What is Tinnitus?
Tinnitus is the feeling of ringing in the ear or an added sound heard by the patient. Patients affected by tinnitus often describe it as a continuous or an intermittent buzzing, whistling, chirping, or a hissing sound. Some patients may hear other sounds in the ears like whooshing, humming, etc. Tinnitus may affect one or both ears.
The sounds in the ears can be soft to loud and may have a continuously same or changing pitch and volume. The disturbance is felt more when the patient is trying to sleep or work in a quiet environment where background noise is low. On the contrary, some patients become overly sensitive to sound (called hyperacusis).
Although the tinnitus does not directly lead to hearing loss, it can surely hinder the concentrating and listening abilities of the patients. If the condition is left unattended for a prolonged period, it can also lead to psychological problems.
Our inner ear helps in maintenance of balance the body, acts as receptors of sounds and transmits signals to the brain. Loud noises can damage the sound-sensitive cells in the inner ear temporarily or sometimes permanently if it is very loud.
Disturbance in the conduction of sound by the inner ear or processing of the sound signal by the central nervous system may lead to tinnitus. (more info)
Causes of Tinnitus
- Ear infection
- Sinus infection
- Blockage in the ears caused by wax
- Meniere’s disease
- Old age
- Continuous exposure to loud sounds
- Sudden exposure to loud sound
- Head or neck injury
- A tumour affecting VIII cranial nerve.
- Side-effects of some medications such as aspirin, quinine and chloroquine, some of the sedatives, antidepressants, painkillers, antibiotics, diuretics.
- Damage to the jaws causing temporomandibular joint disorder
- Otosclerosis; a condition where the small bones in the inner ear become immobile
- Some medical conditions such as hypothyroidism, diabetes, high BP, anaemia, cardiovascular diseases, autoimmune disorders and circulatory disorders.
- Extreme stress and fatigue
- Excessive Intake of alcohol or caffeinated beverages, cigarette smoking may worsen the condition of a tinnitus patient
- Migraine headaches
There are many causes of tinnitus. It may be a standalone medical condition sometimes that is induced or may also be an indicator of an underlying medical condition. When the medical condition gets addressed, the tinnitus too will be resolved.
Tinnitus may be associated with disorders causing vertigo or dizziness. (get more info)
People prone to tinnitus are those who work for a long time in a noisy environment such as carpenters, repair workers using noisy machines, rock musicians, pilots or any others who are exposed to sudden loud sound or operate in noisy environments. People who listen to loud music for long durations may develop tinnitus over a period.
Objective & Subjective Tinnitus
In subjective tinnitus, only the patient suffering from tinnitus hears the ringing or similar sound in the ear.
On the contrary, in objective tinnitus, a doctor too can hear the tinnitus in the patient’s ear with the help of a stethoscope.
At NeuroEquilibrium, we have designed advanced testing and treatment equipment to diagnose and treat tinnitus.
Otologists, neurotologists, otolaryngologists, and audiologists are the experts in this field who diagnose tinnitus and its severity through various physical and behavioral tests to check your hearing ability.
Tests to Diagnose Tinnitus
Visual Analogue Scale – The patient is asked to rate the loudness of the internal noise in the ear on the scale of 0 – 10. The patients perceive their ringing-in-the-ear sound louder than it is, due to subjective tinnitus. Checking the loudness on the decibel scale of 0-10 helps the doctors to understand the severity of the tinnitus.
Andiometry– To assess the hearing of the patient. If there is hearing loss-the type of hearing loss and its severity is gauged.
Tinnitus Matching – Sounds with different pitches are played to the patients and are asked to select the close one in the set that resembles the sound they experience in the ear. The recognition of a pitch that is closely similar to the one that the patient hears in his ear helps the doctors understand the frequency level of the tinnitus in the patient.
Loudness Match Test – The patient is asked to match the intensity of sound he hears in his ear. The test aids the doctors in understanding the range of the sound of the tinnitus in a patient.
Impedance audiometry with Eustachian tube function tests– should be done to determine middle ear pressure, stapedial reflexes and ET function.
Effective Ways to Treat Tinnitus
It is important to try to ascertain the underlying cause of tinnitus.
Tinnitus caused by excess ear wax build up – Wax is produced in the ear to protect and lubricate it.Cleaning with ear buds can push the wax further inside causing blockage of the ear canal.
Tinnitus caused by ear infection – The doctors will prescribe antibiotics to reduce infection in the ear.
Tinnitus caused by TMJ (temporomandibular joint) disorder –Any undue pressure or injury may harm the joint and cause tinnitus. An orthodontist, dentist or ENT doctor can treat this condition successfully.
