What is Tinnitus?

Tinnitus is the perception of sound when actual external noise is absent. It is commonly referred to as ringing in the ears but tinnitus can be perceived as buzzing, ringing, or hissing, whistling, swooshing, and clicking. The sound may be high pitched or low pitched and it may be heard in one or both ears. Tinnitus is a common symptom affecting over 37 million Americans in the past year. Tinnitus increases with age but it can affect children as well. It is common in men than women especially smokers. Tinnitus can be intermittent lasting over five minutes or continuous and both may have a significant impact on the patient. The sound may be pulsatile or non-pulsatile. Pulsatile tinnitus usually indicates underlying significant pathology and prompt for adequate diagnosis workup, though non-pulsatile tinnitus may also be associated with underlying disease.

What causes Tinnitus?

  • Exposure to loud noises
  • Ear and sinus infections
  • Heart or blood vessel Diseases 
  • Ménière’s disease
  • Brain tumors
  • Hormonal changes in women
  • Abnormalities of thyroid function 
  • Medications such as some antibiotics, cancer medications and water pills

What are the different types of Tinnitus?

There are two types of tinnitus:

  • Subjective Tinnitus: This is the most common reported tinnitus and the sounds are only perceived by the patient Subjective tinnitus is usually associated with auditory and neurological reactions to hearing loss, but can also be caused other medical disorder. 
  • Objective Tinnitus:  It is very rare and the sound are audible to both the patient and other people. The sound is usually caused by a blood vessel problem or a middle ear bone condition.

A rare variant of tinnitus is pulsatile tinnitus which is usually caused by vascular or blood vessel disorder. People affected describe the perception of hearing their heartbeat inside their ear. It’s more likely to happen in older people because blood flow tends to be more turbulent in arteries whose walls have stiffened with age. It can also occur in younger people with atherosclerotic disease or growing tumor

How to diagnose Tinnitus?

A detailed medical history and physical examination are crucial in the evaluation of tinnitus. Physical examination usually includes a complete head and neck examination, including cranial nerve examination and evaluation of the tympanic membrane. Diagnostic imaging such as CT angiography or MRI may be required for a patient presenting with constant pulsatile tinnitus because it may herald life-threatening underlying condition

How to treat Tinnitus?

There is presently no known cure for tinnitus and it is generally managed with behavioral strategies and sound-generating devices which includes:

  • Cognitive-behavioral therapy (CBT). CBT is an intervention directed at teaching patients to alter their psychological response to their tinnitus by identifying and reinforcing coping strategies, distraction skills, and relaxation techniques.
  • Tinnitus retraining therapy (TRT). This technique is based upon bypassing or overriding abnormal auditory cortex making tinnitus less noticeable or less bothersome. 
  • Biofeedback and stress management. Biofeedback is a relaxation technique that helps control stress by changing bodily responses. The goal of biofeedback is to help people manage tinnitus-related distress by changing the patient’s reaction to it.

More information on the cause and treatment of tinnitus can be found here

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