Tinnitus


TINNITUS

Description:

Alternative Names: Ringing in the ears; Noises or buzzing in the ears; Ear buzzing.

Tinnitus is a condition commonly known as "ringing in the ears". The ringing sounds are brain-induced; that is, ringing is perceived in the absence of any external auditory stimulation. In addition to ringing sounds, roaring, hissing, clicking and other non-externally generated sounds are also classified as tinnitus. Chronic tinnitus can be caused by noise exposure, disease, excessive use of aspirin or other pain relievers, and use of certain antibiotics.

According to the American Tinnitus Association (ATA) it is estimated that approximately 50 million persons in the U.S. have intermittent or permanent tinnitus. Of these, approximately 10-12 million have severe and chronic tinnitus. The ATA reports that of these some two million persons are completely disabled by the condition. Severe tinnitus in some drastic cases has led to suicide.

Unfortunately, many armed forces personnel serving overseas are subjected to noise environments that can directly lead to tinnitus even when these personnel use earplugs. To make the problem worse, many of these service personnel are predisposed to not use such protective devices when in harm's way - potentially to their own detriment. Excessive noise exposure from firing weapons, and exposure to ordinance and IED's can initiate life-long tinnitus even without traumatic brain injury being a consequence. In the worst case of serious traumatic brain injury as a consequence of explosive IED's, tinnitus may also accompany the primary injury and negatively impact recovery.

For the general population, tinnitus is also associated with listening to music players (i.e. I-pods) at elevated volume levels for extended periods of time. An increased incidence of tinnitus is also observed in the elderly.

Whether we realize it or not, the incidence of tinnitus is increasing while at the same time tinnitus remains a largely unaddressed problem. Since brain pathways associated with hearing are partially common to those affecting emotions, the potential for serious debilitation to many in our society is compounded.

While research is ongoing, there is currently no known cure for tinnitus. This being the case, can anything be done to help those with tinnitus cope with the condition.

Tinnitus retraining therapy, hypnosis, and psychotherapy have been useful to certain individuals. These regimes can take extended periods of time (over two years) to be effective - if they become effective at all. Tinnitus masking machines and specialized hearing aids have also been useful.

Vitamins, herbal concoctions and homeopathic formulations on the other hand have not been shown in controlled studies to be - at best - any more effective than placebos - although many tinnitus-onset sufferers try them out of desperation in attempts at obtaining relief.

Some tinnitus sufferers - especially those with mild cases - habituate to the ringing, hissing or other brain-induced "sounds". For the vast majority of sufferers, however, habituation doesn't seem possible and the prescription "learn to live with it" is of little consolation to them.

Tinnitus can be extremely disturbing to people who have it. In many cases it is not a serious problem, but rather a nuisance that may go away. However, some people with tinnitus may require medical or surgical treatment. Twelve million Americans have tinnitus, and one million experience it so severely it interferes with their daily activities.

Tinnitus can arise in any of the four sections of the hearing system: the outer ear, the middle ear, the inner ear, and the brain. Some tinnitus or "head noise" is normal. A number of techniques and treatments may be of help, depending on the cause.

Some of the most common include a sound of crickets or roaring, buzzing, hissing, whistling, and high-pitched ringing.

Other types of tinnitus include a clicking or pulsatile tinnitus (the noise accompanies your heartbeat).

The most common type of tinnitus is known as subjective tinnitus, meaning that you hear a sound but it cannot be heard by others.

A much more uncommon sort is called objective tinnitus, meaning your doctor may sometimes actually hear a sound when he or she is carefully listening for it.

Symptoms:

Tinnitus involves the annoying sensation of hearing sound when no external sound is present. Tinnitus symptoms include these types of phantom noises in your ears:

    Ringing.

  • Buzzing.

  • Roaring.

  • Clicking.

  • Whistling.

  • Hissing.

The phantom noise may vary in pitch from a low roar to a high squeal, and you may hear it in one or both of your ears. In some cases, the sound can be so loud it interferes with your ability to concentrate or hear. Tinnitus may be present all of the time, or it may come and go.

Causes and Risk factors:

Tinnitus is not a disease in itself but rather a reflection of something else that is going on in the hearing system or brain.

Probably the most common cause for tinnitus is hearing loss. As we age, or because of trauma to the ear (through noise, drugs, or chemicals), the portion of the ear that allows us to hear, the cochlea, becomes damaged.

Current theories suggest that because the cochlea is no longer sending the normal signals to the brain, the brain becomes confused and essentially develops its own noise to make up for the lack of normal sound signals. This then is interpreted as a sound, tinnitus. This tinnitus can be made worse by anything that makes our hearing worse, such as ear infection or excess wax in the ear.

Tinnitus caused by ear trauma is usually noticed in both ears, because both ears are usually exposed to the same noises, drugs, and other influences

Loud noise exposure is a very common cause of tinnitus today, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise from firearms, high intensity music, or other sources.

