Tinnitus

What Is Tinnitus?

Have you ever experienced a sensation of ringing in your ears? Perhaps you have experienced other abnormal sounds such as a whistling, buzzing or hissing in your ears when no one else could. The sound may have become more intense or it might have faded away only to return again. Some patients observe that such sounds tend to be more prominently felt when the surroundings are particularly quiet. You may even have felt a throbbing sound that coincided with your pulse or heartbeat. This condition is known as tinnitus.

It is defined as the perception of sound in the absence of any actual external sounds. This can be temporary or persistent. It is a symptom associated with a variety of disorders ranging from metabolic disorders or cardiovascular disease or even psychological stress and depression. While this sensation can be disturbing and disconcerting, it does not necessarily mean that there is anything seriously wrong with your health.

Why Do Some People Suffer From Tinnitus?

When a person develops tinnitus, this may be an early sign of age-related hearing loss. However, it could also be a symptom of something more serious. Tinnitus, in fact, is not a disease in itself. Instead, it is a symptom that can indicate a variety of possible disorders.

Sometimes, there is a physical obstruction in the ear which may be no more than a buildup of earwax. Other times, there is serious neurological damage that is responsible for the abnormal sounds that the patient is hearing.

A fuller list of possible causes includes:

• Exposure to loud noises.
• Age-related hearing loss.
• Stress.
• Atherosclerosis.
• Hypertension.
• Head congestion.
• Nasal congestion.
• Excessive buildup of earwax in the ear canal.
• A foreign object blocking the middle ear.
• Stiffening of the bone in the middle ear.
• Sudden changes in air pressure.
• Anemia.
• Acoustic neuroma.
• Meniere’s disease.
• Otosclerosis.
• Depression.
• Disorders affecting the temporomandibular joint.
• Neurological problems as a result of head or neck trauma.
• A side-effect of certain prescription medications. This includes antibiotics, non-steroidal anti-inflammatory drugs, and antibiotics.
• Endocrine disorders such as an overactive or underactive thyroid gland.
• Infectious disease such as Lyme disease.
• Autoimmune disorder as in the case of fibromyalgia.

What Are The Symptoms?

Tinnitus itself is a symptom that could be caused by a variety of different conditions, as we have just seen. It is characterized by abnormal auditory sensations. It is often described as a ringing in the ear. More details follow:

• A ringing, buzzing, hissing or roaring sound in the ears. This does not correspond with any external sounds.
• Unusual sensitivity to sound.
• Symptoms may worsen when the person is suffering from stress or fatigue.
• The intensity of the symptoms may vary over the course of the day.
• The patient may not notice the sounds as much when they are busy or mentally engaged in some other activity.
• Symptoms vary when the patient moves their head, eyes or jaw in a certain manner.
• The condition may be unilateral or bilateral.
• Irritability.
• Anxiety.

Are There Different Types Of Tinnitus?

Yes. Generally speaking, there is a very simple method of classifying different cases of tinnitus. Primary tinnitus is any condition in which the symptoms have no apparent cause, although this may be related to hearing loss. Secondary tinnitus is any case of tinnitus that can be linked with an identifiable cause whether that might be a medical condition, trauma or occupational exposure.

There is another, more detailed, scheme of classification depending on the nature of the cause for the condition:

• Subjective tinnitus: This is the most common form of tinnitus. It is often associated with long-term exposure to loud noises. This is common in instances of occupational exposure to loud sounds for extended periods of time. Construction workers or miners are examples of individuals who suffer such exposure as an occupational hazard. Tinnitus could also be caused by a single instance of exposure to loud noises.
• Objective tinnitus: This is a very rare form of tinnitus. In fact, the sounds perceived by the patient can actually be heard by another individual by means of a microphone placed in the patient’s ear. The cause may be put down to muscle contractions or abnormalities in blood vessels.
• Neurological tinnitus: There is a neurological basis for the abnormal auditory symptoms experienced by the patient. For instance, this may be caused by a condition such as Meniere’s disease.
• Somatic tinnitus: This type of tinnitus tends to affect only one ear. It tends to originate with a problem in the sensory system. Otherwise, it may be influenced by changes in the sensory system. Certain kinds of muscle spasms or a disorder of the temporomandibular joint are examples of conditions that can lead to somatic tinnitus.

Tinnitus can also be classified according to the quality of the abnormal auditory sensations. These different types are described below in brief:

• Pulsatile tinnitus: In this case, tinnitus manifests in a rhythmic fashion coinciding with the patient’s heartbeat. There may be a vascular disorder responsible for it.
• Musical tinnitus: The auditory sensations experienced by the patient actually come together to create a melody or musical sounds.
• Low-frequency tinnitus: The patient generally complains of a low-frequency rumbling or murmuring in their ear.

Are There Likely To Be Any Complications?

Having tinnitus can be disturbing and even debilitating. It can interfere with the patient’s ability to perform simple everyday tasks. If this condition persists for an extended period of time, the patient can become depressed or withdrawn and this can affect their social life, professional life and overall quality of life.

They may not be able to sleep normally. The loss of healthy sleep can lead to a variety of disturbances and deficits. For instance, the person may find it difficult to remain alert and concentrate mentally.

Diagnosis, treatment, & prevention

Tinnitus in itself is easy to diagnose based on the patient’s description of symptoms. However, the process of diagnosis does not end here. Your doctor will need to find out what is responsible for the abnormal auditory sensations you are suffering from. In order to do this, certain other tests or diagnostic procedures may be performed. Following a simple hearing test, you may be referred to a specialist for further clarity as to the cause. You may need to undergo diagnostic imaging which can help to identify tumors of foreign objects in the ear canal.

The treatment is by first addressing any underlying health issue associated with the condition (if any). Some of the health issues that might be associated with tinnitus are:

• Vascular conditions– A blood vessel condition (tumor, aneurysm, atherosclerosis etc.) might be associated with the symptoms of tinnitus. Conditions such as carotid atherosclerosis might lead to pulsatile tinnitus. Medications, surgery etc. might be employed to treat the condition.
• Vestibular neuritis– A viral infection of the inner ear can lead to tinnitus. Antiviral drugs can be prescribed based on the severity of the disease.
• Impacted ear wax– Impacted ear wax can be removed by a professional in order to treat tinnitus.

Using a different medication– Antibiotics (such as erythromycin,  polymyxin B, vancomycin, and neomycin) cancer medications (such as mechlorethamine, vincristine etc. ), water pills or diuretics (such as bumetanide, ethacrynic acid or furosemide) etc. can cause tinnitus. Getting a replacement drug prescribed can help in overcoming the symptoms of tinnitus.

Noise Suppression: Suppression of the tinnitus noise with the help white noise can be done. Use of white noise machines, hearing aids, masking devices and tinnitus retraining devices can reduce the noise.

Medications: Some drugs can help in reducing the severity of the symptoms of tinnitus. Some of these drugs are- Alprazolam, Tricyclic antidepressants (such as amitriptyline and nortriptyline) etc.

Transcranial Magnetic Stimulation (TMS): Neuromodulation using TMS can help in some cases of tinnitus. It is a painless and non-invasive procedure.

Counseling and Education: Counseling by a psychologist or a licensed therapist can help the individual in coping with anxiety and depression related to the condition. Education about the condition can help in learning about the triggers of the condition.

Support groups can help to learn methods to cope with the condition and live healthily. Avoiding the irritants and triggers can help in the prevention of tinnitus. Protecting the ear from damage due to various conditions can also help in preventing tinnitus.

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