Tinnitus is a type of medical condition in which the patient hears different sounds like buzzing or ringing in the ears. The sounds may be of different types including buzzing, swishing, clicking or any other type of sound. In this condition, it seems that the sound is not coming from an external source but from within the head or the ears. It is a very abnormal sound which may have its origin in the outer ear, inner ear, middle ear or the brain. In the United States, around 25 million Americans which is 10 percent of the total adult population are said to have experienced symptoms of Tinnitus at least for 5 minutes in a year according to the National Institute on Deafness and Other Communication Disorders (NIDCD). It has been reported more in the White population while the people having problems of ringing in the ear in the US are twice higher than the South or Northeastern parts.
It can be a big nuisance and it can cause difficulty in the daily life of people who have it. In most of the cases, the problem may go away in a certain time while for some people the symptoms may last for a longer time. Those people who have a long-lasting problem of ringing in the ear may require surgical or medical treatment. According to reports around 16 million US citizens seek solutions for Tinnitus every year. 25 percent of people who have tinnitus have difficulty in adjusting to their daily life. There are various kinds of sounds which the person experiences in this problem. It can be a sound like that of a cricket, buzzing, whistling, hissing, etc. Another type is a clicking or pulsatile tinnitus in which the sound follows the heartbeat. Subjective tinnitus is the most common type in which the person hears sounds which other people won’t hear. Objective tinnitus is a very uncommon type in which the doctor may hear the certain sound too.
There are other problems or symptoms which arise with Tinnitus including stress and fear caused by Tinnitus, ear pain, anxiety, difficulty to sleep, depression, difficulty in concentration or difficulty in hearing. However, it is important to understand that Tinnitus is not a disease or illness in itself but it is a sign or symptom of some other problem. Those problems are as listed below:
- Loss of hearing
- Infection in the ears
- Collection of wax in the ears
- Continuous Exposure to loud noise
- Trauma to the ears
- A side effect of some medicines
- Meniere’s disease
- Tumours forming near the ears including a Brain tumour
- Problems in the flow of blood
- Pregnancy-related reaction
- Thyroid becoming overactive
- If the pressure increases in the fluid which surrounds the brain
- Disorder of temporomandibular joint
Causes of Tinnitus
As already mentioned earlier, Tinnitus is more of a symptom of some other underlying problem than an illness in itself. It may be caused by some problem related to the mechanism of hearing. The various causes are as follows.
- Blood flow or Tumours
Pulsatile or throbbing kind of Tinnitus can be because of blood flow in the arteries and the veins which are attached to the ears. It can also be due to the increase of blood flow in the tumours.
- Muscle spasms
Clicking type of Tinnitus can be the result of problems related to the palate or the muscle in the top part of mouth going into spasm. Because of this the Eustachian tube which maintains pressure in the ears continuously opens or closes. Other neurological diseases like Multiple sclerosis which are connected with muscle spasms also may be the cause of Tinnitus. They may cause spasms in the certain part of ears because of which repeated clicking is heard.
- Temporomandibular joint
Abnormal conditions in the Temporomandibular joint can be a cause of Tinnitus or repeated clicking sound heard in the ears.
- Vestibulocochlear nerve damage
The work of vestibulocochlear nerve is to transmit sound from the ear to the brain and if it is damaged then it may also cause tinnitus. It may happen because of a drug problem or a tumour.
- Meniere’s disease
This disease is linked to loss of hearing and vertigo. It can be a cause of Tinnitus.
As a person grows older, they may have problems with their hearing which is related to tinnitus.
The growth of bone in an abnormal way around the middle ear is known as Otosclerosis. It can sometimes be a cause of Tinnitus.
There are various types of Trauma which damage the hearing power and causes Tinnitus too. Barotrauma is caused when a change in the air pressure damages the air. Barotrauma can be caused when air pressure changes suddenly while flying or because of the pressure during scuba diving.
Symptoms of Tinnitus
- The main symptom of Tinnitus is that the person hears sounds which other people can’t hear.