Ten million Americans have suffered irreversible noise-induced hearing loss, and 30 million more are exposed to dangerous noise levels each day, according to the NIDCD.

Other causes of tinnitus include drugs such as aspirin (if overused), aminoglycoside antibiotics (a powerful form of infection-fighting drug), and quinine.

Meniere's disease includes dizziness, tinnitus, and fullness in the ear or hearing loss that can last for hours, but then goes away. This disease is actually caused by a problem in the ear itself. The tinnitus is merely a symptom.

A rare cause of subjective tinnitus includes a certain type of brain tumor known as an acoustic neuroma. The tumors grow on the nerve that supplies hearing and can cause tinnitus. This type of tinnitus is usually only noticed in one ear, unlike the more common sort caused by hearing loss usually seen in both ears.

Causes of objective tinnitus are usually easier to find.

Pulsatile tinnitus is usually related to blood flow, either through normal or abnormal blood vessels near the ear. Causes of pulsatile tinnitus include pregnancy, anemia (lack of blood cells), overactive thyroid, or tumors involving blood vessels near the ear. Pulsatile tinnitus can also be caused by a condition known as benign intracranial hypertension-an increase in the pressure of the fluid surrounding the brain.

Clicking types of objective tinnitus can be caused by jaw joint misalignment (TMJ) problems or muscles of the ear or throat "twitching."

Diagnosis:

Your doctor will examine your ears, head and neck to look for possible causes of tinnitus.

    You'll need a complete hearing (audiological) exam. This can help rule out or identify possible causes of tinnitus.

  • Your doctor will check your ears to see if earwax or another problem inside your ear may be causing tinnitus symptoms. In addition, he or she will attempt to hear noise with a stethoscope over the area of your head and neck around the ears.

  • Be prepared to discuss when your symptoms started, how much they bother you and whether anything makes them worse. Your doctor will want to know exactly what your tinnitus sounds like, whether it occurs in one or both ears, and if it's a steady sound or if it comes and goes.

  • Your doctor may ask you to move your eyes, clench your jaw or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.

  • Depending on the suspected cause of your tinnitus, you may need radiologic (X-ray) imaging tests such as CT or MRI scans.

The exact sounds can help your doctor identify a possible underlying cause.

    Muscle contractions around your ear can cause sharp clicking sounds that happen in bursts. They may last from several seconds to a few minutes.

  • Blood vessel problems, such as high blood pressure, an aneurysm or a tumor can amplify the sound of your heartbeat in your ears (pulsatile tinnitus).

  • Meniere's syndrome can cause continuous low-pitched ringing sounds in one ear. Tinnitus may become very loud before a vertigo attack (a sense that you or your surroundings are spinning or moving).

  • Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus that may be continuous, or may come and go.

  • Earwax, foreign bodies or hairs in the ear canal can rub against the eardrum, causing a variety of sounds.

  • Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However, if there's hearing loss also, tinnitus may be permanent.

  • Long-term noise exposure, age-related hearing loss or medications can cause a continuous, high-pitched ringing in both ears.

  • Acoustic neuroma can cause continuous, high-pitched ringing in one ear. After a few years, it can also cause hearing loss or distortion.

  • In many cases, the cause of tinnitus is never found. Your doctor can discuss with you steps you can take every day to reduce the severity of your tinnitus or help you cope better with the noise.

Exams and Tests

Initial evaluation will include a complete history and physical examination of the head and neck including the various nerves in the area.

A complete hearing test (audiogram) will also be performed. Depending on the type of tinnitus, either a special audiogram known as an auditory brainstem response (ABR) or a brain scan such as a computerized tomography (CT) scan or magnetic resonance imaging (MRI) may also be required.

In some cases, your blood pressure and possibly some blood tests for hyperthyroidism may be taken. In very rare instances, a spinal tap may be performed to measure the fluid pressure in the skull and spinal cord.

Treatment:

It is important to keep in mind that tinnitus is a symptom, not a disease. As such, the optimal treatment strategy should be directed toward eliminating the disease, rather than simply alleviating the symptom. Also, because tinnitus may be symptomatic of a more serious disorder, it is important to try to find the medical cause before deciding on treatment.

Preventing and Minimizing Tinnitus

Here are a few things patients can do to help prevent and minimize tinnitus:

    Reduce exposure to extremely loud noise.

  • Avoid total silence.

  • Decrease salt intake.

  • Monitor one's blood pressure.

  • Avoid stimulants such as caffeine and nicotine.

  • Exercise.

  • Reduce fatigue.

  • Manage stress.

  • Educate yourself.

  • While there is no known cure for most forms of tinnitus, there are many management options available and most tinnitus sufferers can find varying degrees of relief from one or a combination of the following.

Medications: There is no single medication that works on all tinnitus patients. Some of the antidepressants and anti-anxiety medications available are helpful for certain tinnitus patients. However more research is needed in this area.

Auditory Habituation or Tinnitus Retraining Therapy: These techniques consist of two main components -- directive counseling and low level sound generators.

