Tinnitus is the condition in which there is a perception of sound when no real external sound is present. It can be described as ringing, buzzing, clicking or roaring in the ear.
Tinnitus is a symptom rather than a disease and is part of many ear disorders & side effects of drugs.
TYPES OF TINNITUS
- Subjective: Arises from hearing loss & diseases of the ear.
- Objective: Objective tinnitus can be detected by other people and is sometimes caused by an involuntary twitching of a muscle
- Pulsatile: Sound heard that beats with the pulse around the ear & caused due to underlying conditions like hypertension & atherosclerosis. Can be a symptom of a life threatening condition like carotid artery aneurysm.
SIGNS & SYMPTOMS
- Present in one or both ears
- Can be described as ringing, buzzing, hissing, humming, tinging, whistling, ticking, clicking, roaring, beeping, sizzling, etc.
- Problems in concentration
- Anxiety disorder
- Sleep disturbance
- In many people tinnitus is present with some amount of hearing loss or impairment
- Complications of tinnitus include: Deafness.
- Traumatic noise exposure that damages hair cells in the inner ear.
- Somatic or craniocervical tinnitus in which movement of the head or neck can cause the condition.
- Neuroplastic alteration in the brain due to disturbed sensory input caused by hearing loss.
- Noise induced hearing loss
- Due to drug side effects: Drugs that have ototoxic side effects can cause tinnitus. As many as 260 medications have this side effect, some of them are; aminoglycosides, loop diuretics, ciplatin, quinine, etc.
- Due to underlying conditions like hypertension & atherosclerosis which can cause pulsatile tinnitus; increased awareness of blood flow or turbulence in the blood flow near the ear.
RISK FACTORS FOR TINNITUS
- Middle ear effusion
- Presbycusis, age associated hearing loss
- Meniere’s Disease
- Mercury or lead poisoning
- Exposure to ototoxic agents like certain solvents & chemicals
- Neurological disorders like Arnold–Chiari malformation & multiple sclerosis
- Metabolic disorders like vitamin B12 deficiency & iron deficiency anemia
- Benzodiazepine withdrawal
- Intracranial hypertension
- Carotid artery aneurysm or dissection
- Trauma or injury to the head, neck or ear
- Earwax accumulation.
- Physical examination of the head, neck & ear. The patient may be asked to make head & neck movements, for checking tinnitus associated with such movements.
- A pure tone audiometry is conducted and an audiogram is generated for measurement of various parameters associated to the condition like pitch, loudness & hearing threshold.
- Diagnostic test called Electronystagmography (ENG), performed to detect the cause of the condition & detect presence of balance problems.
- Imaging test like MRI or CT scan are done to obtain the images of the vestibular system & the area of the brain associated with the ear, for detection & diagnosis of any neurological disease, structural problems or functional problems.
- Otoscopy for aid in diagnosis & detection of infection or inflammation in the ear or presence of a foreign body in the ear.
- Treatment of underlying conditions or disorders with relevant drugs to manage the associated symptoms like tinnitus.
- Management of hypertension & atherosclerosis
- Treatment of ear infections & inflammation
- Stopping use of drugs that can lead to ringing in the ear
- Medications for the management of anxiety & depression
- Botox injection prescribed in objective tinnitus
- Caroverine, a drug used in few countries for management of tinnitus.
- Cognitive behavioral therapy
MANAGEMENT & PREVENTION OF TINNITUS
- Relaxation exercises
- Sound therapy
- Use of hearing aids
- Use of tinnitus masking machines
- Transcranial magnetic stimulation
- Earwax removal
- Reducing alcohol consumption & smoking
- Taking extra care when a person is involved in or dealing with harmful chemicals, solvents & agents.