Tinnitus

Tinnitus (from the Latin word tinnītus meaning "ringing")

- is the perception of sound within the human ear in the absence of corresponding external sound.

Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period (but usually with some duration), ear infections, foreign objects in the ear, nose allergies that prevent (or induce) fluid drain, or wax build-up. Tinnitus can also be caused by natural hearing impairment (as in aging), as a side effect of some medications, and as a side effect of genetic (congenital) hearing loss. However, the most common cause is noise-induced hearing loss.

As tinnitus is usually a subjective phenomenon, it is difficult to measure using objective tests, such as by comparison with noise of known frequency and intensity, as in an audiometric test. The condition is often rated clinically on a simple scale from "slight" to "catastrophic" according to the practical difficulties it imposes, such as interference with sleep, quiet activities, and normal daily activities.

Tinnitus is common; about one in five people between 55 and 65 years old report symptoms on a general health questionnaire, and 11.8% on more detailed tinnitus-specific questionnaires.

Characteristics

Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise, but in some patients it takes the form of a high pitched whining, electric, buzzing, hissing, screaming, humming, tinging or whistling sound, or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping, or even a pure steady tone like that heard during a hearing test.  It has also been described as a "wooshing" sound, as of wind or waves. Tinnitus can be intermittent or it can be continuous, in which case it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw, or eye movements.

Prevention

Tinnitus and hearing loss can be permanent conditions. If a ringing in the ears is audible following lengthy exposure to a source of loud noise, such as a music concert or an industrial workplace, it means lasting damage may already have occurred.

Prolonged exposure to sound or noise levels as low as 70 dB can result in damage to hearing (see noise health effects). For musicians and DJs, special musicians' earplugs play an important role in preventing tinnitus; they can lower the volume of the music without distorting the sound and can prevent tinnitus from developing in later years. For anyone using loud electrical appliances, such as hair dryers or vacuum cleaners, or who work in noisy environments such as building sites, where earmuffs are impractical, earplugs are also helpful in reducing noise exposure. While operating lawn mowers, hammer drills, grinders, and similar, earmuffs may be more appropriate for hearing protection.

It is also important to check medications for potential ototoxicity. Ototoxicity of multiple medicines can have a cumulative effect, and can greatly increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.

Treatment

There are a number of treatment options available, each with its own procedures and explanations as to why it can be beneficial to someone suffering from tinnitus.  Since different treatment strategies may be more suitable for particular cases of tinnitus, we will focus on your needs and expectations when selecting the appropriate method of treatment.

One treatment strategy that is frequently employed is Sound Therapy, where asound generator is used to provide relief from tinnitus.  Sound generators can be small noisemakers that resemble hearing aids or can include such things as sound pillows, radios, televisions, etc.

With Sound Therapy, the sound generator helps to reduce the perceived strength of the tinnitus signal by introducing a background noise that partially covers the tinnitus signal.  Ultimately, over time, less priority and importance is assigned to the tinnitus and relief is achieved.

Another well-known treatment strategy is Tinnitus Retraining Therapy (TRT).  In TRT, emphasis is placed on education and how the brain is involved in the perception of tinnitus.  The goal of TRT is to gain knowledge and understanding of the mechanisms underlying your tinnitus, which will help you gain more control over your emotions and reactions to the tinnitus.  The desired result is that you will place less importance and priorities on your tinnitus, which will then help you, cope with it more efficiently.  Sound Therapy is an important component of TRT.  As a result, TRT provides a more effective combined solution to tinnitus treatment.

In addition to Sound Therapy and TRT, there are also psychological models of treatment that may include biofeedback, behavioral treatment, existential treatment and many more.  Depending on the severity of your tinnitus, a psychological approach can be used in conjunction with other types of treatment when indicated.

As with any treatment plan, results take time and there are no “quick fixes.”  Some immediate relief may take place, but ultimately, the goals are to become more comfortable with your tinnitus, realize that it is not life-threatening and, most importantly, know that you have control over your reactions to it.

 

A tinnitus sound generator (TSG) is a small hearing instrument-like device that delivers sound to the ear to help provide relief from perceived tinnitus.  TSG products come in a variety of shapes and sizes, including instruments that sit over the ear called behind-the-ear (BTE) instruments as well as custom-made options that are designed to fit into the unique contours of your ears.

Like hearing aid technology, TSG technology has improved greatly over the years.  The noise generated by the instruments can be modified to provide individualized and comfortable settings for your specific needs.  The noise can be modulated as needed to provide a more soothing “ocean-like” sound (similar to the tide rolling in and out) that can be more relaxing than the traditional noise provided by previous TSG products.  There are also automatic features, which make it easier to you to go through your daily activities without having to “fiddle” with the devices.  The technology will automatically increase the volume of the TSG when you are in quiet (where your tinnitus is more noticeable) but lower the volume when speech is present or in noisier situations (where your tinnitus is less apparent). 

Should you have complaints of tinnitus AND hearing loss, there are advanced options called combination devices that offer the unique flexibility of having both a TSG and hearing aid in the same device.  Two separate instruments are not necessary to treat two different individual conditions.  Talk to one of our audiologists to determine what options may be most appropriate for you.

 

Tinnitus rehabilitation takes time.  Remember that tinnitus itself does not cause harm.  Rather, it is your reactions to the tinnitus that can affect your life.  Learning to cope with your tinnitus is a process and should be carefully monitored and treated over a period of time.

Some patients report quick relief using TSG or combination devices.  They find that the devices “take the edge” off the tinnitus.  The goal of the devices is to decrease the perceived strength of the tinnitus by suppressing it with the therapeutic noise generated by the instruments.  Over time, it is expected that habituation to (getting used to) the tinnitus will occur.  When this happens, you can learn to live comfortably with your tinnitus. 

Studies have shown that it can take 3-6 months for complete habituation to occur and maximum benefit to be achieved when using TSG or combination devices.  However, others report that treatment is needed for 9-12 months or as long as two years.  Results will vary.  Regardless of the length of your treatment plan, you will need to work with your audiologist to identify what works best for you and to commit to the recommended treatment program.

 

For most individuals, there are no quick fixes for tinnitus, but there are some lifestyle changes to manage your tinnitus more effectively.  Here are some tips that may be helpful:

  • Maintain good dietary and lifestyle habits (exercise):

Restricting intakes of sodium and caffeine may help to reduce the perceived strength of the tinnitus signal.  Additionally, moderate exercise can aid in stress reduction, general health, sleep patterns, etc.

  • Keep busy:  By occupying your time with a variety of enjoyable activities and engaging in tasks that require attention, less time may be spent focusing on your tinnitus. 
  • Avoid complete silence:  By adding some light background noise (for example: music, television) the strength of your tinnitus signal may be reduced against the background noise.  This can be useful during quiet times or when trying to fall asleep.  

Wearing hearing protection only when needed:  Inappropriate use of hearing protection can increase sensitivity of the hearing system, making you more aware of your tinnitus.  Hearing protection should only be used when exposed to hazardous levels of noise that could damage your hearing and potentially make your tinnitus worse.  Hazardous levels of noise can damage, and even destroy the hair cells in your inner ear.  Increased damage to hair cells can magnify your tinnitus.

http://en.wikipedia.org/wiki/Tinnitus