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What is Tinnitus? Common causes, symptoms and management principles

Ear, Nose and Throat | September 7, 2014 | Author: The Super Pharmacist

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What is Tinnitus? Common causes, symptoms and management principles

Tinnitus is a ringing, hissing, roaring, clicking, chirping or humming sound in your ear(s) when there is no such sound in the room and no one else around you can hear it. The sound can be low, moderate to severe in intensity. It can be low-pitched or high-pitched. It can be transient or persistent. It can be episodic or constant.

It is not too difficult to imagine how a loud constant noise in your ear that is not audible to anyone else, can disrupt your peace of mind. It can interfere with your sleep, your focus at work and your social communication. Tinnitus can greatly affect your quality of life.

Even though tinnitus is a fairly common condition, fortunately it is rare in such severe forms. At any given moment 1 in 10 people may experience tinnitus but only a tenth of those will have it to a severe degree. While most people with tinnitus will have episodes that resolve spontaneously within days, some may have the chronic form of the condition which can persist for years.

Mechanism and Causes

Tinnitus may not always have a cause, or at least one that can be accurately diagnosed with available methods. However current thinking about its mechanism of origin focuses on the role of sensory receptors in the inner ear.

Somehow, when these are damaged, abnormal sound perception occurs without an external stimulus. Since their damage will cause hearing loss as well, tinnitus is frequently associated with hearing loss.

In fact, the two most common causes of tinnitus are also the two most common causes of hearing loss. These are age-related hearing loss (presbycusis) and noise-induced hearing loss.

Some other causes of tinnitus include:

  • Earwax
  • Infections
  • Medicines
  • Meniere’s disease
  • Head trauma
  • Temporomandibular joint problems
  • Atherosclerosis
  • Arteriovenous malformation

Types of Tinnitus

While most of the above causes are associated with a tinnitus perceptible only to the patient (subjective tinnitus), a few of them such as an arteriovenous malformation can give rise to a sound audible to the examining doctor as well (objective tinnitus). When the tinnitus is due to a vascular cause, the sound will correspond to the heartbeat (pulsatile tinnitus).

Treatment and Management principles

The initial aim of management will be to treat any identifiable underlying cause. In some cases it can be as simple as removing impacted earwax or stopping or changing precipitating medications. In other cases extensive investigations such as a CT (computerised tomography), an MRI (magnetic resonance imaging) or an MRA (magnetic resonance angiography) may be required to locate the pathology, which may then require surgery by an otolaryngologist. Temporomandibular joint problems will be referred to a dental specialist. In many cases no specifically treatable cause can be identified. In other cases tinnitus persists despite removal of apparent causes.

The two most common causes of tinnitus, mentioned above, are themselves due to irreversible processes. All this means that many people with tinnitus will have to cope with the condition for the long-term. Treatments for such persons are targeted at symptomatic relief and alleviating the stress and dysfunction that can come with tinnitus. tinnitusSuch treatments include:

  • Masking devices that produce white noise to obscure the tinnitus.
  • Home remedies such as light music or keeping the TV or radio on at a low volume while sleeping.
  • Hearing aids. These are especially recommended if there is some degree of hearing loss with the tinnitus.
  • Tinnitus retraining therapy (TRT).This technique employs sound devices and counselling sessions to train the brain to not focus on the tinnitus and gradually become oblivious to it.

There is no medicine that will cure tinnitus as a symptom. Antidepressants such as amitriptyline and benzodiazepines such as alprazolam have been used with some success. Zinc and vitamin supplements have been tried. Ginkgo and homeopathic cures are available. Nevertheless, the wonder cure for tinnitus has yet to be unearthed.

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References

Han BI, Lee HW, Kim TY, Lim JS, Shin KS. Tinnitus: characteristics, causes, mechanisms, and treatments. Journal of Clinical Neurology. 2009;5(1):11–19.

Hofmann E, Behr R, Neumann-Haefelin T, Schwager K. Pulsatile tinnitus: imaging and differential diagnosis. Dtsch Arztebl Int. 2013;110(26):451–458.

Jastreboff PJ. Tinnitus retraining therapy. Progress in Brain Research. 2007;166:415–423.

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