Tinnitus is a medical terminology for the sensation of ringing or buzzing in the ear. People affected with tinnitus also describe it as a whooshing, whistling, hissing or clicking sound in the ear, that is either continuous or sporadic. The sounds in the ear vary in pitch and tone from a soft grumble to a shriek.
The appearance of tinnitus is mostly in older people, about 60-70 years. However, only aged are not the tinnitus sufferers! Studies show that about 10-15% of the adult population suffers tinnitus and the majority comprises of older adults.
It is not uncommon that people hear ringing or whooshing sound in their ear once in a while, especially when the water has gone into the ear or the exposure of the ears to high wind etc. But the continuing tinnitus is very bothersome and disrupts the daily life.
Adverse effects of Tinnitus
- Loss of hearing ability
- Mood swings
- Inability to focus
Types of Tinnitus
There are 2 types of tinnitus-
Objective Tinnitus: The doctor hears the sound of ringing (or other) from the patient’s ear. This condition is quite rare.
Subjective Tinnitus: Only the patient hears the sound of his/her ear. This condition is the usual kind of tinnitus.
Time to know what causes Tinnitus
- Problem with vestibular system
Vestibular system or the inner ear manages the hearing and balancing functions of the body. The fluid and nerve endings in the vestibular region indicate the brain about the body’s position with regards to gravity and movement.
The 8th cranial nerve also called vestibulocochlear nerve conveys balance and hearing signals to the brain from the inner ear. Any damage to this nerve instigates tinnitus and vertigo.
The problem in this region of the ear affects the hearing ability and causes disequilibrium of the body, causing dizziness, vertigo or a false sense of motion. Read causes of dizziness.
Meniere’s disease, Perilymph fistula, Vestibular neuritis and Acoustic neuroma are major vestibular disorders that cause tinnitus and dizziness.
- Problem with the middle ear
Middle ear comprises of thin bones called ossicles that carry the sound waves coming through eardrums to the inner ear. The inner ear organs convert these sound vibrations into electrical impulses and transmit to the brain.
If these ossicles get stiff, they hamper the process of carrying sound vibrations to the inner ear and result in tinnitus. This condition is called Otosclerosis.
Other examples of the middle-ear problem causing ringing in the ear are Otitis media, Cholesteatoma, and Myoclonus.
Other reasons for tinnitus can be
- Head, neck or jaw injury
Injury to these parts may sometimes damage the musculoskeletal structure of the TMJ ( TemporoMandibular Joint), causing tinnitus. Under such state, the sounds in the ear are harsher and keep changing the perceived location and severity.
- Excess build-up of earwax
- Side effects of a medication
Chemotherapy drugs, certain antibiotics and anti-inflammatory medicines, aspirin, and medicines that contain quinine and salicylates induce tinnitus.
- Vascular issues
Disproportionate blood flow in the vessels during high or low BP, hardening of arteries, or a vascular tumour triggers Pulsatile tinnitus. It is a rhythmic sound in tune with a heartbeat that arises from blood vessels closer to the inner ear.
- Living under prolonged period of highly stressful situations
- Sudden or continual exposure to loud sound
- Sinus infection
- Hormonal variation
- Autoimmune syndrome
- Vitamin deficiency
- Excess intake of alcohol or caffeine
- Lyme disease
- Depletion of cerebrospinal fluid
- Prolonged exposure to lead
The severity of the sound in the ear depends on the cause of tinnitus. When the tinnitus is the result of head or neck injury, the noise in the ear is usually loud and high pitched.
Evaluation and Treatment of Tinnitus
An otologist, neurotologist, otolaryngologist and an audiologist are the specialist doctors who diagnose and assess the severity of the tinnitus. Medical causes need to be ruled out one-by-one to arrive at the right cause of the tinnitus.
There are advanced diagnostic devices and tests to check for the causes of tinnitus, such as audiogram, tympanogram, otoacoustic emission testing, auditory brainstem response test, electrocochleography (EcochG), VEMP, MRI, and blood tests.
Many times a tinnitus is the result of psychogenic disorders. A neuropsychological test is recommended for the patients to evaluate such a possibility.
After the diagnosis of the cause of tinnitus, the course of treatment is suggested by the doctors accordingly. It can be a medication program, dietary changes, counselling, hearing aids, therapies or devices that either desensitise the patients to the sound or mask the noise.
The cochlear implants stimulate the auditory nerve strands and mask the noise in the ear. The implant is more useful when the patient has lost partial to full hearing ability.
Antibiotics (to treat ear infection), anti-depressants, anti-anxiety, SSRIs (Selective Serotonin Reuptake Inhibitors), vasodilators, vitamin and mineral supplements, antihistamines are recommended for tinnitus patients for reasons like treating infection, controlling allergies, dilating the blood vessels, comforting etc.
A little tweaking in the diet does soothe the tinnitus discomfort. Such as reduced intake of coffee, tea, alcohol, tobacco, salt, and carbonated drinks. It is best to avoid salt or sugar concentrated drinks and eateries.
Deep breathing and visualisation exercises, hypnosis, yoga and meditation help reduce anxiety and isolation fear.
Psychological help is essential when someone is suffering from tinnitus to boost confidence and find ways to overcome the negative feelings owing to the annoying sounds in the ear.
The masking devices are largely recommended and used for the sheer simplicity of the reason that they create white noise that overlaps the irksome sounds in the ear. It can be a sound of the sea, rainfall, breeze, or any other soothing and distracting sound.
The masking devices help the tinnitus patients go about in their daily lives, focus on the activities and fall asleep peacefully.
Tinnitus coupled with hearing loss is best addressed with hearing aids. It is imperative to set the hearing aid at regular sound level. The hearing aid with excessively loud sound creates more disturbance and uneasiness.
Tinnitus Retraining therapy
The TRT retrains the brain on how it perceives and reacts to tinnitus. For example, the typical perception is tinnitus is intrusive and annoying and generate emotions like anger, anxiety, fear and helplessness.
The therapy aims to change such outlook towards tinnitus helping the patient pay less attention to the sounds in his ear and live a healthy life.
If the tinnitus is the result of an acoustic neuroma or a perilymph fistula, surgery can help address the problem.
Acoustic neural stimulation
The studies show positive inputs from the people who have undergone acoustic neural stimulation. A small hand-held device and a headphone are used to desensitise the brain to the noise in the ear, by changing the auditory pathways and the autonomic nervous system.
An audiologist tunes the frequency of this device to overlap the spectrum of the sound in your ear, thus stimulating the limbic system. The limbic system is an arrangement of nerves in the brain involving memory and emotions. Limbic system together with auditory pathways and autonomic nervous system, help desensitize the brain to the tinnitus.
Dr Anita Bhandari is an MS(ENT) with a fellowship in Otology and Neurotology from Singapore General Hospital. She has authored many chapters in ENT related subjects and has 3 patent pending technologies to her credit. She assisted as a Principal Investigator in a UNICEF collaborated project for underprivileged children. Anita is a known face and an acknowledged speaker at the national and international conferences on Vertigo and Balance disorder Management. NeuroEquilibrium is her dream project to help people suffering from dizziness and lead a thriving life.