Disease: Tinnitus

    Tinnitus facts

    • Tinnitus is abnormal ear noise.
    • Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the brain.
    • In addition to ringing in the ears, other symptoms associated with tinnitus include:
      • Stress due to fear of tinnitus
      • Ear pain
      • Anxiety
      • Depression
      • Difficulty sleeping
      • Difficulty concentrating
    • Persisting unexplained tinnitus is evaluated with a hearing test (audiogram).
    • Measures can be taken to lessen the intensity of tinnitus.

    What causes tinnitus?

    Tinnitus is a symptom, not a disease, and it has a variety of causes that may arise anywhere in the hearing mechanism. It begins in the ear with the tympanic membrane and the cochlea, where sound is transmitted into electrical energy for the brain to perceive.

    • Tinnitus that is throbbing (pulsatile) may be due to blood flow through arteries and veins adjacent to the ear, as well as tumors that are vascular, having increased blood flow within them.
    • Tinnitus that is described as clicking may be due to abnormalities that cause the muscle in the roof of the mouth (palate) to go into spasm. This causes the Eustachian tube, which helps equalize pressure in the ears, to repeatedly open and close. Multiple sclerosis and other neurologic diseases that are associated with muscle spasms may also be a cause of tinnitus, as they may lead to spasms of certain muscles in the middle ear that can cause the repetitive clicking.
    • Temporomandibular joint (TMJ) abnormalities may cause a repeated clicking sound in the ear.
    • Damage to the vestibulocochlear nerve, responsible for transmitting sound from the ear to the brain may cause tinnitus. This may be due to drug toxicity or a tumor (for example, acoustic neuroma).
    • Meniere's disease, which is associated with hearing loss and vertigo, may also cause tinnitus.
    • As people age, their hearing may decrease and there can be associated tinnitus.
    • Otosclerosis, which is caused by abnormal bone growth in the middle ear, can sometimes cause tinnitus.
    • Trauma may also be a cause of tinnitus and hearing loss. This includes barotrauma, whereby air pressure changes can damage ear function.
    Picture of the Ear Anatomy

    What are the symptoms of tinnitus?

    • The sound of tinnitus may be constant or it may come and go intermittently.
    • It may be throbbing.
    • It may occur in one ear or in both ears.
    • Most often, the sound is a high pitched continuous tone, but it may also be described by the patient as a click, buzz, or a hum.
    • Tinnitus is often associated with hearing loss and the patient may complain of decreased hearing, even if the tinnitus is absent.

    How is tinnitus diagnosed?

    The patient's history and description of symptoms is the key in determining what might be causing tinnitus.

    Your health-care professional will want to know the quality of the abnormal sound, and whether it is constantly present or if it comes and goes.

    • Does it involve one or both ears?
    • Does the sound pulsate, or does it sound like a rush or flow?
    • Does it click?
    • Has there there exposure to loud noises or sound at work, at home or at play?
    • Is there associated decreased hearing/hearing loss?

    Each sound type may a give a clue as to the cause of tinnitus.

    The patient's medications are often reviewed since tinnitus may be a side effect of many medications.

    Physical examination usually focuseson the head and neck, including the ear canals and tympanic membranes. The cranial nerves are often examined to look for weakness in facial, mouth, and neck muscles or numbness in the face that might be associated with a tumor. Your health care professional may listen over the larger arteries in the neck trying to find an abnormal sound (bruit) that might be the cause of tinnitus.

    An audiogram or hearing test may be performed to look for associated hearing loss. It may also note a change in hearing function between the ears that might offer a clue as to the cause.

    Depending upon the situation, MRI scanning of the brain structures might be indicated, and consultations may be requested from a variety of specialists.

    What are the treatments for tinnitus?

    Tinnitus is a common complaint, and up to 20% of Americans have experienced it. This symptom may last for only weeks or months and then resolve spontaneously, though for some individuals it may last for years. The tinnitus may be significant enough to interfere with an individual's activities of daily living. For this reason, treatment may be directed at decreasing the effect of tinnitus on daily life. The depression and insomnia that are sometimes associated with tinnitus may also need to be addressed.

    For the small number of patients who have a vascular cause for tinnitus, repairing the abnormal blood vessel may help reduce the noise.

