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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