Tinnitus, (pronounced tih-NIGHT-us or TIN-ih-tus) is a ringing, swishing, or other type of noise that seems to originate in the ear or head. Most of us will experience tinnitus or sounds in the ears at some time or another. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), almost 12 percent of men who are 65 to 74 years of age are affected by tinnitus. Tinnitus is identified more frequently in white individuals, and the prevalence of tinnitus in the U.S. is almost twice as frequent in the South as in the Northeast.
Tinnitus can be extremely disturbing to people who have it. In many cases it is not a serious problem, but rather a nuisance that may go away. However, some people with tinnitus may require medical or surgical treatment. Twelve million Americans have tinnitus, and one million experience it so severely it interferes with their daily activities.
Tinnitus can arise in any of the four sections of the hearing system: the outer ear, the middle ear, the inner ear, and the brain.
TINNITUS CAUSES
For people to be able to comprehend tinnitus causes it is best that they know that the cochlea which is located in the inner ear is lined by hair cells which when undamaged, move when it is stimulated by the pressure of sound waves. This movement will activate the cell to release electricity to the hearing nerves and send electric signals to the brain which then translates the sound.
Tinnitus will cause sounds in the ear because when there is hearing impairment, the hair cells are damaged which causes complete or partial hearing loss. Loss of hearing is mainly caused by cochlear trauma from loud noise or accidents which damage the hair cells. Damaged hair cells will move randomly and since it is unable to control it, the cells send random electrical impulses to the brain which it interprets as noise, which then causes tinnitus.
Tinnitus is the perception of noises in the ears which are often described by the sufferer as a ringing, buzzing, hissing sound Temporary tinnitus causes are impacted ear wax, infections in the ear or punctured ear drums. Medicines like aspirin may also cause temporary tinnitus. Tinnitus is frequently related to hearing loss. When a tinnitus is complemented by hearing loss and dizziness, there is a possibility that a person has Meniere’s disease. Meniere’s disease is an inner ear abnormality which is characterized by symptoms of vertigo (severe dizziness), ear ringing, intermittent hearing loss and a feeling of fullness in the ear. Also a rare but yet serious cause of ear ringing is acoustic neuroma which is the presence of a tumor in the nerves of the inner ear.
Other tinnitus causes include age related hearing loss which is presbycusis. This usually happens at around the age of 60. Tinnitus causes that are related to trauma in the inner ear can be from exposure to loud sound. Temporo-mandibular joint problems also cause tinnitus. Head or neck injuries may cause tinnitus too. Atherosclerosis is one of the tinnitus causes. Cholesterol build up in the veins of the inner ear will cause the flow of blood to be forceful thus creating pulsatile sounds. Hypertension and other factors that can cause hypertension like stress, caffeine and alcohol are also tinnitus causes.
It is very important to have a complete medical check up, which must include a hearing test to come up with a proper diagnosis. In about half of the cases, tinnitus causes cannot be identified. To be able to determine the appropriate cure for tinnitus it is very important to know the tinnitus causes. The treatment will depend on the cause.
Diagnosis
If you think that you have tinnitus, consult your doctor to determine if a cause for the tinnitus can be found and subsequently treated. If medical treatment is not appropriate, ask if there is an audiologist in your area who has knowledge about tinnitus treatments.
The audiologist will assess a patient's hearing and counsel them regarding non-medical treatment options. Becoming educated about the nature of tinnitus may be extremely useful in relieving anxiety and seeking ways of coping with the condition.
Treatment
It is important to keep in mind that tinnitus is a symptom, not a disease. As such, the optimal treatment strategy should be directed toward eliminating the disease, rather than simply alleviating the symptom. Also, because tinnitus may be symptomatic of a more serious disorder, it is important to try to find the medical cause before deciding on treatment.
Preventing and Minimizing Tinnitus
Here are a few things patients can do to help prevent and minimize tinnitus:
Reduce exposure to extremely loud noise
Avoid total silence
Decrease salt intake
Monitor one's blood pressure
Avoid stimulants such as caffeine and nicotine
Exercise
Reduce fatigue
Manage stress
Educate yourself
While there is no known cure for most forms of tinnitus, there are many management options available and most tinnitus sufferers can find varying degrees of relief from one or a combination of the following.
