Tinnitus

Tinnitus is the perception of sounds not generated in the external environment. It is common and many people will experience it at some point in their lives.

People with tinnitus often describe the sound as ringing, buzzing, swishing or clicking.While it can be disturbing to someone who has it, for many with tinnitus it is not a serious problem. Some, however, may require medical or surgical treatment.

Types of Tinnitus

1. Subjective tinnitus: The most common variety of tinnitus. Only you can hear the sound.These include the sounds of crickets, roaring, buzzing, hissing, whistling and high-pitched ringing.
   
2. Objective tinnitus: This sound can be heard by yourself as well as the doctor. It is less common and makes up less than 5% of cases.

Prevalence

Tinnitus is very common and many people will experience it at some point. Studies show that up to 10-15% of the population suffers tinnitus severe enough to seek medical attention.The prevalence increases with age. More men than women are affected.

A person with tinnitus often complains of sounds of ringing, roaring, buzzing or chirping of crickets that may involve one or both ears. There may also be complaints of pulsatile tinnitus with associated symptoms that include hearing loss and dizziness.

Tinnitus, itself, is not a disease but may be a sign of damage in the hearing system or brain.

• Hearing loss is the most common cause of tinnitus. Hearing loss can be due to normal ageing or trauma to the cochlea (the hearing organ) through noise, drugs, or chemicals.
  
  It has been suggested that because the cochlea is no longer sending normal signals to the brain, the brain develops its own noise to make up for the lack of normal sound signals.This is interpreted as sound - tinnitus.
• Loud noise exposure damages the hearing and is a common cause of tinnitus. Many people are unaware and unconcerned about the harmful effects of excessively loud noise at discos or from using earphones.
• Anything that affects our hearing, such as an ear infection or excess wax in the ear can make tinnitus worse.

Subjective tinnitus

• Meniere’s disease is a common cause of subjective tinnitus. Someone suffering from this complains of fullness in the ear or hearing loss, roaring tinnitus and dizziness that can ast for hours.
• Acoustic neuroma is a rare cause of subjective tinnitus. It is a tumour that grows on the nerve that leads from the brain to the inner ear.The affected person usually notices the tinnitus and hearing loss in one ear, unlike the more common type caused by hearing loss that is usually felt in both ears.
• Drugs such as aspirin (if overused) and some antibiotics are also other causes of tinnitus.

Objective tinnitus

• Blood flow, either through normal or abnormal blood vessels near the ear is usually the cause of objective tinnitus. Causes of pulsatile tinnitus (tinnitus that corresponds to the heartbeat) include pregnancy, anaemia, an overactive thyroid gland, or tumours involving blood vessels near the ear (glomus tumour and arteriovenous malformation).
• The narrowing of the carotid artery (a major blood vessel to the brain) can also cause pulsatile tinnitus.
• Benign intracranial hypertension, a condition where an increase in the pressure of the fluid surrounding the brain causes pulsatile tinnitus.
• Jaw joint misalignment problems or muscles of the ear or throat ‘twitching’ can cause clicking types of tinnitus.

The ENT surgeon will take a complete history and physical examination of the head and neck including the various nerves in the area.

See an ENT specialist to determine the actual cause of your tinnitus.

A hearing test (audiogram) will be performed. Depending on the symptoms and examination as well as the type of tinnitus, other investigations may be needed. These can include either a special audiogram known as an auditory brainstem response (ABR), a brain scan such as a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan.

Treatment for tinnitus depends on the underlying cause. In most cases, tinnitus is caused by damage to the cochlea. There is normally no need for treatment in such cases other than reassurance. If the patient is extremely bothered by the tinnitus, there are a number of treatment options.

• Relaxation exercises help to control muscle groups and circulation throughout the body. This may reduce the intensity of tinnitus in some individuals.
• Masking of the noise with a competing sound at a constant low level, such as a ticking clock, radio static (white noise) or soothingsounds (rain, running water) may make it less noticeable, since tinnitus is usually more bothersome in quiet surroundings. Hearing aids may reduce tinnitus while the patients are wearing them.
• Medications that can be prescribed include tricyclic antidepressants and betahistine. Tricyclic antidepressants may have a role especially in patients with concomitant depression. Betahistine is a vasodilator that may improve blood circulation in the cochlea. Herbal medications and vitamins that have been advocated are gingko biloba and Vitamin B.
• Tinnitus Retraining Therapy (TRT) is a multimodality therapy that incorporates counselling, patient education and the use of low level white noise tinnitus maskers. This therapy has shown significant promising results in certain studies. Where the tinnitus is caused by other rare problems (such as a tumor or aneurysm), treatment of the tinnitus involves fixing the main issue.