- The sound is usually buzzing, whistling or ringing type which accompanies the heartbeat.
- Sometimes in case of Meniere’s disease, hearing loss and dizziness is caused along with the sound.
- There may be continuous sound or it may come and go occasionally.
- It may happen in either of the ears or both ears.
- There may be a high pitched continuous sound or it may also be some sort of a click, hum or buzzing sound.
Diagnosis of Tinnitus is done by a Physician doctor or an expert in ear, nose and throat (otolaryngologist). Audiologists are responsible to conduct tests of hearing and its assessment. The medical practitioner carefully studies the patient history and the symptoms to diagnose the underlying cause of Tinnitus. Questions may be asked by the doctor regarding the type of sound, its occurrence and recurring nature. Various types of other questions may be asked by the doctor to the patient, which are as follows.
- Does the sound occur in one or both ears?
- Is there a clicking type of a sound?
- Are there signs of hearing loss?
- Does the patient feel vertigo or dizzy?
- Is the sound pulsating or like a flow?
- Is the patient exposed to loud noise or sound at a workplace, home or anywhere else?
- Are you taking any type of medications? Certain medications can also cause tinnitus.
The doctor will conduct a Physical examination in the ears, head and the neck. The auditory canals and tympanic membranes will also be carefully examined. Cranial nerves are short nerves which connect from the brain to face, head and neck. Cranial nerves are responsible for hearing so neurological checkup is also required. A tumour or some abnormal condition pressing the nerve may cause a certain type of weakness or numb feeling in the face, neck or mouth. The doctor may attempt to hear the carotid arteries present in the neck because, in case of carotid arteries stenosis, there may be a transmission of sound to the ears which can cause tinnitus.
Audiogram or test of hearing is one medium to check if there is any hearing loss in one ear or both the ears.
Radiology tests including tests like CT scan, MRI and ultrasound tests may be recommended by the doctors to check the different possibilities for tinnitus. Radiology tests may be conducted on the neck, ears or the head.
Referral to a Specialist
Special referring to a Specialist doctor is necessary to seek further advice and treatment regarding the Tinnitus. It will help to get rid of the root cause which eliminates the symptoms.
Treatments for Tinnitus
Tinnitus may resolve itself over a certain time or it may even last for many years. It is a very common problem among most Americans. Treating it is very important because it may be related to depression, insomnia etc. It may also be a result of certain medications. In such cases stopping such medication with consultation from the doctor is necessary to stop the symptoms of tinnitus. Electrical stimulation and repetitive transcranial magnetic stimulation are other useful methods applied for the treatment. Some of the medications used to treat tinnitus are as given below.
- Benzodiazepine medications like alprazolam help to reduce the symptoms of it.
- In the middle ear, Corticosteroid injections can be used to reduce inflammation.
- Different Antidepressant may also be useful to suppress the symptoms of it.
- In some people, Prostaglandin analogues like misoprostol can be beneficial.
Surgery may be necessary to treat tinnitus in special cases like Meniere’s disease, tinnitus caused by glomus tumours, Acoustic neuromas or arteriovenous malformations. Behavioural and cognitive therapies can also be of great help in the treatment. Tinnitus retraining therapy is a way in which the nerve pathways related to hearing are trying to be retrained so that they get used to different sounds. Such type of Habituation helps to ignore the sound unless special concentration is made on the sound. Special counselling and a sound generator are necessary for this treatment. It can be a combined effort of Audiologists and otolaryngologists. Relief therapy, Masking, Biofeedback, Stress reduction, Depression counselling and electrical stimulation are other methods.
As it is said Prevention is better than cure so it is best to adopt measures to prevent Tinnitus in special conditions. It can be caused by continuous exposure to loud noise. Musicians, factory workers and construction workers are exposed to risks so it is best to minimize the exposure to loud sound to be safe from tinnitus. Sound protection equipment should be used at those times to be safe. If it occurs while using a medicine then immediate medical advice should be sought.