Tinnitus is the perception of sound that has no external source. The sensation is commonly described as ringing in the ears, but the sound can be perceived to be inside or outside the head or in one or both ears. The sound quality is commonly described as humming, tonal ringing, hissing, static, roaring, or a cicada-like clicking. Objective tinnitus, which is a sound generated within the body by blood flow, muscle contractions, or cochlear emissions that can be detected and measured by an external observer, is very rare. The much more common variant is subjective tinnitus.
Tinnitus occurs in up to one fourth of adults, but is severely bothersome in less than 10 percent of those persons. When severe, tinnitus can negatively affect sleep, concentration, emotions, and social interactions. The loudness, severity, and effect of tinnitus can change over time. It can progress in severity in some persons, while it can lessen or disappear in others. Tinnitus is almost always associated with hearing loss, especially high-frequency hearing loss. That is why audiologic (hearing) testing is an important component in the evaluation of persistent tinnitus. In evaluating tinnitus, it is important to look for ear pain or drainage as that may indicate an infectious source. Someone with a history of tinnitus with vertigo and/or imbalance may have Meniere’s disease, an acoustic neuroma (growth on the acoustic nerve), or migraine-associated tinnitus. Brain imaging (MRI or CT scan) is usually not indicated unless the patient has tinnitus in only one ear, pulsatile tinnitus, or one-sided neurologic abnormalities or one-sided hearing loss.
Because tinnitus may change over time, treatment is often problematic. In addition, studies have shown that the majority of people with tinnitus are minimally bothered by it. Many people who seek help with tinnitus do so out of concern that it is a symptom of a possible worse disease such as progressive hearing loss and deafness. A wide range of drug classes have been tested in the treatment of tinnitus with limited success. These medications include antidepressants, anti-anxiety medications, anti-seizure medications, and anesthetics, as well as herbal extracts, dietary supplements, and vitamins. One of the mainstays of treatment that has had better success is acoustic stimulation. Sound, in a variety of forms and intensities, has been used for centuries to treat tinnitus. The use of sound is based on the concept that hearing loss causes homeostatic compensatory changes in the brain (known as central auditory gain) to maintain proper ear neurologic function. In other words, in response to hearing loss, the brain basically turns up the volume. Using sound treatment allows the brain to turn the volume back down. In addition, psychological intervention has been successful in decreasing the negative effect of tinnitus on a patient’s life and well-being.
If you or someone you know suffers from tinnitus, it is important to be medically evaluated, but also to remember that tinnitus rarely remains the same over time and that there is a good chance that it may lessen by itself.
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