TINNITUS

Tinnitus is the sensation of sound heard by the patient, which may be described variously as ringing, buzzing, hissing, etc. McFadden defined sound as the conscious experience of sound that originates within the head of its owner, in other words without any external source. This sound may be experienced in one or both ears, though often the patient is not sure and may feel it as coming from the head. The tinnitus sound may vary in the type of sound, its pitch may be low or high or varying, it may be constant or intermittent and soft, loud or variable in intensity.

The prevalence of tinnitus is quite common. It affects all age groups but its incidence increases with age. It is seen in both sexes though said to be more common in males. Hearing loss is often associated with tinnitus though it is not necessary.

Causes

Some of the common causes of tinnitus include:

Exposure to loud noise
Age related hearing loss or presbyacusis
Wax
Injury: Head or whiplash injury
Ear infection: Otitis media, secretory otitis, labyrinthitis
Drugs: Tinnitus may be caused by certain drugs like aspirin, anti-malarial medicines like quinine and chloroquine, antibiotics belonging to the –mycin group like gentamycin and streptomycin, drugs used for chemotherapy, and some diuretics.
Certain medical conditions like hypertension, anaemia, thyroid disorders, and diabetes, etc
Meniere's Disease
Tumours of the cerebellopontine angle like acoustic neuroma
High caffeine intake
Alcohol consumption
Migraine

Patients complaining of tinnitus should undergo audiological and thorough medical evaluation to ascertain the underlying cause.

Management

A thorough history regarding onset, type of sound and how it is affecting the lifestyle of the patient must be taken. There are 2 types of tinnitus:

Subjective: this sound is heard only by the patient
Objective: this type of tinnitus can be heard by the doctor.

Diagnosis

Audiometry to find out level, frequency and type of hearing loss. Tinnitus is often associated with change in hearing levels.
Tinnitus matching: Different types and frequencies are presented to the patient via the audiometer. The patient is asked to identify the sound which best matches to their own tinnitus sound. After matching the frequency, the level or intensity of sound is also matched. Different kinds of diseases may be associated with different kinds of tinnitus. For example, low-pitched tinnitus is seen in patients of Meniere’s Disease while the sound is high pitched in Ototoxicity.
Impedance audiometry: Done to determine Eustacian tube function, middle ear pressure, ossicular chain integrity and stapedial reflex.
Imaging like MRI may be required in some cases where tumours in the CP angle like acoustic neuroma are suspected.

Treatment

The treatment will be dependent on the cause of tinnitus being produced. Treatment of the underlying cause remains the basis of management.

Devices used in treatment

Hearing aids – when hearing loss and tinnitus occur together, amplification of sound will improve hearing and also mask the tinnitus.
Masking devices – these devices deliver an added sound to the ear which masks the troublesome tinnitus sound. This sound is a type of white noise which is not irritating and distracts the attention from the ringing sound. Tinnitus matching helps the doctor decide the frequency at which the masker is to be set.
Tinnitus Retraining Therapy – this was proposed by Jasterboff as a habituation therapy. This treatment involves using a masker to distract the patient from the annoying tinnitus sound while letting them hear it at a much lower amplitude. Counseling sessions are given so that the patient perceives the tinnitus sound to be normal at the subconscious level without consciously getting disturbed. This treatment is said to be quite effective. However, it needs to be followed for 12-18 months for adequate response.
Biofeedback – this is a relaxation technique which works by allowing the patient to control their stress reaction in response to the annoying tinnitus.
Cognitive Therapy – intensive counseling aimed at changing perceived effects and stress responses of the body and emotional centers to tinnitus.
Cochlear implants – in patients who have profound hearing loss with annoying tinnitus, cochlear implants may provide a solution to improve hearing along with control of tinnitus.

Tips to help in dealing with Tinnitus

Increase ambient noise: Playing soft music helps to distract attention from the tinnitus.
Avoid silence: The tinnitus sound is always more bothersome when there is silence like early mornings, late at night, etc. Try to avoid silence as it makes the tinnitus seem louder and more troublesome.
Avoid smoking: Smoking leads to vasoconstriction of the arteries supplying the auditory nerve. This can lead to a compromise of blood supply to the sensitive auditory cells and worsen the tinnitus.
Restriction of alcohol.
Protection from loud noise: If you are working in an environment which has high intensity sound, be sure to use ear protection devices to protect the delicate auditory nerves from damage.

Myths about Tinnitus

It is incurable.
It will damage your hearing.
Hearing aids to not help.
It is an indicator of brain disease.
It is dangerous or life threatening.

Tinnitus can be treated with a proper evaluation and timely diagnosis.