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What is tinnitus?

Dr. Neetu Modgil, Saturday, January 22, 2022

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

 

1.      Hearing Aids for SNHL induced tinnitus

2.      Surgery for causes like:

  • Perforation in ear drum
  • Osteoma (External ear tumor)
  • Fluid behind ear drum
  • Otosclerosis
  • Acoustic Neuroma

 3.      Medication for causes like:

o   Meniere’s disease

  • Sinusitis
  • Cardiovascular diseases
  • Stress & Anxiety

 4.      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.

  

5.      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)

     6.      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

 

7.      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. 

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