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Tinnitus

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Introduction to tinnitus

Unusual perception of sound (buzzing, ringing, roaring, whistling or hissing) in the head or ears, in the absence of any external acoustic (sound) sources is medically termed as tinnitus. The word tinnitus is derived from the Latin word, tinnire, which means ‘to ring.’ In UK, approximately 1 in 10 people are affected by tinnitus at some point of their lives while in America 1 in 7 or 8 people are affected by tinnitus.1,2 It is commonly prevalent among adults aged 40–80 years and occasionally in children.

The frequency of tinnitus in a patient may be irregular, continuous or pulsatile (synchronous with the heartbeat). Irrespective of the frequency, tinnitus is bothersome and is often quite upsetting. Several patients get accustomed to its presence while others might get depressed. By and large, stress exacerbates tinnitus.

Underlying Cause for Tinnitus

Most cases of tinnitus can actually result from the same conditions that cause hearing loss. The underlying conditions that might lead to tinnitus include the following:2,3

  • Unspecific lesion of the ear or the central auditory (hearing) system.
  • Noise-induced hearing loss.
  • Ototoxic medications (medications that might be toxic to ears, for example, salicylates aminoglycoside antibiotics and some chemotherapeutic drugs).
  • Ear or sinus infections.
  • Vascular middle ear tumors.
  • Thyroid disorder, higher cholesterol levels, vitamin B12 deficiency.
  • Depression and anxiety.
  • Circulatory system disorder.
  • Head/neck trauma.

Classification of Tinnitus

Tinnitus may be vibratory and nonvibratory type. The former type is caused by transmission of vibrations to the cochlea (inner ear structure) from adjacent tissues or organs while the latter type is produced by biochemical changes in the nerve mechanism of hearing. On the other hand, tinnitus is also classified as subjective or objective tinnitus. The most common is subjective tinnitus that is a condition, where only the patient perceives the unusual sound. The physician or the examiner or the ENT specialist can perceive objective tinnitus through a stethoscope placed over head and neck structures in the vicinity of the ear.

Evaluation of Tinnitus

Initially, evaluation of the patient with tinnitus begins with past medical history (such as onset, location, pattern and characteristic of tinnitus; hearing loss; and exposure to ototoxic medications/factors) followed by a thorough head and neck examination and audiometric testing (such as audiography, speech discrimination testing and tympanometry). Patients with unilateral (one ear) or pulsatile tinnitus are more likely to have serious underlying disease and should be referred to an ENT specialist.2,5 Depending on the severity of tinnitus, several patients require both MRI and CT scan to satisfactorily assess the underlying pathology.4

Treatment of Tinnitus

The severity of tinnitus varies from an occasional perception of noise in one or both ears, to an unbearable sound that drives some people to attempt suicide.5 First and foremost, the underlying condition has to be treated efficiently. Other treatments tend to reduce or mask the noise, and thereby alleviating the tinnitus. Few cases of tinnitus are irreversible and such patients are adequately counseled by professionals. Vitamin A, vitamin C, cyanocobalamin, nicotinic acid, magnesium, and zinc, or copper supplementation might be helpful.2 Drugs that are prescribed commonly for tinnitus include tricyclic antidepressants (amitriptyline and nortriptyline) and alprazolam. Medications may be helpful but cannot cure tinnitus, and might reduce the severity of symptoms or complications.

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References

1.Brunger K. Managing tinnitus. J Fam Health Care. 2008; 18(2): 47–48.

2.Pray JJ, Pray WS. Tinnitus: When the ears ring. US Pharmacist. 2005; 30(6).

3.Crummer RW, Hassan GA. Diagnostic approach to tinnitus. Am Fam Physician. 2004; 69: 120–126.

4.Fortune DS, Haynes DS, Hall JW. Tinnitus. Current evaluation and management. Med Clin North Am. 1999; 83: 153–162.

5.Schleuning AJ. Management of the patient with tinnitus. Med Clin North Am. 1991; 75: 1225–1237.

Tinnitus signs and symptoms

Written by: healthplus24.com team

Date last updated: March 23, 2015