or trauma, and ear disease. Strain to the head and neck muscles and temporomandibular joint disorder (TMJ) can also cause tinnitus.
No two tinnitus cases are the same. This means that even if the cause of the tinnitus in two tinnitus patients is the same, their symptoms won’t be the same, and it won’t affect their lives in the same ways.
Let's take a look at them.
Types of Tinnitus
1. Subjective Tinnitus
Subjective tinnitus is the most common type of tinnitus. These tinnitus patients are the only ones who can hear the tinnitus noise. The biggest cause of subjective tinnitus is exposure to loud noise, and it can be temporary or permanent depending on the severity of the damage done to the ears.
2. Objective Tinnitus
This is a very rare type of tinnitus. Unlike subjective tinnitus, objective tinnitus isn’t only heard by the tinnitus patient; it can also be heard by an audiologist using a stethoscope.
Vascular deformities or involuntary muscle contractions often cause objective tinnitus.
Since medical professionals can usually find the cause of objective tinnitus, it’s the only type of tinnitus that medical professionals can cure. When the underlying condition causing the ringing is treated, the tinnitus will stop.
3. Neurological Tinnitus
Neurological tinnitus is often caused by a problem with the brain's auditory functions. The brain's auditory function can be affected by disorders like Meniere’s disease. This affects the brain’s ability to interpret sound signals sent from the inner ear.
4. Somatic Tinnitus
Somatic tinnitus stems from a problem with the sensory system. It can be triggered or worsened by moving certain parts of the body. In most cases, the cause of somatic tinnitus is outside the ears, like muscle spasms.
5. Pulsatile Tinnitus
Pulsatile tinnitus is a type of tinnitus that’s in sync with the tinnitus patient’s pulse or heartbeat. It’s often caused by turbulence or increased blood flow in blood vessels near your ear. This turbulence can be caused by several factors, like clogged blood vessels.
6. Musical Tinnitus
Musical tinnitus is also known as auditory imagery or musical hallucinations. Instead of hearing random noises in their ears, people with musical tinnitus hear a melody or a tune. Musical tinnitus is common in people with hearing loss.
What Is Low-Frequency Tinnitus?
Low-frequency tinnitus noises sound like the two lowest octaves on a piano. It’s often perceived as a deep droning, murmuring, or rumbling noise.
Because of the way its sounds and the uncertainty of the noise’s origins, it’s one of the tinnitus with the strongest effect on tinnitus patients.
Low-frequency tinnitus isn’t just annoying; some tinnitus patients have described it as a noise that can drive someone crazy or even make them question their sanity.
Low-frequency tinnitus can also sound like a low-pitched hum. This has made it easy for people who have another phenomenon known as The Hum to believe that they have tinnitus, but that isn’t exactly the case.
What Is the Hum?
The Hum is what some people call common reports of an annoying, low-frequency humming, rumbling, or droning noise that not everyone can hear. People from the United States, United Kingdom, New Zealand, and Canada have reported experiencing this phenomenon.
Although it’s most commonly called “The Hum,” some parts of the world have their own name for this phenomenon. For example, you might have heard it called "Taos Hum" in New Mexico or the "Windsor Hum" in Ontario.
People have attributed The Hum to local mechanical sources from industrial plants, highway traffic, and air traffic.
Although scientists have conducted studies, the actual source remains a mystery.
Do I Hear Real Noise?
Scientists conducted a study in the United Kingdom to distinguish between environmental hums and low-frequency tinnitus. People who complained about hearing a low-pitched hum were tested to find out if they heard internally produced noise or actual airborne environmental sound.
The acoustic tests included hum-matching and hearing acuity. Researchers asked participants to distinguish between tinnitus and real airborne noise. While the results showed that ten of the 48 participants definitely had low-frequency tinnitus, most individuals couldn't be classified.
A doctor or audiologist can test your hearing and look for underlying causes of tinnitus. Pinpointing a cause can help improve your condition, and it can eliminate the possibility that your humming is part of The Hum.