Medications to treat tinnitus- Patients are advised to stay in a sound rich environment.
Anti- anxiety or antidepressant drugs are often prescribed by doctors to treat tinnitus.
Devices to treat tinnitus
Hearing aids – A well-fitted hearing aid can reduce the distracting sounds in the ears and helps in effective hearing.
Masking devices – Also called as noise suppression devices, these are similar to a hearing aids. This device plays an added sound to distract the patient from focussing on ringing sound caused by tinnitus. The doctor sets the frequency of the instrument after loudness and pitch matching tests so that the pitch in the device matches that of a perceived sound of the tinnitus experienced by the patient.
Tinnitus instruments – It is a combination of a hearing aid and masking device.
Tinnitus Retraining Therapy – It is a habituation therapy that helps the patients to perceive the annoying inner noise in the ear to be normal at the subconscious level so that the conscious mind does not get disturbed by the sounds in the inner ear.There are two stages in TRT
- Using a tinnitus instrument and
- Conducting counseling sessions by an experienced doctor.
This treatment is very effective in treating tinnitus and takes around a year or two to show results.
Biofeedback – It is a relaxation method that helps patients to control and manage their stress reactions to inner ear noise. Many tinnitus patients find it helpful in addressing their problem.
Cognitive Therapy – An intensive counseling of the patients along with the use of a masking device and medications has proved to be very beneficial in treating tinnitus in the patients.
Cochlear implants – The device emits electrical signals to the brain to treat severe to profound deafness. If the tinnitus patient has severe hearing loss, this treatment can very efficiently provide lasting relief to the patient. However, if the patient has only tinnitus and not hearing loss, this implant is not recommended.
White noise generating machines – The patient can be advised to play a background music of falling rain, the sound of the sea, river or similar kind of sounds to keep herself distracted from the noises in the ear.
Alternative Treatments for Tinnitus
What else can you do to handle tinnitus better?
- Quit smoking – Smoking cigarettes is injurious to health! It’s worse if you have tinnitus. Smoking causes narrowing of the blood vessels to the sensitive auditory nerves cells that help you hear and also stimulates your body. This action heightens sounds that you hear in your ears.
- Play soft music – If your tinnitus is too bothering, playing a soft music at the backdrop will help you immensely. It distracts you from focussing on tinnitus and help you concentrate on your daily activities.
- Avoid the triggers – Many tinnitus patients observe that their tinnitus or ringing in the ear condition worsens when they take certain foods, beverages, or medications. It is best to avoid such triggers to keep the sounds in your ear less bothersome.
- Guard your ears – If you are in a noisy place (concerts/ pubs) or doing work that generates noise (using power drilling tools/ factories / vacuum cleaners that make a loud noise); wear earplugs or cover your ears.
Common myths about Tinnitus
- It is incurable
- Only those who have hearing loss get affected by tinnitus
- Tinnitus cause deafness
- Hearing aids are of no help in relieving tinnitus
- Tinnitus is caused only by hearing loud music or by using ear buds.
- Tinnitus is an illusion
Tinnitus can be addressed effectively by timely diagnosis and apt treatments.
NeuroEquilibrium’s team of specialist doctors work on tinnitus condition and its symptoms and offer help to patients suffering from tinnitus to lead a normal life. (read more)
Author: Dr. Anita Bhandari
Dr.Anita Bhandari is MS(ENT) and a consultant Neurotologist practicing in Jaipur, India. She has done a fellowship in Otology and Neurotology from Singapore. She has set up a state-of-art Vertigo and Ear Clinic in Jaipur (www.vertigoandearclinic.com) which is amongst the most advanced vertigo clinics in India.
Dr. Bhandari is actively involved in development of diagnostic equipment in the field of diagnosis and rehabilitation of vertigo and balance disorders. She has contributed to the development of Computerized Dynamic Visual Acuity , Cranio-Coprpography , Subjective Visual Vertical , Video Nystagmography and
Posturography diagnostic equipment and has two patents in this field . She has also been involved in development of Virtual reality for vestibular rehabilitation . She is Scientific advisor to NeuroEquilibrium, a unique project to set up 500 super-specialized vertigo and dizziness clinics in India , Asia & Africa leveraging cloud technology.
She has authored chapters on ‘Vestibular Physiology’, ‘Dynamic Visual Acuity’, ‘Surgical treatment of vertigo’, ‘Difficult cases in vertigo’ in various Neurotology textbooks. She is an invited speaker in various Vertigo & Neurotology conferences across the world.