What is Tinnitus?
Tinnitus is primarily a hearing disorder. It is commonly called as ringing in the ears. It can be a hiss, clicking or roaring sound in the ears. These peculiar sounds are experienced in persons with the disorder even when there is no external sound that causes disturbance in the ear drums. It is a non-auditory disorder which may surface off and on or may occur continuously.
Tinnitus is generally an age related disorder since elders above the age of fifty are the most affected persons (1). But teenagers or middle aged people may also get affected due to some other medical conditions not necessarily connected to ears.
Tinnitus itself is not a disease but it is a symptom for various health disorders like hearing loss, emotional stress, disorders related to the heart or blood vessels, infections in the ear, tumors in the brain etc.
Tinnitus can occur in one or both the ears. It is generally diagnosed by the description provided by the patient based on the perceptions of the person affected or by conducting certain clinical tests like audiogram and neurological examinations on the person (2).
Consequences of tinnitus are physical, psychological and evensocial based on the severity of the disorder. It could lead to stress and depression in the affected person.
Types of Tinnitus
Tinnitus is classified into three different types namely, subjective, objective and pulsatile.
Subjective tinnitus is the most common form which is caused due to some disorder in the inner ear or auditory nerve. Damage caused to the hair cells of the inner ear due to frequent exposure to noise results in tinnitus. Here again, it is sub classified as otic and nonotic tinnitus (3). When the cause of tinnitus is due to disorder in the ear it is otic and when it is caused due to other reasons it is called nonotic.
Objective tinnitus is caused by muscle spasms or involuntary twitching of the muscles around the inner ear. Only a small percentage of patients are affected by this particular type of tinnitus.
Pulsatile tinnitus is caused due to the irregular noise of the blood flow. Increased blood turbulence in the inner ear leads to this type of disorder. Generally this type of disorder is considered as a blood vessel disorder. This type of tinnitus occur due to consumption of certain medicines like aspirin and anti-depressants.
Occurrence of any of the three types of tinnitus may be caused by one or more of the following disorders:
- Hearing loss due to ageing.
- Blockage by earwax.
- Infections in the ear due to sinus or due to any other damage or wound in the ear.
- Problems relating to disorders of the blood vessels or heart disorders
- Hormone imbalances, particularly in women. However, men are more prone to tinnitus particularly due to regular smoking.
- Side effects due to consumption of certain medicines for treating other disorders. If tinnitus already exist, consumption of certain medicines could aggravate the disorder.
- Tumors in the brain
- Problems due to hypo or hyper thyroid
- Very loud noises in the surroundings
- Abnormal growth of the ear bone which is mostly a genetic disorder.
- Injuries in the neck or head
- When tinnitus affects only one ear, it is attributed to a peculiar disorder called acoustic neuroma wherein a nerve running between the brain and the ear is affected by benign tumor.
- Sometimes during brisk walking, a jarring noise may occur due to seismic effect and consequently contraction of the muscles or abnormal movement of the bones in the inner ear could develop. This condition may vanish upon slowing down the pace of walking. When it persists consultation with an ear specialist is needed.
- Onset of Meniere’s disease caused due to abnormal fluid pressure in the inner ear.
While there can be a number of causes that may lead to tinnitus, some are easily identifiable but quite a few are unknown.
Having got on idea about different causes, we may look into the probable symptoms which are experienced by a person suffering due to tinnitus.
Symptoms of Tinnitus
- The most common symptom of tinnitus is ringing in the years. Some persons affected may experience hissing, buzzing or whizzing sound. Such abnormal sound may be continuous or intermittent. For some people the ringing sound may increase during bed time in view of the surrounding calmness. Whatever sound a person experiences due to tinnitus is from within and not from outside or the environment.
- Heavy headedness is another common symptom of tinnitus.
- Sudden hearing loss particularly in only one ear is an important symptom that surfaces on account of tinnitus. In this type of disorder, the person experiencing such hearing loss may have other medical conditions like cardiovascular disorders.
- Each off the symptom has to be carefully studied in order to ascertain the causes and treat them appropriately.
Diagnosis of the patient by conducting relevant laboratory and clinical tests are essential to determine the causes and to provide treatment based on the diagnosis. Observations based on the Diagnosis of the ear, nose and throat by conducting audiometric tests, blood tests and imaging tests, and taking a holistic view based on the causes and other disorders in the patient, appropriate treatment methodology must be worked out. The most important point here is that evaluation of the patient by specialist doctors is a must to determine the causes and fix the treatment.
Treatment for tinnitus
Treatment of tinnitus is based on the underlying cause. Tinnitus due to noise pollution can be cured by just protecting the ears from such noises. If the disorder is due to other causes appropriate medical attention must be provided.
Hearing aids and their role
Subjective form of tinnitus is generally treated by administering simple medicines to remove infections in the ear in addition to protecting the ears from abnormal external sounds. Besides, usage of hearing aids or avoiding exposure to loud noises may provide the required relief. When the person affected by the disorder do not experience any discomfort or interference in the normal routine and the symptoms or causes do not give room for any anxiety, certain therapies are found to be useful. Some therapies which can provide such relief are:
- Sound therapy aimed at neutralizing the hissing sound in the ears. Here the tinnitus effect may be temporarily subdues as long as the sound therapy is in place. But the symptom can again surface once the therapy is stopped.
- Tinnitus retaining therapy is aimed at making the noise created by tinnitus to be a non-disruptive noise and customizing the abnormal sound on account of tinnitus
- Cognitive behavioral therapy can be attempted to relieve the patients from depression even though the noise due to tinnitus does not go away but some sort of psychological relief is achieved by the patient.
Treatment for Objective Tinnitus
Objective tinnitus has to be treated differently after conducting appropriate diagnosis of the inner ear to find out the particular cause. Hear again, the causes and symptoms alone provide the clue to initiate tests to find out the disorder in the inner ear. In addition to the ear, the nose, throat and torso are also tested for any abnormal function.
It is the pulsatile type that poses serious risk to the patient and more challenge to the doctor to treat it. Any irregular noise or turbulence in blood flow may be due to some serious disorder of the cardiovascular system. Hence it is necessary to be more careful in attempting different types of treatment. Delay in diagnosing the causes could lead to escalation of the problem needing intensive care. If the sound experienced in the fear due to tinnitus by any person resembles the heart beat the anxiety is more and immediate medical attention is required.
The type of tinnitus can be identified only after experiencing the symptoms for some time. Hence it is necessary to consult a doctor even at the early stages in order to rule out any underlying serious cause, which need to be attended to immediately.
Initial stages of tinnitus can be treated with some home remedies normally guided by a consultant.
How to prevent Tinnitus?
Certain preventive measures are also possible in avoiding the occurrence of tinnitus as well as in getting relief as long as the discomfort experienced is not of a serious nature. Preventive measures include:
- Stopping smoking and drinking completely
- Avoiding exposure to loud noises
- Usage of ear protection methods including hearing aids
- Regularly exercising in order to maintain the cardiovascular health
- Protecting the ear from infections
- Avoiding self-medication and ensuring appropriate consultations with a physician on the medicines consumed.
- Adopting healthy life style and stopping unhealthy habits
- When teenagers experience tinnitus,it is an indication of future hearing loss. Such people must be advised against use of music systems particularly with headphones as these habits has the potential to accelerate the hearing loss quickly.
It must be understood that tinnitus can only be managed as no permanent solution is presently available to get rid of it.