Is the Hum a Type of Low-Frequency Tinnitus?
Even though some studies have tried to prove that The Hum is the same as low-frequency tinnitus, we don’t think it is. This is because many people who hear The Hum have been able to get rid of it by changing location. Some people said they stopped hearing the hum when they left their house and moved to another house in the same city.
If a person can move away from the humming in their ear by going to another house, it's probably not tinnitus. That sound has an external source; you just haven’t identified it yet.
The Hum is a low-frequency sound, and low-frequency sounds can travel miles due to their high energy content. This makes it hard for people to identify the exact source of the noise. People who live close to industrial areas, factories, or railroad diesel locomotives often complain of hearing The Hum.
Some audiologists believe that most people’s Hum problems are based on the physical world and a keen focus on innocuous background sounds. The use of psychology and relaxation techniques can minimize The Hum’s effects.
Causes of Low-Frequency Tinnitus
Now that we’ve established what isn’t a cause of low-frequency tinnitus (AKA, The Hum), let’s dig into some actual possible causes of this pesky tinnitus sub-category.
Even though the exact source of low-frequency tinnitus usually isn’t clear, below are some known causes.
1. High Blood Pressure
High blood pressure can cause low-frequency tinnitus.
To break it down, the force of blood pushing against your blood vessels is known as blood pressure. When blood pressure is low or high, it can affect the viscosity of your blood. Viscosity is the stickiness and thickness of your blood, and it determines how easily blood flows through blood vessels.
Blood pressure is high when systolic pressure (the pressure when your heart beats) is above 130, and diastolic pressure (the pressure when your heart rests between beats) is higher than 80.
When your blood pressure is high, your blood’s viscosity increases. This reduces the blood flow through your capillaries. When this happens, the capillaries that supply blood to your inner ear’s structure can no longer provide the right amount of blood. Over time, this can result in hearing problems, including tinnitus.
Besides the fact that this change in blood pressure can cause low-frequency ringing in the ear, medications used to treat high blood pressure can also cause tinnitus.
Some high blood pressure drugs are ototoxic. This means that the side effects can affect hearing and cause tinnitus. Examples of ototoxic high blood pressure medications are high doses of loop diuretics and high doses of aspirin.
2. Anxiety and Stress
This may sound strange, but anxiety and stress can cause or worsen tinnitus. Studies have proven that people who have post-traumatic stress disorder are more susceptible to developing tinnitus.
Not only do stress and anxiety cause tinnitus, but they also cause high blood pressure. As you already know, high blood pressure can cause low-frequency tinnitus.
When you are stressed, your body produces hormones that can increase blood pressure. This increase in blood flow can cause the sound of that blood flowing through your body to become audible.
The relationship between tinnitus and stress is circular. Stress and anxiety can cause tinnitus, and tinnitus can worsen stress and anxiety. Anxiety causes you to pay more attention to the tinnitus noise, making it have a more severe effect on your life.
Shifting your focus away from the noise and getting proper treatment for post-traumatic stress disorder can decrease your perception of this tinnitus noise.
3. Poor Blood Circulation
There is a link between your heart health and your hearing. Heart diseases like atherosclerosis can narrow or stiffen your arteries.
When diseases plague arteries, they can get blocked by plaque. In more severe cases, they can even spasm and rupture.
When plaque clogged your arteries, it affects your blood flow. This results in inadequate blood flow to the inner ears.
The survival and the proper functioning of hair cells in the inner ear heavily depend on adequate blood supply because they receive oxygen through the blood.
The hair cells located in the cochlea in the inner ear are responsible for converting noise sent from the middle ear into electrical impulses that it sends to the brain, where it’s interpreted as sound.
When poor circulation deprives of oxygen due to poor blood circulation, they can get damaged. This damage can cause phantom noises (tinnitus) in the ear. If the hair cells are destroyed, it can result in hearing loss.
You cannot regenerate hair cells in the inner ear, so sadly, any hearing problem caused by damage to hair cells is permanent.
