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

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.