Tinnitus

Ever think you’re hearing things that aren’t there? Well, in some cases that might justify a trip to a psychiatrist, but not always. Some folks experience background noise that may or may not be associated with hearing loss. It can take the form of a variety of sounds, and can range from minimal to extensive enough to disrupt concentration or normal hearing. Please join me as we take a closer look at this very common condition called tinnitus.

What is Tinnitus?

Tinnitus is a malfunction of the auditory system that results in an individual hearing sounds inside their head or ears that have no external source.  The noise is often described as ringing, roaring, or buzzing, but may take the form of just about anything, including chirping, thumping, or humming, and can range in pitch from low and dull to high and piercing. It can be found in one or both ears and/or in the head. Tinnitus is classified in one of two ways: subjective or objective. Subjective tinnitus causes sounds that only the patient can hear. Objective, on the other hand, produces sounds that can also be heard by a health practitioner during an examination, such as through the use of a stethoscope or other diagnostic instrument.

Keep in mind that tinnitus is not a disease, but a symptom that can be the result of a number of medical conditions. It can also be associated with hearing loss related to aging. It is rarely an indication of a serious health problem, but it can sometimes be produced by tumors of the head and neck. Tinnitus is a very common condition, affecting as many as 40 million adults in the United States alone.

What Causes Tinnitus?

A quick overview of the inner ear will help us to understand the causes of tinnitus better. Microscopic hairs on each of the thousands of auditory cells move in response to sound waves that enter the ear from the outside environment. The movement of these hairs triggers an electrical current that discharges electricity through the auditory nerve, and the brain converts these electrical impulses into sound. If these fragile hairs become damaged in any way, they cease to function properly, and can begin to transmit false or “random” signals that cause the brain to interpret these as sound. This dysfunctional movement of the hairs can create “static” that makes it difficult for the brain to properly process legitimate sounds. The result can be a din of meaningless background noise.

The above scenario is responsible for most subjective tinnitus, which is the most common type. How does the inner ear become damaged? In a variety of ways.  Some of the most common include:

• Noise-related damage:  In addition to hearing loss, exposure to excessively loud noise levels can result in tinnitus as well. Common factors that cause such damage are machinery such as chainsaws, heavy construction equipment, jackhammers, and the discharge of weapons. The use of headphones on portable music devices can also result to exposure to decibel levels that can handily damage the inner ear. It is crucial to avoid such sources of noise by wearing protective equipment or keeping the volume level down. Remember, hearing damage is always permanent.  Tinnitus may be managed, but hearing loss can never be restored.
• Presbycusis (age-related hearing loss):  This gradual hearing loss that is typical of the aging process in many folks usually begins around the age of 60.
• Trauma:  Injuries to the head or neck may result in hearing loss and/or tinnitus.
• Otosclerosis:  This condition is characterized by a loss of flexibility in the bones of the middle ear. While the cause for otosclerosis is not fully understood, it is thought to be an inherited disease. It can produce tinnitus, as well as hearing loss and balance problems.
• Certain medications:  Common culprits are aspirin and some types of antibiotics. Long-term use is usually necessary in order to produce damage to the inner ear. The good news is that in most cases, both hearing and tinnitus will improve when the use of the offending medications is stopped.
• Excessive earwax, especially if it is impacted.
• Ear infections:  If left untreated, ear infections can lead to hearing damage and tinnitus.
• Meniere’s Syndrome:  An illness characterized by excessive pressure in the inner ear.
• Systemic conditions such as anemia, hypothyroidism, and syphilis.

The less common form of tinnitus is objective, also known as pulsatile tinnitus. It is characterized by noise that is usually found in beat with the rhythm of your heart. It can also be heard by one examining the patient. It is most often linked to disorders of the blood vessels. Common causes for such tinnitus are:

• Hypertension:  High blood pressure can result in tinnitus. It is often more noticeable if aggravating factors such as caffeine, alcohol, or stress are present. (Don’t be fooled though. Most hypertension cannot be “heard” or “felt.” That is why it is sometimes called “The Silent Killer.”)
• A-V Malformation:  This is a disorder that occurs where arteries and veins meet, and it can cause tinnitus in the form of head noise.
• Turbulent blood flow:  Disruption of circulation due to a kink or other problem in the jugular vein or carotid artery can result in objective head noise.
• Atherosclerosis:  Often known as “hardening of the arteries,” this occurs when cholesterol or other fatty deposits cause blood vessels to be narrowed and the flow of blood impeded. The vessels also become less flexible and cannot expand properly. The blood must therefore be pushed harder in order to circulate. In addition to heart disease, stroke, and other circulatory conditions, atherosclerosis can also result in pulsatile tinnitus.

