Tinnitus is the ringing sound or noise in the ear. The origin of the sound is within the patient. Mostly, it is unilateral (heard only in one ear) but can also be bilateral (heard in both the ears). A survey says that at least 15% of the population suffers from tinnitus. Almost 85% with ear problems suffer from tinnitus. It can be seen in children to adults but it mostly diagnosed in adults over 50 years.
The sound heard by the patients varies in pitch and loudness. It is often described by the patients as
Tinnitus is annoying in quiet surroundings particularly at night when there is less background noise. Tinnitus can be acute or chronic and persistent. 1 in 5 persons with tinnitus suffers from chronicity.
Clinically, the tinnitus is classified into two types :
1. Subjective tinnitus – heard only by the patients
2. Objective tinnitus – even heard by the doctor using a stethoscope
There are three ways to describe a patient’s perception of the tinnitus sound :
Tonal Tinnitus: The perception of continuous sound. The perceived volume of the tinnitus often fluctuates. It is often associated with subjective tinnitus.
Pulsatile Tinnitus: The perception of pulsing sounds, often in synchronized with the patient’s heartbeat. It is often associated with objective tinnitus.
Musical Tinnitus: The perception of music or singing. It is also known as Musical Ear Syndrome, Musical Tinnitus is very rare.
Causes of tinnitus
Prolonged exposure to loud sounds is the most common cause of tinnitus. About 90% of the incidence is associated with noise induced hearing loss where the cochlea responsible for hearing in the inner ear is affected, followed by age related hearing loss (Presbycusis).
Tinnitus is not a disease itself, but rather a symptom of underlying health condition. It disappears when the underlying cause is treated. In most cases, tinnitus is a sensorineural reaction in the brain to damage the ear and auditory system. Sometimes, tinnitus is psychogenic and no cause can be found in the ear or central nervous system.
Main causes are
1. Hearing loss – Noise induced hearing loss, Presbycusis
2. Obstructions in the middle ear – Earwax, Foreign bodies
3. Head and neck trauma
4. Traumatic brain injury
5. Ototoxic drugs – Non-Steroidal Anti-Inflammatory Drugs (NSAIDS), Diuretics, Antibiotics
* Noise exposure from work, headphones, concerts.
* Gender – men are affected more than women
* Hearing loss
* Age – older individuals are more susceptible
The people who are experiencing tinnitus must visit a hospital for an examination and evaluation to determine the cause for the tinnitus.
An evaluation can help in excluding any rare (objective tinnitus) life-threatening causes of tinnitus. A visit to an otolaryngologist is preferred for examination.
– Treat the underlying cause
– Reassurance and psychotherapy
– Techniques of relaxation and biofeedback
– Sedation and tranquilizer
– Masking of tinnitus by use of a fan or loud clicking clock or hearing aid in persons with hearing loss.
TINNITUS RETRAINING THERAPY (TRT)
Jastreboff from the University of Maryland described a neurophysiologic model for the generation of tinnitus and the basis for habituation therapy. His therapeutic model aims to attenuate connections between auditory, limbic, and autonomic nervous systems and thus create tinnitus habituation.
Tinnitus habituation is blocking the tinnitus related neuronal activity to reach the level of consciousness. With this therapy patients suffering from tinnitus lose awareness of tinnitus and also do not get annoyed even when they do have tinnitus.