Tinnitus – April 2012

The Causes and Management of “Tinnitus”

Famous Quotes

“My ears whistle and buzz continuously…this condition is truly frightful!” Ludwig van Beethoven, 1802

“I have severe hearing damage.  It’s manifested itself as tinnitus, ringing in the ears at the frequencies I play guitar.  It hurts, it’s painful, and it’s frustrating.” Pete Townsend, guitarist for The Who, 1978

Introduction

Tinnitus is the perception of sound in the ears or head.  It is experienced by 20% of the adolescent and adult population of America, but varies in severity.  It may be continuous, or intermittent.  It is certainly more prevalent with advancing age, but is alarmingly common in children and adolescents.

Tinnitus may be brief and self-limiting (after exposure to extreme noise), or be a life-long chronic disability.

The human brain is responsible for the “production” of tinnitus in response to irritation or damage of the hearing pathways.  Tinnitus is frequently heard at the exact pitch or frequency that the effected ear fails to hear well.  Therefore, a person with high pitched ringing will often have a high tone hearing loss, and the patient with buzzing, roaring or rushing tinnitus may have a loss at the mid and lower pitches in hearing.

Generally, tinnitus has no cure, but can be managed and made more tolerable.  On occasion, ear infections, growths, wax impactions or offending medications can be identified and corrected.

Medical Evaluation

All patients with tinnitus must have a complete hearing test, since hearing loss, even minor, can be at the root of the problem.  Often, the audiologist can match the pitch of tinnitus with a specific tone deafness. A thorough physical examination of the ears, sinuses and facial region is done.

Rarely, MRI or CT scanning is indicated.  Each patient with tinnitus is unique, and therefore the evaluation is tailored to the individual. Usually, blood tests are not particularly useful in evaluation of tinnitus. You should tell your ENT doctor if you have poorly controlled hypertension, diabetes or thyroid disease that can aggravate tinnitus.

Causes or Aggravatging Factors of Tinnitus

  1. Tinnitus is usually related to measurable hearing loss, typically in the higher frequencies, usually from the aging process, or prior acoustic trauma (exposure to loud noise).   Many patients tell me “If it weren’t for this noise in my ears, I would hear better!!” The truth, however, is the hearing loss itself is provoking the brain to create the tinnitus that torments us.  We are seeing more tinnitus in younger patients due to chronic use of headphones and “ear buds”.  Men and women of the military may experience tinnitus immediately after their exposure to firearms, or years/decades later.  Persons exposed to loud noise on the job, or recreationally, are more likely to damage nerve hearing and have tinnitus.  Prior head trauma (concussion) can cause temporary or chronic tinnitus as well.
  2. Reversible and treatable causes of tinnitus include impacted ear wax, infections or growths of the ear, or disorders such as Meniere’s Disease, a fluid build-up in the inner ear chamber.  These causes of tinnitus are unfortunately not found nearly as frequently as those causes in #1 above.
  3. Chemicals and drugs:
    A.  Beverages, foods and inhalants containing caffeine, nicotene, alcohol, THC (found in marijuana), chocolate, tea leaves, excess salt all can aggravate tinnitus.  A very common aggravating factor for tinnitus is excess caffeine intake through drinking coffee, tea or energy drinks.
    B.  Over-the-counter and prescription drugs associated with tinnitus: Aspirin, Naproxysen (Aleve), Ibuprofen (Motrin, Advil), Celebrex or any of the drugs in the class “non-steroidal anti-inflammatory”.  Usually, the higher the dose of these medications, the more likely they will cause tinnitus. As a rule, “low dose” aspirin (81mg daily) will not cause tinnitus. Also, any decongestant such as Sudafed, or combination cold remedies may cause tinnitus.

Treatment

  1. Avoid exposure to loud noise – wear earplugs (pre-made such as “Mack’s, or custom fitted by hearing aid audiologist).
  2. Try to avoid drugs and chemicals that aggravate the ringing (see above), especially caffeine, nicotene and other stimulants.  Discuss with primary care doctor any drugs you find on list at end of handout that may aggravate tinnitus.
  3. If you have a hearing loss, consider a digital hearing aid. Seventy percent of patients with hearing loss causing tinnitus will be relieved of much of their ringing with a hearing aid. For people with near normal hearing, a Tinnitus masker (looks like a hearing aid, produces a constant white noise) can be worn during the day.  These are expensive, and may interfere with hearing.
  4. Focus on staying rested, managing stress and regular exercise.
  5. Try making techniques. They are useful especially at rest or sleep.  Create a competing noise such as a ticking clock, white noise from radio or TV, soothing music.  You can purchase tapes, CDs and downloads of “relaxing noise” on the computer (iTunes has a section of “relaxation sounds” to download).  Products that generate pleasant masking noise are also available at specialty stores such as Sharper Image and Brookstone.
  6. Treat Depression. Over 50% of patients who are troubled by chronic tinnitus are clinically depressed.  Ask your primary care doctor to consider initiating therapy with “SSRI’s (newer medications for depression).  If depression is treated, the disability from tinnitus is greatly reduced.
  7. Some patients have found some relief using Melatonin (natural substance in vitamin section) for tinnitus relief before bedtime, Ginko Biloba or Niacin during the day.  There is no scientific evidence any of these supplements are effective, however.
  8. Biofeedback, counseling, and acupuncture have been tried with varying degrees of success.
  9. Try to be reassured that your ringing is NOT a sign of a serious condition, after you complete your evaluation with us.  IF your symptoms change (worsening hearing, vertigo, weakness of facial muscles, severe headache or other neurologic symptoms such as severe weakness or numbness, you must return for evaluation or discuss your condition with your main physician or with Dr. Kreutzer.

Conclusions

I probably see over 5 patients every day that complain of tinnitus.  In my 30-year career in ENT, that amounts to around 30,000 individuals with this complaint with whom I have worked.  With each patient, I share the frustration of not generally being able to offer them an easy solution to this frustrating symptom. The management of this condition is usually more in your hands than mine.  I hope my suggestions, reassurance and support are useful to you.

Please investigate the American Tinnitus Association website for new research and support.

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