What Treatments Are Available for Tinnitus?

The first thing to consider when evaluating a patient for treatment of tinnitus is any underlying cause. For example, if certain medications may be triggering tinnitus, they may be changed or eliminated. If earwax is a problem, deal with that and it may make the tinnitus disappear as well. Some causes are not so easy to deal with though. If tinnitus is the result of permanent auditory damage, the tinnitus must be managed in different way because the hearing damage cannot be corrected.

Some medications have been tried, with limited success. These include certain tricyclic antidepressants, muscle relaxants, and nervous system depressants, all of which have a litany of undesirable side effects.

Some of the most effective treatments for tinnitus involve noninvasive coping mechanisms and lifestyle changes. Some options for managing tinnitus include:

• Dietary changes:  Some sufferers of tinnitus have had great success at improving the condition by eating healthily and eliminating certain items from their diet. Stimulants such as coffee and soft drinks, as well as alcohol, tend to make tinnitus worse for many folks. In addition, lowering the amount of fat and cholesterol in the diet can improve or avoid circulatory problems that can worsen tinnitus.
• Gingko biloba:  Supplementation with this herb is known to increase circulation, especially to the brain. Some people with tinnitus have seen excellent improvement in the condition when taking gingko biloba, especially if the type of tinnitus they have is circulatory system related. Supplementation with zinc has also shown some promise for many tinnitus patients.
• Exercise:  Regular workouts will also increase circulatory system function and reduce stress, and may result in improvement of tinnitus as well. Pace yourself, and increase the intensity of your routine slowly and steadily. At first tinnitus may worsen for some folks when exercising, but staying the course will typically lessen tinnitus symptoms.
• Tinnitus Retraining Therapy (TRT):  This management tool focuses on training the brain to look beyond the tinnitus, and virtually learn to overlook or at least minimize the effects of the noise. Patients are taught to tolerate the tinnitus to the point where it is no longer disruptive to their daily lives. This is especially effective for subjective tinnitus that is the result of permanent damage to the auditory system.
• Hearing aids:  Sometimes if hearing loss is improved or corrected via the use of a hearing aid, tinnitus will improve by default. The theory is that if legitimate noise is heard better, the background noise of tinnitus will not be as disruptive.
• Noise masking:  Some victims of tinnitus find that if they have some soft music or a fan running in the background, it helps to quietly overcome tinnitus. There are even devices that are similar in size and appearance to hearing aids that are called tinnitus maskers.
• Cochlear implants:  This surgically implanted hearing aid device can also help folks who also suffer from tinnitus, typically in conjunction with hearing loss.
• Electrical stimulation:  Sending electrical impulses through the auditory nerve via an implant has been effective for some folks with tinnitus. This procedure was first used in the early 1800’s, and has evolved somewhat over the last 200 years.
• Hyperbaric oxygen chamber therapy:  This treatment is very popular in Germany for tinnitus. It involves the inhalation of 100% pure oxygen while enclosed in a special pressurized chamber.

An interesting study involving tinnitus patients indicates that attitude towards the malady has a big impact on how disruptive it can be. Learning to cope and not let the unwanted noise annoy or agitate you is key to managing tinnitus. Since stress is a factor in many tinnitus cases, if folks allow tinnitus to distress them, it only makes things worse. In a way, learning to deal with tinnitus is a lot like learning to deal with pain. If patients can overcome the emotional impact of the disorder, half the battle is won.

As with most health issues, the best treatment is prevention, and tinnitus is no exception. Consistently making good dietary, exercise, and lifestyle choices, especially from a young age, is the best remedy for most of our modern sicknesses, including tinnitus. In addition to that, protecting your hearing is essential. Most young folks don’t give too much thought to their hearing, but consistently and foolishly exposing yourself to excessive levels of noise will inevitably result in unpleasant consequences, such as hearing loss or tinnitus, later in life. What you sow you shall reap.