    For those patients whose tinnitus is caused by an adverse or toxic reaction to a medication, stopping the drug may allow the hearing mechanism to recover.

    Tinnitus relief remedies

    The following common and easy remedies may be of benefit to some individuals with tinnitus.

    • Reducing or avoiding caffeine and salt intake, as well as quitting smoking may help relieve tinnitus symptoms.
    • Some patients with tinnitus have been found to have lower zinc levels and may benefit from zinc supplementation.
    • One study showed melatonin may help tinnitus sufferers, particularly those with disturbed sleep due to the tinnitus. However, this has not  yet been verified in controlled studies.
    • Ginkgo biloba has been touted as a natural tinnitus remedy, though controlled studies to date have not shown it to be effective.
    • There are some behavioral and cognitive therapies that have been successful in treating tinnitus. Seeking out a multidisciplinary program at a tinnitus center may improve the chances of successful treatment. The types of therapies include tinnitus retraining therapy, masking, and behavioral therapy.

    Tinnitus medications

    There are few medications that seem to be effective in the treatment of tinnitus. Two that have shown some mild benefit include alprazolam (Xanax), a benzodiazepine that may also help with the anxiety and insomnia associated with tinnitus, and dexamethasone (Decadron), a steroid that can be injected into the inner ear to help decrease inflammation.

    Depression is often associated with tinnitus, and antidepressant medications have worked in some instances to decrease the intensity or resolve the noise altogether.

    Some small studies have suggested that the prostaglandin analogue, misoprostol (Cytotec), may be of some help for certain patients with tinnitus. Many other medications that have been used historically for tinnitus, however, have not demonstrated compelling evidence to necessarily recommend their routine use. These include lidocaine, anti-seizure medications, niacin, and other over-the-counter dietary and herbal supplements.

    Tinnitus retraining therapy

    Tinnitus retraining therapy is a form of treatment that tries to retrain the nerve pathways associated with hearing to get the brain used to the abnormal sound. Habituation allows the brain to ignore the tinnitus noise signal, and it allows the patient to become unaware that it is present unless they specifically concentrate on the noise. This treatment involves counseling and the use of a sound generator that is worn. Audiologists and otolaryngologists (ear, nose and throat specialists) often work together in offering this treatment.

    Tinnitus relief therapy

    In addition to tinnitus retraining therapy, other treatments exist which attempt to relieve tinnitus, and each patient may benefit differently depending upon the cause of the tinnitus and their response to treatment. Some options include the following:

    • Masking
    • Biofeedback
    • Stress reduction
    • Depression counseling
    • Electrical stimulation for patients with hearing loss

    Acupuncture

    The use of acupuncture in the treatment of tinnitus has not demonstrated any definitive efficacious benefit when evidence from various studies has been reviewed.

    What are the symptoms of tinnitus?

    • The sound of tinnitus may be constant or it may come and go intermittently.
    • It may be throbbing.
    • It may occur in one ear or in both ears.
    • Most often, the sound is a high pitched continuous tone, but it may also be described by the patient as a click, buzz, or a hum.
    • Tinnitus is often associated with hearing loss and the patient may complain of decreased hearing, even if the tinnitus is absent.

    How is tinnitus diagnosed?

    The patient's history and description of symptoms is the key in determining what might be causing tinnitus.

    Your health-care professional will want to know the quality of the abnormal sound, and whether it is constantly present or if it comes and goes.

    • Does it involve one or both ears?
    • Does the sound pulsate, or does it sound like a rush or flow?
    • Does it click?
    • Has there there exposure to loud noises or sound at work, at home or at play?
    • Is there associated decreased hearing/hearing loss?

    Each sound type may a give a clue as to the cause of tinnitus.

    The patient's medications are often reviewed since tinnitus may be a side effect of many medications.

    Physical examination usually focuseson the head and neck, including the ear canals and tympanic membranes. The cranial nerves are often examined to look for weakness in facial, mouth, and neck muscles or numbness in the face that might be associated with a tumor. Your health care professional may listen over the larger arteries in the neck trying to find an abnormal sound (bruit) that might be the cause of tinnitus.

    An audiogram or hearing test may be performed to look for associated hearing loss. It may also note a change in hearing function between the ears that might offer a clue as to the cause.

