Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head.
Tinnitus has sometimes been described as ‘the sound of silence’ because all people, if they are seated in a completely quiet soundproofed room, will hear a type of rushing or hissing sound. Usually this noise is masked by environmental sounds. Hearing words, songs or voices is not included in the definition of tinnitus.
It is when this type of noise becomes intrusive into everyday life that it can become immensely irritating and becomes known as ‘tinnitus’. The noises of tinnitus may vary in pitch from low frequency to high frequency; they maybe intermittent or permanent and they usually vary in the intensity of sound. Some people spend a long time looking around the house for whatever it is that must be making the noise, other people fear that they may be developing a brain tumor.
Sometimes people notice that the intensity of the noises can alter according to various activities such as exercise, the drinking of coffee or wine and other stimuli.
Children can suffer from tinnitus as well as adults, which can be frightening for them when they do not understand what is happening. When tinnitus is first noticed, it can be very worrying.
What causes tinnitus?
Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the brain. Some tinnitus or head noise is normal. If one goes into a sound proof booth and normal outside noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body sounds, because outside noise masks them. Anything, such as wax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum can also cause tinnitus.
One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently tinnitus. These days loud noise exposure is a very common cause of tinnitus, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms, and high intensity music, mobile phones etc. Some medications like aspirin and other diseases of the inner ear Meniere’s syndrome can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (Acoustic Neuroma).
Investigations
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), or is it associated with hearing loss or loss of balance .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, CT scan or 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.
Treatment
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 have recommended niacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing.
Generally the treatment of tinnitus falls into two main areas: tinnitus counseling or the use of mechanical devices such as hearing aids or white noise generators to control the symptoms.
Some simple measures can be very effective. If you find that the tinnitus is loudest when you are trying to get to sleep, try putting a small radio next to your bed, turning the tuning dial to a frequency in between two stations so that you hear ‘white noise’, and turn the volume down low so that you can only just hear the noise.
This will give your ears something else to listen to and many people find it a very useful method of getting to sleep. Other people use relaxation tapes, again with the volume down so that you can only just hear it.
Tinnitus counseling
This is a system whereby the cause of the tinnitus is clearly explained and the approach to understanding and controlling its significance in the patient’s daily life is clarified.
Help is given to combat the most debilitating mental effects of such noises. Tinnitus retraining therapy is a type of tinnitus counseling which is extremely effective at reducing the threat and the intrusiveness of tinnitus and consists of a combination of explanation, counseling and controlled use of white noise generators or hearing aids.
Mechanical devices
The use of hearing aids or tinnitus maskers amplify surrounding noises so that the tinnitus is no longer heard. Hearing aids are ideal if there is an associated hearing loss with the tinnitus. Tinnitus maskers are not so commonly used any more, but worked on the idea that a continuous noise, generated in the ear canal by the masker, would mask the tinnitus and would also provide an effect for several hours after it had been switched off.
White noise generators
These are sometimes used during tinnitus counseling and as a part of tinnitus retraining. Again, they can provide a less threatening, more controllable type of noise than the tinnitus, but need to be used as part of the retraining – they are not a solution in themselves.
Other types of treatment
Multiple types of treatment have been tried for tinnitus, and although they can be helpful for some patients, none of them will help all patients. Hypnosis and acupuncture can occasionally help.
Extracts of Gingko biloba is another method, but no properly controlled study has shown a positive effect. In general, drug treatments are not very helpful. Some types of sedatives have been used, but they are not good for long-term use and do not solve the problem.
It is estimated that about 30% to 40% of the population will suffer from tinnitus at one point in their life, particularly if they have hearing loss. The vast majority will either have intermittent tinnitus which is manageable, or more persistent tinnitus which is can be controlled without any significant treatment.
A small minority will require further management and it is these patients who will require referral to an ear nose and throat surgeon or an audiological physician.
Things to do to lessen intensity of the tinnitus
It is important to realize that the hearing system is one of the most delicate and sensitive mechanisms in the body. Since it is a part of the general nervous system, it is sensitive, to some degree, by anything that affects the overall health of the individual (both physical and psychological). Therefore, in order to lessen the intensity of tinnitus, it is advisable to make every effort to-
Avoid exposure to loud sounds and noises. Control blood pressure. Decrease salt intake. Avoid nerve stimulants such as coffee,colas caffeine, tobacco and nicotine. Reduce anxiety. Try to stop worrying about the tinnitus. Often, the more you worry and concentrate on the noise, the louder it will become. Get adequate rest and avoid fatigue Avoid aspirin or aspirin products in large quantities.
Tinnitus Masking
Utilize masking noise. Tinnitus is usually more bothersome when the surroundings are quiet, especially when you are in bed. A competing sound such as a ticking clock, a radio, and a fan or white noise machine may help mask tinnitus. Small hearing aid like devices which generate a competitive sound may help reduce the awareness of the tinnitus.
