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What is Tinnitus?Toggle accordion item
Tinnitus is noise heard in the head or ears. It is extremely common -- occurring in 20 percent of the United States population. No one person describes tinnitus like the next person.
It may be described as:
- Low or high pitched
- Containing more that one sound
- Extremely loud and distracting or very soft and hardly noticeable
- Subjective (heard only by the person)
- Objective (heard by others nearby)
Tinnitus is a symptom, not a disease itself. It is frequently, but not always, associated with hearing loss. It can be thought of as a sign of irritation or injury to the hearing system, much like pain or temperature sensations of the skin. Most people experience tinnitus at some point in time. For example, noise exposure such as a concert or a loud party may result in a loud ringing in the ears noticed when returning home to a quiet environment.
This kind of tinnitus is temporary, resolving in a few hours. The presence of persistent tinnitus and tinnitus associated with hearing loss should prompt an evaluation by an ENT or otologist/neurotologist. Pulsatile tinnitus, tinnitus with balance problems, and unilateral tinnitus also require evaluation for the underlying etiology.
Objective TinnitusToggle accordion item
Objective tinnitus is an unusual. It is audible to both the patient and others. The otologist may hear faint objective tinnitus by listening with a stethoscope or a special earpiece. It may be caused by muscle spasm and by abnormalities in blood vessels.
Myoclonus of the Stapedius and Tensor Tympani
There are two muscles within the middle ear attached to the middle ear bones. These are the stapedius, attached to the stapes, and the tensor tympani, attached to the malleus. Normally, these muscles function as a protective mechanism against loud sound. When the muscle begins to spontaneously contract, it usually does so in a rhythmic pattern and gives the impression of a repetitive clicking or fluttering sound. Although it is annoying, this type of tinnitus is not dangerous, is often brief, and usually resolves without treatment.
The palate muscles and muscles of the eustachian tube (the cartilaginous and bony organ between the middle ear and back of the throat) are additional sources of myoclonic and spastic activity which can be heard in the ear. A patient may observe myoclonus in the palate by opening the mouth and watching the palate vibrate.
What causes myoclonus is unclear. The muscles of the ear, eustachian tube, and palate are subject to the same forces that cause muscle spasm in any other muscle of the body including stress and anxiety. Often there is not apparent reason.
Both middle ear and palatal myoclonus can be effectively treated with relaxation techniques, stress relief, and occasionally necessitate a muscle relaxant. If these measures fail, surgery may be necessary. The otologist will open the middle ear to section the muscles. The patient may get immediate relief.
Vascular or Pulsatile Tinnitus
It is common to occasionally hear one's own heartbeat in the ears. This is a result of blood flow through large blood vessels, the carotid artery and jugular vein, carrying blood to and from the heart and brain. In addition, there is a network of microscopic vessels traversing the middle ear. In times of stress, such as strenuous exercise, illness, and middle ear infections, the flow of blood is temporarily increased and may be more audible.
An evaluation by a physician is important when pulsatile tinnitus is progressively louder, constant, or is associated with hearing loss, hoarseness, or swallowing problems. This may be due to thickening of the carotid artery, common with aging, or tortuosity in the course of the vessels. Other considerations are vascular tumors or aneurysms. Further evaluation including MRI and/or CT scans will be necessary.
What is Subjective Tinnitus?Toggle accordion item
Most tinnitus is heard only by the patient. There are many potential causes of this type of tinnitus. The inner ear, hearing nerve, and brain are very delicate and may be injured by one or more of several different mechanisms including age, genetic and hereditary disease, infection, allergy, inflammation, tumors, metabolic problems such as diabetes or low- or high-thyroid, loud noise, prescription and over-the-counter medications, nicotine, and -- last but not at all least -- stress and fatigue.
Why does Subjective Tinnitus Make Me Feel So Bad?Toggle accordion item
Most people with tinnitus are not bothered by it. But for the 20 percent that are, it can be significantly disruptive to one's work and family life. Because tinnitus can stimulate the centers of the brain responsible for emotion, some patients experience significant anxiety, depression, irritability and other strong emotional responses.
The hearing system and emotion centers of the brain are intimately linked to the autonomic nervous system. The autonomic nervous system controls all the functions of our body, and performs most functions automatically, beyond conscious control.
Because it is closely linked to the emotion center, certain emotions result in physical changes in the body; for example, anger can increase the rate of heartbeat. It is responsible for the "fight or flight" reaction, the reaction that prepares the body to react to danger. It is this response that makes the hairs stand up, pupils of the eye dilate, the respiratory rate increase, and blood drain out of the face as it is shunted to muscles of the arms and legs.
The autonomic reaction to tinnitus often results in problems with sleep, inability to pay attention to issues other than tinnitus, a high level of reactiveness, and suppression of positive emotions.
How is Subjective Tinnitus Evaluated?Toggle accordion item
Although the physician cannot "hear" the tinnitus, there are tests which may help quantify the pitch and loudness of the tinnitus. A hearing test is also important during the evaluation. Hyperacusis is an abnormal sensitivity to normal every-day sounds that often accompanies tinnitus. It can also be measured.
Of course, the most important part of an evaluation for tinnitus is a thorough history and physical exam by an ENT or otologist. A hearing test is performed. Special tests such as blood tests, MRI, CT, and auditory brainstem response are sometimes needed.
How is it Treated?Toggle accordion item
There are many approaches for the treatment of tinnitus. If a metabolic, drug, infectious, or inflammatory cause is identified, specific treatment can be initiated. This may include changing or eliminating medications, managing elevated blood sugars, and treatment with antibiotics, antivirals, and/or anti-inflammatories. If a tumor is found it may be treated with surgery or radiation, or it may be simply watched.
Most tinnitus is idiopathic, meaning a specific cause is not identified. Simple measures may significantly alleviate the tinnitus.
Self-Help Techniques to Reduce Tinnitus:
- Avoid loud sound.
- Eliminate nicotine and caffeine.
- Avoid stressful situations.
- Rest. Get at least 8 hours of uninterrupted sleep every night.
- Avoid too much quiet. Use a fan, noisemaker (ocean waves, birds, rain sounds) or quiet radio music at night to mask the irritating tinnitus as you are trying to sleep. During the day, you may find yourself less bothered by the tinnitus if your mind and body are engaged in activities and there are other sounds in the room for your brain to listen to.
- Avoid focusing on the tinnitus by frequently discussing it with your family.
In cases where self-help techniques are not sufficient, other management options include:
- Stress reduction
- Relaxation techniques including massage and acupuncture
- Treatment for depression and anxiety
- Sleeping aids
- Hearing aids to improve underlying hearing loss
- Family support
- Professional support groups such as the American Tinnitus Association
- Tinnitus Retraining Therapy
- Gingko biloba. Some patients find this herbal medication helpful, but the scientific data is inconclusive. Gingko biloba may increase the risk of bleeding.