Low-Frequency Tinnitus Treatment
There is no known cure for tinnitus. In most cases, what’s prescribed as a tinnitus treatment doesn't treat tinnitus. Instead, it treats the underlying health condition responsible for tinnitus. When the underlying cause is identified and treated, the tinnitus will subside and eventually disappear.
It’s a major challenge when treating low-frequency tinnitus when ringing’s actual cause isn’t known, and most people with low-frequency tinnitus have no idea where their ringing originated. In these cases, healthcare providers usually prescribe standard tinnitus treatment and therapies to help alleviate the symptoms.
Below are treatments or therapies that can help relieve low-frequency tinnitus symptoms.
1. Tinnitus Retraining Therapy (TRT)
Tinnitus retraining therapy is a habituation therapy aimed at retraining how the brain, auditory system, and central nervous system receive, process, and interpret sound.
The therapy consists of two sections. The first section includes a series of counseling sessions to devise ways to ignore the tinnitus noise the same way you ignore background noise.
The second aspect uses sound therapy to weaken or drown out the tinnitus noise. An audiologist inserts a device that generates low-level noise into the tinnitus patient’s ear. The noise the device generates will have the same volume and pitch as the tinnitus noise.
Tinnitus retraining therapy lasts for 12 to 14 months. It’s currently recognized as the most effective treatment for tinnitus. Tinnitus patients begin to experience relief six months into the therapy.
2. Cognitive Behavioral Therapy
Cognitive-behavioral therapy is psychotherapeutic or psycho-social therapy aimed at helping people handle negative thoughts to improve their mental health.
Cognitive-behavioral therapy effectively treats low-frequency tinnitus, especially if it’s caused by stress and anxiety.
CBT helps tinnitus patients identify and change disturbing and destructive thought patterns that negatively affect their emotions and behaviors.
With this therapy, tinnitus patients focus less on the tinnitus noise and how it’s affected their lives.
Changing how they think about the tinnitus disturbance diverts attention, making the noise less obvious and reducing the anxiety and stress it causes.
3. Tinnitus Masking
During tinnitus masking, audiologists apply an external sound that affects the tinnitus noise. In some cases, low-frequency tinnitus becomes evident at night or in quiet environments; the use of tinnitus maskers can relieve these tinnitus symptoms.
Tinnitus maskers generate white noise, which introduces natural and artificial noise into a tinnitus patient’s environment. This masks the tinnitus noise and makes it less noticeable
You can wear tinnitus maskers above the ear or place them around your room. In the absence of formal tinnitus maskers, tinnitus patients can use air conditioners, humidifiers, and fans to generate a similar white noise effect.
4. Lifestyle Changes
Lifestyle changes can help reduce the severity of low-frequency tinnitus. This is very effective if a known problem like hypertension causes tinnitus.
Lifestyle changes you can make include:
Eating a healthy diet
Mindful stress reduction therapies
Reducing salt intake
Quitting smoking and drinking
Reducing caffeine intake
Seeking counseling for stress and anxiety
Low-frequency tinnitus is one of the most annoying types, but with the right medical attention and guidance, you can get relief from the symptoms.
While undergoing treatment for your tinnitus, ensure that you pay attention to your mental and emotional health. Avoid activities or circumstances that can heighten your stress and anxiety, and try engaging in relaxing activities like yoga and meditation.
“Although tinnitus can be difficult to deal with, there is hope. Even with some minor adjustments, most people can improve their situation dramatically.” - Drew Sutton, MD, Board-Certified Otolaryngologist.
If you treat any health condition with a medication that you suspect worsens your tinnitus, inform your doctor immediately so they can prescribe an alternative medicine.
Drew Sutton M.D.
Drew Sutton, MD is a board-certified otolaryngologist. He has extensive experience and training in sinus and respiratory diseases, ear and skull base surgery, and pulmonary disorders. He has served as a Clinical Instructor at Grady Hospital Emory University for more than 12 years.