Tinnitus (means ringing in Latin) is sound sensation in the ear or head. Tinnitus is not a disease rather an annoying symptom of myriad of conditions, caused by minor changes in the sensitive hearing system (Cochlea and auditory nerve).
In most cases tinnitus is not harmful but patient should be investigated properly to find any treatable condition.
Most important is History and Identification of hearing loss and Clinical Examination of ear by otoscope/operating microscope with detail head and neck examination by specialist.
Brain-stem Evoked Response Audiometry
CT scan (especially if tinnitus is asymmetrical, 10% of cases it may be a tumor (Acoustic Neuroma).
Blood Investigations to test Anaemia- CBC, Hypothyroidism- TSH, Diabetes-sugar, Syphilis- FTABS and lipid profile.
Tinnitus pitch matching and masking.
I. Causes of tinnitus Related to ear (otologic):** Cause may be in the external, middle or inner ear
Fluid in the middle ear
Acute and chronic otitis media
Ototoxic drugs (such as ACE inhibitors, Antibiotics-ciprofloxacin, erythromycin, streptomycin, and vancomycin, Anti depressant-alprazolam, Anti-malarials-chloroquine and quinine, B-blockers, Diuretics-acetazolamide and amiloride, NSAIDs and Aspirin)
Objective causes are less frequent:
Aneurism of carotid artery (it is synchronous with pulse)
Vascular tumor of middle ear
Tinnitus synchronous with respiration may occur with abnormally patent Eustachian tube (mostly seen after weight loss).
II. Causes of tinnitus not related to ear:
Disease of CNS, anemia, arteriosclerosis, hypertension, hypotension, hypoglycemia, epilepsy, migraine
There is at present no effective surgery or medical therapy for the treatment of tinnitus.
In majority of cases our system adapts to noise over a period of time and is accepted as a part of normal environment.
Treat the treatable cause like otosclerosis, menieres, abnormally patent Eustachian tube, acoustic neuroma. (Read More)
Tinnitus General measures and prevention, life style modification:
Take care of the body by giving it enough rest, sleep and water.
Dietary supplements Vitamins A, C, E, and B group and Zinc
Micro nutrients to prevent noise induced hearing loss
Support and stress management; taking a positive step in controlling the condition and changing response to it
Decrease intake of salt
Avoid food with high sugar
Limit exposure to loud noise, occupational and recreational
Avoid aspirin, and NSAIDS
Avoid ototoxic medicine
Avoid nicotine, alcohol, caffeine
Take steps to lower blood pressure and cholesterol
Ginkgo Biloba extract is an effective, well tolerated whilst not effective in every single patient, the proven benefits far outweigh any risks.
Tinnitus Retraining Therapy
Person can be habituated to sound in the environment, so aim is to train the brain to adapt to sound.
TRT has 2 elements- Direct counseling and sound therapy
Tinnitus is more noticeable and disturbing when environment is quiet. Person with tinnitus thinks that sound is because of or can cause some serious damage to brain or inner ear. This negative emotional response from our subconscious brain (limbic system) travels to conscious brain-cortex, so person reacts.
In sound therapy instead of treating patient surrounding sound is manipulated so that it becomes less noticeable, here are many ways to achieve the goal such as:
Table top devices-environmental sound machine, water fountain, clocks, fan, radio
CD based system
Combination of hearing aid and masker
Cochlear implant/electric stimulation
Effective counseling is most critical aspect of tinnitus management. Tinnitus sufferers are anxious and frightened by the presence of tinnitus and need a careful and clear explanation of the nature of the disorder.
The patient who is severely disturbed by tinnitus can be described as having additional emotional problems, such as depression or anxiety disorder.
Treatment of these emotional problems, along with helping the patient to learn better coping strategies can often help the patient deal with their tinnitus (House, 1997). The objective is to desensitize the individuals so that they can accept its presence and still choose to ignore it.
Distress caused by tinnitus is in correlation to degree of attention paid to tinnitus and shifting attention of person to a different signal is bio feedback.
Biofeedback is quite effective relaxation technique; it teaches person to control certain autonomic body functions such as pulse, muscle tension and skin temperature. Goal is to help person manage stress not by reducing stress but by changing the body reaction to it.
Music- Music has clear associations with the limbic system, the part of the brain that is responsible for emotion.Music is soothing to soul, relieves pain and anxiety, But music emphasizes the low frequencies and has little power in high frequency and tinnitus patient mostly has less hearing in high frequency and hear better at lower frequency.
To correct this mismatch neuromonics are created (creator Dr Paul Davis and Peter Hankey, Australia). Modified music is delivered through high fidelity ear phones that match hearing and tinnitus level.
A breathing technique in pranayama is used to control, improve or refine the breathing processes, thereby energizing the body and calming the mind . Paroxysmal Gamma brain waves produced during the Bhramari Pranayama which is associated with positive thoughts, feelings of happiness and acts as a natural antidepressant.
The Bhramari Pranayama is one such ancient ‘Yogic’ breathing exercise that not only includes a unique breathing technique, but also entails placing the body in a relaxing posture with simultaneous generation of a constant humming sound during the phase of expiration. The sound generated in BP is akin to the humming of a bumble bee (Ramdev, 2005). The individual also actively concentrates his/her mind (mindfulness) at the centre of the forehead while closing both ears using the thumbs and placing light pressure on the eyes using the fingers of each hand respectively.
There is increased brain activity that causes tinnitus, stimulation of that transcranial magnetic stimulation can reduce that activity and cause relief of tinnitus.
Low-frequency repetitive transcranial magnetic stimulation (rTMS) has been proposed as a method for treating brain’s excitability disorders by reducing this hyper excitability. This has been done in depression and other conditions as well.
Hearing aids have been long recognized to reduce the bothersome effects of tinnitus . Amplified external sounds or the internal noise of hearing aids could mask the tinnitus. Many tinnitus patients with hearing loss have benefited from a hearing aid.
Ultraquiet, a new commercial innovation is a high-frequency bone conduction therapy that aims to reduce long term tinnitus severity by delivering amplitude modulated musical type tones in the range of 10-20 kHz.
Research results have not conclusively identified these treatments as helpful for tinnitus.
Control of inhalational and food allergy
Zinc, magnesium and vit-B12
Herbal ginkgo biloba have mixed result