Tinnitus (pronounced; tinites or tinaites) is from the Latin word; “tinnire” which means “to ring”. Therefore, tinnitus is a sound in the head, ringing in the ear with no external source. To some people, it’s a ringing sound, while for others, it’s whistling, buzzing, chirping, hissing, humming, roaring, sizzling, beeping, songs or sounds that resemble human voice or even shrieking. Most of the patients may report that the sound may seem to come from one ear or both, and from inside the head, or from a distance. It may be constant or intermittent, steady or pulsating.
Causes of tinnitus (ringing in the ear):
However, tinnitus (ringing in the ear) is not a disease but a symptom that can result from several underlying causes. One of the most common causes is noise-induced hearing loss. Other causes include ear infections, disease of the heart or blood vessels, Ménière’s disease, brain tumours, emotional stress, exposure to certain medications, a previous head injury, and accumulation of earwax. Some researchers believe that it is more common in those with depression.
Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise. For example, attending a loud concert can trigger short-lived tinnitus. Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. Other drugs that may cause tinnitus includes but not limited to the following: Ciprofloxacin, Doxycycline, Gentamicin, erythromycin, tetracycline, tobramycin, and vancomycin, chloroquine and quinine, carbamazepine and so many other drugs.
The trend of tinnitus (ringing in the ear):
When it lasts more than six months, it’s known as chronic tinnitus. It’s especially common in people over age 55 and strongly associated with hearing loss.
Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it is rare.
Tinnitus can be classified as subjective or objective. It is subjective tinnitus because it is only you that can hear the noise. But sometimes it’s objective, meaning that someone else can hear it, as well. For example, if you have a heart murmur, you may hear a whooshing sound with every heartbeat; when checked by the health care personnel, they can also hear that sound through a stethoscope. Some people hear their heartbeat inside the ear, a phenomenon called pulsatile tinnitus. This is more pronounced among the aged since the blood flow tends to be more turbulent in arteries whose walls have stiffened with age. Pulsatile tinnitus is usually more noticeable at night when the patients are lying in bed and there are fewer external sounds to mask the tinnitus.
There is uncertainty surrounding the course of chronic tinnitus. Many patients sometimes reported that the symptoms remain the same, and sometimes they get worse. In about 10% of cases, the condition interferes with everyday life so much that you need professional help.
Sound waves travel through the ear canal to the middle and inner ear, where hair cells in part of the cochlea help transform sound waves into electrical signals that then travel to the brain’s auditory cortex via the auditory nerve. When you damage hair cells— by loud noise or ototoxic drugs, for example —the circuits in the brain don’t receive the signals they’re expecting. This stimulates abnormal activity in the neurons, which results in the illusion of sound, or tinnitus.
Tinnitus (ringing in the ear) can also be a symptom of Meniere’s disease, a disorder of the balance mechanism in the inner ear. This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input.
Most tinnitus is “sensorineural,” meaning that it’s due to hearing loss at the cochlea or cochlear nerve level. But tinnitus may originate in other places. Our bodies normally produce sounds (called somatic sounds) that we usually don’t notice because we are listening to external sounds. Anything that blocks normal hearing can bring somatic sounds to our attention. For example, one can have head noise when earwax blocks the outer ear.
At present, there’s no cure for chronic tinnitus. Regardless of the causes it often becomes less noticeable and more manageable over time. The health care providers will usually help ease the symptoms by educating the patients about the condition.For example, for them to understand that it’s not dangerous. And that there are also several ways to help tune out the noise and minimize its impact.
Evaluate and treat underlying problems
It is important to consult health care providers if one develops tinnitus. He or she will take a medical history, conduct a physical examination, and do a series of tests to try to find the source of the problem.
Such questions as; to describe the noise (including its pitch and sound quality, and whether it’s constant or periodic, steady or pulsatile) and the times and places in which they occur. Your clinician will review your medical history, your current and past exposure to noise, and any medications or supplements you’re taking. Tinnitus can be a side effect of many medications, especially when taken at higher doses.
-jaw clenching, tooth grinding, prior injury, or muscle tension in the neck — sometimes make tinnitus more noticeable, so your clinician may ask you to tighten muscles or move the jaw or neck in certain ways to see if the sound changes. If tight muscles are part of the problem, massage therapy may help relieve it.
Tinnitus (ringing in the ear) that’s continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist.
Pulsatile tinnitus calls for medical evaluation, especially if the noise is frequent or constant. MRI or CT imaging may need to check for a tumour or blood vessel abnormality.
Moreover, patients general health can affect the severity and impact of tinnitus, so this is also a good time to take stock of the diet, physical activity, sleep, and stress level — and take steps to improve them. It may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.
Reduce the risk of hearing loss
For patients who are often exposed to loud noises at work or at home, it’s important to reduce the risk of hearing loss (or further hearing loss) by using protectors such as earplugs or earmuff-like or custom-fitted devices.
In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. No single approach works for everyone, so there is a need for various combinations of techniques before finding what works for a particular patient. For patients having age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds.
The most effective approaches are behavioural strategies and sound-generating devices, often used in combination. They include the following:
Cognitive-behavioural therapy (CBT).
Tinnitus retraining therapy (TRT). This technique is based on the assumption that tinnitus results from abnormal neuronal activity.
The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome.
Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off.
Biofeedback and stress management. Tinnitus is stressful, and stress can worsen tinnitus. Biofeedback is a relaxation technique that helps control stress by changing bodily responses.
Other therapies. Other treatments that have been studied for tinnitus include transcutaneous electrical stimulation of parts of the inner ear by way of electrodes placed on the skin or acupuncture needles, and stimulation of the brain using a powerful magnetic field (a technique called repetitive transcranial magnetic stimulation, or rTMS). As of 2014, there were no medications effective for idiopathic tinnitus.
Though there is no cure, most people with tinnitus get used to it over time; for a minority, it remains a significant problem.
Summarily, tinnitus caused by some ototoxic drugs or as a result of Side effects of drugs can go away if the drugs are withdrawn. However, this is dependent on the range of exposure and dosage. Tinnitus due to other factors may last for life or better managed and live with.