Medications
There is no single medication that works on all tinnitus patients. Some of the antidepressants and anti-anxiety medications available are helpful for certain tinnitus patients, however more research is needed in this area.
Auditory Habituation or Tinnitus Retraining Therapy
These techniques consist of two main components -- directive counseling and low level sound generators.
Directive counseling provides intensive, individualized education regarding the causes and effects of tinnitus on the ear, the brain, and the coping mechanism.
Low-level sound generators produce broadband noise via hearing aid type devices at a soft enough level so that the brain perceives both the noise and the tinnitus. Eventually, the brain may relearn a pattern that will de-emphasize the importance of the tinnitus. These devices also may be helpful in desensitizing patients who are overly sensitive to sound.
Acoustic Therapy
The use of an externally produced sound to either cover up or in some way inhibit or alter production of tinnitus can offer relief for some. There are six main methods of acoustic stimulation.
A sound generator, sometimes called tinnitus masker: an ear-level electronic device housed in a hearing aid case that produces a white noise
A tinnitus instrument: a combination hearing aid and sound generator
Hearing aids: help to amplify speech as well as environmental noise and thus stimulate areas of the ear and brain that otherwise may not be receiving adequate stimulation because of the hearing loss
A tabletop or portable sound generator: these can be purchased at certain electronic suppliers such as the Sharper Image.
Home masking: such as the use of electric fans, radios, or television
Music therapy (see below)
Unfortunately, some tinnitus sufferers find that masking noise may merely be a substitute of one annoying sound for another. It is thus better to try to relegate the annoyance of tinnitus to the background of one's consciousness through habituation or retraining methods.
Music Therapy
Many patients find that music, particularly classical passages that don't contain wide variations in loudness (ampliltude) can be both soothing to the limbic system (the emotional processor in the brain that is commonly negatively linked to a patient's reaction to tinnitus) and stimulating to the auditory cortex. If a hearing loss is present, it may be necessary to alter the spectrum of the music so that the cortical neurons.
Amplification
The use of hearing aids and a combination of hearing aids and maskers are often effective ways to minimize tinnitus. While it is not clear whether hearing aids help by amplifying background sounds that can mask out the tinnitus or by actually altering the production of tinnitus, most hearing aid wearers report at least some reduction in their tinnitus. This may be due to the reduction in contrast between tinnitus and silence, or because of the new stimulation provided to the brain.
Neuromonics Acoustic Desensitization Protocol
Neuromonics Acoustic Desensitization Protocol is a process that uses counseling as well as a body worn processor connected to high fidelity earphones that present pleasant music that is filtered in accordance with an individuals hearing loss.
Counseling or Cognitive-Behavioral Therapy
Regardless of the cause of tinnitus, if a person is not bothered by the tinnitus, it ceases to be a problem. Psychological intervention aimed at successfully reducing the stress, distress and distraction associated with the tinnitus can be very productive and often produces the most attainable goals.
Stress Management
The very high correlation between stress and tinnitus disturbance underscores the need to maintain one's composure and logic when trying to cope with tinnitus. Relaxation, guided imagery and self-hypnosis are examples of self-help methods used to help combat the stress, anxiety and sleep disturbances associated with tinnitus.
Other Treatment Options
Other options that may help patients with tinnitus include:
Support Groups -- Local peer support groups offer emotional support to patients and a place to discuss and share treatment techniques.
Dental Treatment -- Jaw joint disorders, called temporomandibular (TMD), may exacerbate tinnitus. Splints and exercises may relieve these problems.
Nutritional Counseling -- All tinnitus patients should maintain a balanced diet.
Biofeedback -- Biofeedback is a technique of making unconscious or involuntary bodily processes detectable by the senses in order to manipulate them by conscious mental control. Biofeedback with counseling can help relieve stress patterns that can worsen the perception of tinnitus.
Alternate Approaches -- Although there is no scientific data showing consistent benefit from approaches such as hypnosis, acupuncture, naturopathy, chiropractic care and many herbal preparations, some patients do perceive a benefit.
Reviewed by health care specialists at UCSF Medical Center.
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