TINNITUS

The Causes

In some cases, tinnitus can be caused by damage to the hair cells in the ear and/or to the nerve fiber. However, in most cases, the real culprit is the brain. When it detects the reduction of auditory input from the ears, it tries to compensate by increasing the power of the sound signals it is receiving. This is akin to turning up the volume of the TV to make it easier to hear faint sounds. This results in stressing out the sound cells and the perception of the phantom sounds that do not really exist.

The common causes of tinnitus include:

• Exposure to high volume levels. This could be from ambient sounds of all kinds, including loud music, explosive sounds, wearing headphone with the volume too loud and so on
• Smoking
• Tinnitus may be gender-related as men are more likely to suffer from it as compared to women
• Advancing years, as the susceptibility increases with age
• Infection or disease affecting the middle ear
• Damage to the hair cells in the ear due to the normal aging process
• Excessive stress that affects or weakens the nervous system as a whole
• Meniere's disease
• Some medications have the potential to cause hearing loss, tinnitus, equilibrium/balance issues such as vertigo and dizziness etc. For example, aspirin is known to cause problems for those with certain types of ear problems
• In very rare cases, tinnitus can be a sign of a more serious medical condition such as a nerve tumor or a brain aneurysm

Treatment

Treatment begins with a detailed assessment of the patient including developing a detailed case history, evaluating the hearing function, establishing the severity of the tinnitus, identification of causal factors, associated symptoms and determining if there are other medical conditions that contribute to the problem.

• The first step is to conduct tests to establish the parameters of the problem. These include:
• A complete examination of the ear to rule out an ear infection, and head and neck examination.
• Hearing tests - basic & advanced audiology test for hearing loss and tinnitus
• Laboratory blood tests
• Imaging studies: CT and MRI brain scan, blood vessel studies
• Discontinuing any ototoxic medications
• Treating any temporomandibular joint (TMJ) problems, which affect the joint between the jaw bone and the cheekbone

There are, at present, no medically proven cures for tinnitus, even though studies have shown positive results from medications, surgery and the use of neural and external sound simulators. Many widely used treatments involve counseling and there is evidence that cognitive behavioral therapy can be helpful. In many cases ignoring the problem rather than focusing on it can be helpful. People become accustomed to the phantom sounds are and able to tune it out.

However, some patients may develop insomnia, anxiety, hearing difficulties, social isolation and depression due to the effects of tinnitus. These patients will benefit from sound therapy, tinnitus retraining therapy (TRT) and cognitive behavioral therapy (CBT). Dealing with these issues, instead of ignoring them, can significantly improve a person's quality of life.

Sound therapy uses external noise to mask the effect of tinnitus. This can be achieved through the use of background music, white noise or the use of special ear maskers. The choice of sound should be that which is pleasant to the patient. Masking devices are only effective as long as they are turned on and the tinnitus reappears when they are turned off. Hearing aids which amplify environmental sounds and redirect attention to those instead of allowing the patient to focus on the phantom sound can be helpful.

Tinnitus retraining therapy involves retraining the auditory system to accept the abnormal sounds of tinnitus as natural rather than disruptive. Ongoing counseling sessions can help patients to cope with the condition. The success of this treatment depends on the severity of the condition and the patient's overall mental health. Studies have shown that this form of treatment provides relief to about 80% of those who receive it.

Cognitive behavioral therapy (CBT) can help relieve depression in people with tinnitus, although it does not appear to reduce the perceived sound.

Prevention

• As there is no accepted complete cure for tinnitus, prevention is critical. The following actions can help in preventing the development of tinnitus:
• Wearing hearing protection such as ear mufflers and earplugs when in noisy environments.
• Listening to personal music and audio devices at low to moderate volumes.
• Being in good overall physical condition and health will not prevent the onset of tinnitus but it will help in reducing the intensity of the condition and also will provide the patient with the strength and ability to deal with the situation more effectively. This can be achieved through regular exercise, a proper and nutritious diet, good sleeping habits, the use of stress management and relaxation techniques and so on.
• Stopping smoking, controlled alcohol consumption and the reduced intake of stimulants like coffee all help in dealing with tinnitus.
• Because there is a clear correlation between tinnitus and obesity and cardiovascular problems, controlling weight and blood pressure are important.
• Do not use cotton swabs for cleaning out the ears as this can cause damage to the eardrums that could result in tinnitus and other hearing problems. If the wax buildup is excessive, consult a doctor to have it removed safely.

If you have or suspect you have tinnitus or other hearing issues, consult with an ENT specialist to determine if there is a problem and if so, begin treatment without delay.

Article by Dr. Sundhari V,
Senior ENT Consultant
Kauvery Hospital