Tinnitus

Tinnitus is an abnormal condition in which the person is hearing sound when it is not present externally. While this state is often described as a ringing, there might also be sounds like clicking, hiss or roaring. 

Rarely people hear unclear voices or music. Pitch of the sound may be low or high and sound may be soft or loud. Sometimes sound appears to come from one ear or both. Quite often these sounds cause depression, anxiety or interferes with concentration of the patient.

The main symptom of tinnitus is when the person is hearing sound when it is not present externally.

Tinnitus can be felt in the head, one or both ears as noise when there is absence of any auditory stimulation. The noise heard during tinnitus can be described in different ways but the most common description is perception of a pure tone sound. 

In some people tinnitus takes the form of a high pitched whining, electric buzzing, hissing, humming, tinging or whistling sound. Also tunes, songs, beeping, sizzling, even sound which slightly resemble human voices are heard in some cases. There is impairment in listening abilities.

Many factors can cause tinnitus. These include:

• AGE- Age related hearing loss can be a major cause of tinnitus. As age of a person increases constantly, hearing worsens and this usually starts at the age of 60 years. Presbycusis, is a medical term to describe this situation. 
• Noise related hearing loss- Loud noises from speakers, loud concerts, equipment such as chain-saw, drill and others used at construction sites, portable gadgets such as MP3 player, iPod and heavy sounds in industrial area may cause considerable damage. Long-term exposure may eventually lead to hearing loss. 
• Earwax blockage- The function of earwax is to protect the ear canal by trapping the dust and inhibiting the growth of bacteria. If earwax accumulates too much, it decreases the hearing capacity of the ear and causes irritation leading to the development of tinnitus. 
• Ear bone- stiffening(osteosclerosis)of these bones may result in improper transmission of impulses, this condition is found out to be hereditary. 
• TMJ disorder-  Temporomandibular joint is a place where the skull meets the lower jaw. problems with this joint may develop tinnitus. 
• Trauma- injuries to head and neck may cause tinnitus because of a susceptible damage to the nerves of ear (vestibulocochlear) or damage in the inner ear or some brain injuries may also cause problems with signal transmission. 
• Acoustic neuroma- the benign tumor of the nerve going from brain to ear usually causing tinnitus in only one ear. BLOOD VESSEL DISORDERS- In some cases tinnitus develops due to vascular disorders in the blood vessels supplying the ear. 
• Atherosclerosis- with increase in age, cholesterol and other deposits gets accumulated in the wall of blood vessels decreasing its ability to contract and expand per each heart beat making blood to move with greater force in the major arteries situated near ear, in this case tinnitus can be heard on both ears. 
• Head and neck tumors- Tumors in the area of head and neck have a tendency to compress the blood vessels of ear which can hamper with hearing abilities. 
• High blood pressure- Hypertension and other factors which increase blood pressure make tinnitus more noticeable. 
• Turbulent blood flow- narrowing of arteries in neck region (carotid artery) can cause turbulent blood flow, leading to tinnitus. 
• Malformation of capillaries- Abnormal connections formed between arteries and veins can also cause tinnitus, this type of tinnitus is usually confined to only one ear. 
• Medications- Antibiotics( Polymyxin B, Erythromycin, Vancomycin, Neomycin), cancer medications (Mechlorethamine, Vincristine) diuretics( Furosemide, Bumetanide) NSAIDs ( Aspirin only in high doses) and Antidepressants may have tinnitus as a side effect.

Doctor will examine your ear, head and neck to diagnose the possible causes of tinnitus. Your Doctor would like you to undergo certain examinations which include:

• Hearing exam- In this test you will be sitting in a sound proof room wearing headphones, various sounds will be played through them and you will be asked to indicate when you hear any sound. The results of your test will be compared with values, normal for your age. This will help rule out or identify the causes of tinnitus. 
• Movement test- your doctor may ask you to move your eyes, arms, neck, and legs, if your tinnitus worsens or changes, it may help to diagnose underlying disease.
• Depending on the primary diagnosis established after physical examination you may need imaging tests such as MRI and CT scans. The kind of sound you hear during the tinnitus helps in diagnosing your condition.

Treatment of tinnitus depends on the diagnosis established by your doctor. Some treatment options consist of: 

• Ear wax removal- removal of impacted earwax can decrease symptoms of tinnitus. 
• Treating a blood vessel condition- vascular disorders such as atherosclerosis, calcification of arteries if treated by medications or by means of surgery can decrease the symptoms of tinnitus. 
• Changing medication- If your medication is found out to be the culprit of tinnitus, a change in these medications will definitely improve the condition.  
• Suppression of harmful noise by the aid of masking devices, white noise machines and tinnitus retraining instruments will help you to recover from the situation.

Although some causes of tinnitus can’t be prevented but some precautions can be taken such as:  

• Use of hearing protection- over time exposure to loud music can damage the hearing capacity of ears and cause loss of hearing, it is always advisable to protect your ears from loud noise. 
• Cardiovascular health- Taking proper care of your cardiovascular system (heart and vessels) can prevent the accumulation of different deposits in the wall of vessels eventually decreasing the risk of tinnitus. Listening to loud music for a long time and continuous use of earphones, headphones or Bluetooth should be avoided.

Little success gained by using alternative remedies in the treatment of tinnitus makes it hard to recommend them, but some approaches are: 

• Acupuncture- in which needles are used to relieve stress. 
• Hypnosis- A state of human consciousness involving focused attention and reduced peripheral awareness. 
• Usage of Ginko bibola, Zinc supplements and vitamin B complex may also help. 
• Neuromodulation by transcranial magnetic stimulation is a painless therapy that has been successful in reducing the symptoms of tinnitus in some people.

Lifestyle modifications are necessary in order to cope with tinnitus, which include:

• Avoid irritants- Reduce exposure to irritants which worsen tinnitus, such as loud music, caffeine and nicotine. 
• Cover up the noise- In a low setting (low volume) a fan, some music, and listening to radio can cover up the noise. Manage stress. proper management of stress by regular meditation, relaxation therapy, exercise will provide relief. 
• Reduction of alcohol consumption- alcohol has a tendency to dilate peripheral blood vessels and constrict central blood vessels causing difficulties in blood circulation. 
• Education: Learning as much as you can about tinnitus and keeping yourselves aware of your condition will help to improve the condition.

Often tinnitus is overlooked and people get used to it.

Some of the major risk factors for tinnitus are:

• Loud noise exposure: prolonged exposure to loud music can damage tiny sensory hair cells in the inner ear that transmit sound to brain. People working at construction sites, musicians and soldiers should use preventive methods. 
• Age- As the age of a person increases, the elasticity of blood vessels near ear decrease posing a threat for future hearing impairment. 
• Gender- Men are more likely to experience tinnitus due to higher amount of cholesterol in their blood. Smoking- Smokers have high risk of developing tinnitus. 
• Cardiovascular problems- people suffering from cardiovascular system problems such as hypertension, atherosclerosis, can increase the risk of tinnitus development.  

Effects of tinnitus are individualistic ranging from fatigue, stress, sleep problems, not being able to concentrate, memory problems, Depression, anxiety and irritability. Tinnitus also acts as a primary indicator of Meniere’s disease (abnormal fluid pressure in the inner ear).