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Tinnitus

Tinnitus

Tinnitus, (pronounced tih-NIGHT-us or TIN-ih-tus) is a ringing, swishing, or other type of noise that seems to originate in the ear or head. Most of us will experience tinnitus or sounds in the ears at some time or another. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), almost 12 percent of men who are 65 to 74 years of age are affected by tinnitus. Tinnitus is identified more frequently in white individuals, and the prevalence of tinnitus in the U.S. is almost twice as frequent in the South as in the Northeast.

 

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 heart beat).

 

  • 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 ears. In some cases, the sound can be so loud it can interfere with your ability to concentrate or hear actual sound. Tinnitus may be present all the time, or it may come and go.
 

There are two kinds of tinnitus:

 
  • Subjective tinnitus is tinnitus only you can hear. This is the most common type of tinnitus. It can be caused by ear problems in your outer, middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound.

 

  • Objective tinnitus is tinnitus your doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, an inner ear bone condition or muscle contractions.
 
If you have tinnitus that bothers you, see your doctor.
 
  • Make an appointment to see your doctor if you develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus doesn't improve within a week.
 
  • See your doctor as soon as possible if you have tinnitus that occurs suddenly or without an apparent cause, or if you have hearing loss or dizziness with the tinnitus.

Causes

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. 
  1. 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.
  2. This tinnitus can be made worse by anything that makes our hearing worse, such as ear infection or excess wax in the ear. 
  3. 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.
  4. 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. 
  5. 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 tumorknown 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.
  1. Pulsatile tinnitus is usually related to blood flow, either through normal or abnormal blood vessels near the ear. Causes of pulsatile tinnitus includepregnancy, 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.
  2. Clicking types of objective tinnitus can be caused by jaw joint misalignment (TMJ) problems or muscles of the ear or throat "twitching".

Treatment

How is tinnitus evaluated?

 

A medical history, physical examination, and a series of special tests can help determine precisely where the tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent or pulsating (synchronous with the heart beat, referred to as pulsatile tinnitus), or is it associated with hearing loss or loss of balance (vertigo). All patients with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the doctor to the diagnosis.

 

Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography scan (CT scan) or,magnetic resonance imaging (MRI scan) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.

 

What is the treatment of tinnitus?

 

After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of the tinnitus (what has caused it, the person's specific symptoms and options for treatment).

 

Tinnitus medications

 

In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a permanent disability that the patient will have to "live with". Some otolaryngologists (ear specialists) have recommendedniacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing.

 

The drug gabapentin (Neurontin, Gabarone), was studied in high doses, and reduced the annoyance level of the tinnitus in some patients, but did not decrease the volume of the noise, and was not found to be better than placebo.

 

A 2005 study in Brazil using acamprosate (Campral), a drug used to treat alcoholism, showed a nearly 87% rate of relief of symptoms. Studies of this drug for treatment of tinnitus are currently ongoing in the United States.

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