    Depending upon the situation, MRI scanning of the brain structures might be indicated, and consultations may be requested from a variety of specialists.

    What are the treatments for tinnitus?

    Tinnitus is a common complaint, and up to 20% of Americans have experienced it. This symptom may last for only weeks or months and then resolve spontaneously, though for some individuals it may last for years. The tinnitus may be significant enough to interfere with an individual's activities of daily living. For this reason, treatment may be directed at decreasing the effect of tinnitus on daily life. The depression and insomnia that are sometimes associated with tinnitus may also need to be addressed.

    For the small number of patients who have a vascular cause for tinnitus, repairing the abnormal blood vessel may help reduce the noise.

    For those patients whose tinnitus is caused by an adverse or toxic reaction to a medication, stopping the drug may allow the hearing mechanism to recover.

    Tinnitus relief remedies

    The following common and easy remedies may be of benefit to some individuals with tinnitus.

    • Reducing or avoiding caffeine and salt intake, as well as quitting smoking may help relieve tinnitus symptoms.
    • Some patients with tinnitus have been found to have lower zinc levels and may benefit from zinc supplementation.
    • One study showed melatonin may help tinnitus sufferers, particularly those with disturbed sleep due to the tinnitus. However, this has not  yet been verified in controlled studies.
    • Ginkgo biloba has been touted as a natural tinnitus remedy, though controlled studies to date have not shown it to be effective.
    • There are some behavioral and cognitive therapies that have been successful in treating tinnitus. Seeking out a multidisciplinary program at a tinnitus center may improve the chances of successful treatment. The types of therapies include tinnitus retraining therapy, masking, and behavioral therapy.

    Tinnitus medications

    There are few medications that seem to be effective in the treatment of tinnitus. Two that have shown some mild benefit include alprazolam (Xanax), a benzodiazepine that may also help with the anxiety and insomnia associated with tinnitus, and dexamethasone (Decadron), a steroid that can be injected into the inner ear to help decrease inflammation.

    Depression is often associated with tinnitus, and antidepressant medications have worked in some instances to decrease the intensity or resolve the noise altogether.

    Some small studies have suggested that the prostaglandin analogue, misoprostol (Cytotec), may be of some help for certain patients with tinnitus. Many other medications that have been used historically for tinnitus, however, have not demonstrated compelling evidence to necessarily recommend their routine use. These include lidocaine, anti-seizure medications, niacin, and other over-the-counter dietary and herbal supplements.

    Tinnitus retraining therapy

    Tinnitus retraining therapy is a form of treatment that tries to retrain the nerve pathways associated with hearing to get the brain used to the abnormal sound. Habituation allows the brain to ignore the tinnitus noise signal, and it allows the patient to become unaware that it is present unless they specifically concentrate on the noise. This treatment involves counseling and the use of a sound generator that is worn. Audiologists and otolaryngologists (ear, nose and throat specialists) often work together in offering this treatment.

    Tinnitus relief therapy

    In addition to tinnitus retraining therapy, other treatments exist which attempt to relieve tinnitus, and each patient may benefit differently depending upon the cause of the tinnitus and their response to treatment. Some options include the following:

    • Masking
    • Biofeedback
    • Stress reduction
    • Depression counseling
    • Electrical stimulation for patients with hearing loss

    Acupuncture

    The use of acupuncture in the treatment of tinnitus has not demonstrated any definitive efficacious benefit when evidence from various studies has been reviewed.

    Source: http://www.rxlist.com

    Tinnitus is a common complaint, and up to 20% of Americans have experienced it. This symptom may last for only weeks or months and then resolve spontaneously, though for some individuals it may last for years. The tinnitus may be significant enough to interfere with an individual's activities of daily living. For this reason, treatment may be directed at decreasing the effect of tinnitus on daily life. The depression and insomnia that are sometimes associated with tinnitus may also need to be addressed.

    For the small number of patients who have a vascular cause for tinnitus, repairing the abnormal blood vessel may help reduce the noise.

    For those patients whose tinnitus is caused by an adverse or toxic reaction to a medication, stopping the drug may allow the hearing mechanism to recover.

    Source: http://www.rxlist.com

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