Directive counseling provides intensive, individualized education regarding the causes and effects of tinnitus on the ear, the brain, and the coping mechanism.

Low-level sound generators produce broadband noise via hearing aid type devices at a soft enough level so that the brain perceives both the noise and the tinnitus. Eventually, the brain may relearn a pattern that will de-emphasize the importance of the tinnitus. These devices also may be helpful in desensitizing patients who are overly sensitive to sound.

Acoustic Therapy: The use of an externally produced sound to either cover up or in some way inhibit or alter production of tinnitus can offer relief for some. There are six main methods of acoustic stimulation.

    A sound generator, sometimes called tinnitus masker: an ear-level electronic device housed in a hearing aid case that produces a white noise.

  1. A tinnitus instrument: a combination hearing aid and sound generator.

  2. Hearing aids: help to amplify speech as well as environmental noise and thus stimulate areas of the ear and brain that otherwise may not be receiving adequate stimulation because of the hearing loss.

  3. A tabletop or portable sound generator: these can be purchased at certain electronic suppliers such as the Sharper Image.

  4. Home masking: such as the use of electric fans, radios, or television.

  5. Music therapy.

Unfortunately, some tinnitus sufferers find that masking noise may merely be a substitute of one annoying sound for another. It is thus better to try to relegate the annoyance of tinnitus to the background of one's consciousness through habituation or retraining methods.

Music Therapy: Many patients find that music, particularly classical passages that don't contain wide variations in loudness (amplitude) can be both soothing to the limbic system (the emotional processor in the brain that is commonly negatively linked to a patient's reaction to tinnitus) and stimulating to the auditory cortex. If a hearing loss is present, it may be necessary to alter the spectrum of the music so that the cortical neurons.

Amplification: The use of hearing aids and a combination of hearing aids and maskers are often effective ways to minimize tinnitus. While it is not clear whether hearing aids help by amplifying background sounds that can mask out the tinnitus or by actually altering the production of tinnitus, most hearing aid wearers report at least some reduction in their tinnitus. This may be due to the reduction in contrast between tinnitus and silence, or because of the new stimulation provided to the brain.

Neuromonics Acoustic Desensitization Protocol: Neuromonics Acoustic Desensitization Protocol is a process that uses counseling as well as a body worn processor connected to high fidelity earphones that present pleasant music that is filtered in accordance with an individuals hearing loss.

Counseling or Cognitive-Behavioral Therapy: Regardless of the cause of tinnitus, if a person is not bothered by the tinnitus, it ceases to be a problem. Psychological intervention aimed at successfully reducing the stress, distress and distraction associated with the tinnitus can be very productive and often produces the most attainable goals.

Stress Management: The very high correlation between stress and tinnitus disturbance underscores the need to maintain one's composure and logic when trying to cope with tinnitus. Relaxation, guided imagery and self-hypnosis are examples of self-help methods used to help combat the stress, anxiety and sleep disturbances associated with tinnitus.

Other options that may help patients with tinnitus include:

    Support Groups -- Local peer support groups offer emotional support to patients and a place to discuss and share treatment techniques.

  • Dental Treatment -- Jaw joint disorders, called temporomandibular (TMD), may exacerbate tinnitus. Splints and exercises may relieve these problems.

  • Nutritional Counseling -- All tinnitus patients should maintain a balanced diet.

  • Biofeedback -- Biofeedback is a technique of making unconscious or involuntary bodily processes detectable by the senses in order to manipulate them by conscious mental control. Biofeedback with counseling can help relieve stress patterns that can worsen the perception of tinnitus.

  • Alternate Approaches -- Although there is no scientific data showing consistent benefit from approaches such as hypnosis, acupuncture, naturopathy, chiropractic care and many herbal preparations, some patients do perceive a benefit.

Prevention: In many cases, tinnitus is the result of something that can't be prevented. However, taking care of your health can help prevent certain kinds of tinnitus.

Use hearing protection: Over time exposure to loud noise can damage the nerves in the ears, causing hearing loss and tinnitus. If you use chainsaws, work in an industry that uses loud machinery or use firearms (especially pistols or shotguns), always wear over-the-ear hearing protection.

Protect your ears from loud music: Long-term exposure to amplified music with no ear protection or listening to music at very high volume though headphones — when using an MP3 player, for example — can cause hearing loss and tinnitus.

Take care of your cardiovascular health: Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to blood vessel disorders.

Medicine and medications:

Drugs can't cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications. Possible medications include:

    Tricyclic antidepressants, such as amitriptyline and nortriptyline, have been used with some success. However, these medications are generally only used for severe tinnitus, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.

  • Alprazolam (Niravam, Xanax) may help reduce tinnitus symptoms, but side effects can include drowsiness and nausea. It also has the potential to become habit-forming.

  • Acamprosate (Campral), a drug used to treat alcoholism, is effective in relieving tinnitus for some people. However, more research is needed to determine how well it works for tinnitus.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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