A history of tinnitus

As it’s Tinnitus Awareness Week it seems fitting that we take a look back in time to see how the understanding of this condition has evolved. Tinnitus is the name given to the perception of noise or ringing in the ears that seemingly has no external source. It is a relatively common condition, affecting an estimated 1 in 5 people. Although it is often associated with hearing loss, it does not lead to hearing loss and many people who have tinnitus have otherwise perfect hearing. Most report experiencing it as either a ringing, buzzing, humming, hissing, throbbing or occasionally music or singing, though this is very rare.

The first written reference to tinnitus dates all the way back to Ancient Egypt. A medical text named the Crocodilopolis (dated to c. 1650 – 1532 BCE) makes a reference to a “bewitched” ear or “humming” in the ears. In an attempt to cure it the text recommends creating an infusion of oil, frankincense, tree sap, herbs and soil, and administering this to the external ear with a reed stalk. The Mesopotamians also referenced the condition and would chant to try and get rid of “whispering” or singing in the ears.

We may be prone to believing that any and all so called “remedies” that were spoken of any time before the 20th century were misguided nonsense, but it was in fact the Greco-Roman period that produced the most common method of relief still used today. It was in the writings of people such as Aristotle and Hippocrates that the idea of “masking” tinnitus with other sounds was first written about. The idea was that “a greater sound” could be used “to drive out the less”. This idea of ‘masking’ is still used as treatment for those who have tinnitus today. Many people with tinnitus use white noise, background noise or nature sounds etc to make the tinnitus less noticeable, especially when trying to sleep.

Understanding of tinnitus remained relatively primitive during the Renaissance period. During this period the prevalent belief as to what caused the sensation was the idea that it was caused by trapped wind in the ear canal, which would circle around inside the ear creating the ringing or buzzing noise. Clinicians would attempt to cure it by surgically piercing or cutting a small hole in the mastoid in an attempt to release this trapped wind.

Clinicians started to draw distinctions between different types of tinnitus as early as 1683. The french otologist Jean Marc Gaspard Itard famously labelled them as “true” and “false” tinnitus in 1812. “True” tinnitus is extremely rare; Itard described it as sounds perceived in the ear “by the patient and the clinician” when the latter is close enough to the sounds source in the body of the patient or can use amplifiers to hear it. This is now known as “objective” tinnitus. The second and much more common type he called “false”tinnitus. This he described as a phenomenon that can’t be heard by anyone “other than the patient him or herself”. This form of tinnitus where the perceived sound is not the result of no physical stimulation in the body of the patient. This is now referred to as “subjective” tinnitus. This distinction is still the predominant understanding of tinnitus today.