What is tinnitus?
What is tinnitus?
- Tinnitus is a sound that is perceived by the person inside one or both ears that does not originate from an external sound source.
Various ways in which patients express Tinnitus complaint:
- Ringing
- Hissing
- Buzzing
- Roaring
- Clicking
- Ocean sound
- Pulsating Heartbeat
- Sound similar to the one made by insect Cricket
Types of tinnitus
- Subjective
Can only be perceived by the patient
Most common type (95%)
- Objective
Can be heard by others
Rare (<5% of all tinnitus cases)
Usually pulsatile (in sync with heartbeat)
Causes: vascular or muscular
Causes of Tinnitus
- Most caused by some sort of change to the auditory system
80% of patients with SNHL (Sensorineural Hearing Loss) have tinnitus Hearing loss results in changes in the neural activity of the auditory system, which the auditory cortex interprets as sound
- Hearing loss, in cases of noise-induced hearing loss (NIHL)
- External or middle ear issues (wax, osteoma, ear drum perforation, otosclerosis, fluid behind ear drum)
- Internal ear (Meniere’s disease, Damage of hair cells in inner ear)
- Acoustic neuroma (UNILATERAL tinnitus)
- Medications
- Sinus/allergy issues
- Dental issues (TMJ-temporal-mandibular joint syndrome)
- Neurological (Multiple sclerosis)
- Stress & anxiety
- Cardiovascular
Reaction to Tinnitus aggravate it:
- Only about 20% of people with tinnitus are bothered by it
- The tinnitus itself isn’t the problem. The person’s REACTION to it is what is problematic.
- Tinnitus may result in irritability, fatigue/sleep disturbance, depression, suicidal thoughts
- These patient’s need to be referred to a mental health professional
TREATMENT
- Hearing Aids for SNHL induced tinnitus
- Surgery for causes like:
- Perforation in ear drum
- Osteoma (External ear tumor)
- Fluid behind ear drum
- Otosclerosis
- Acoustic Neuroma
- Medication for causes like:
o Meniere’s disease
- Sinusitis
- Cardiovascular diseases
- Stress & Anxiety
- Masking:
- Use of noise to temporarily mask or “cover up” the tinnitus so it cannot be perceived
- This is often successfully accomplished when patients with hearing loss use traditional hearing aids. The amplification of environmental noises often reduces or completely masks tinnitus.
- New generation hearing aids have optional tinnitus maskers built-in for when hearing aids aren’t enough to mask tinnitus
- Different types of noise are utilized in masking: white noise, pink noise, brown noise, grey noise (all have varying complexity based on frequency components)
- Maskers with or without hearing aid are available and customised for every patient according to hearing test and tinnitus mapping.
- Tinnitus Retraining Therapy
- Jastreboff created TRT
- Combines counselling with use of noise generators
- Counselling: reclassify tinnitus to a category of neutral signals
- Sound therapy: weaken the tinnitus-related neural activity
- Goal: Habituation to the tinnitus (no longer pay attention to it)
- Neuromonics
- Six to eight months therapy protocol
- Uses spectrally modified music that has been tailored according to each patient’s hearing and tinnitus characteristics
- Combined with an underlying neural stimulus
- Retrains the brain to filter out tinnitus disturbance
- Recent Advances
- Acoustic coordinated reset neuromodulation
- Magnetic and Electrical brain stimulation
Take home Message:
Don’t deal with tinnitus by sitting at home. Kindly go and visit your doctor for finding the cause behind your tinnitus. Tinnitus is a symptom not a disease. We need to find the cause behind tinnitus to treat it.