MEDICAL CONDITIONS
Tinnitus
(Ringing and Other Ear Noise)
What is tinnitus?
Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases it is not a serious problem, but rather a nuisance that may in time go away. It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise.
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 for example, 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 (tympanic membrane) 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. Loud noise exposure is a very common cause of tinnitus today, 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. Some medications (aspirin, for example) and other diseases of the inner ear (Meniere's syndrome) can cause tinnitus. Tinnitus can in rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).
How is tinnitus evaluated?
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 (vertigo). At the very least, all patients with persisting unexplained tinnitus need a careful hearing test (audiogram). Certain 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, computer tomography (CT) or, magnetic resonance imaging (MRI) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.
What is the treatment of tinnitus?
After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of the tinnitus, i.e., what has caused it, and your options for 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.
Is there anything 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 and colas (caffeine) and tobacco (nicotine).
- Reduce anxiety.
- Try to stop worrying about the tinnitus. Often times, the more you worry and concentrate on the noise, the louder it will become.
- Get adequate rest and avoid fatigue.
- Exercise.
- 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 or a radio may help mask tinnitus. Small hearing aid like devices which generate a competitive sound may help reduce the awareness of the tinnitus.
- Biofeedback may help or diminish tinnitus in some patients.
- Hearing aids may help some patients with hearing loss and tinnitus. However a trial before purchase is advisable.
- Avoid aspirin or aspirin products.
- Tinnitus is abnormal ear noise.
- Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the brain.
- Persisting unexplained tinnitus is evaluated with a hearing test (audiogram).
- Measures can be taken to lessen the intensity of tinnitus.
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