Coping with Tinnitus

Tinnitus or a ringing sensation in the ears, like many other conditions, affect the quality of life. Many people who have tinnitus claim that they find it hard to think, sleep, concentrate, or enjoy silence. Untreated tinnitus can lead to irritability, insomnia, and even depression. With so many people struggling, ENT specialists around the world have been looking for solutions that might cure tinnitus, or at least lift some of the burden. If you have tinnitus, or know someone who does, this information might help you come up with some solutions.

What is Tinnitus?

Tinnitus is the perceived sensation of sound in the absence of a corresponding external acoustic stimulus. The word tinnitus originates from the Latin word tinnire (to ring). Tinnitus can be divided into subjective or objective forms: in the former, only the patient is aware of the sound sensation: in the latter, the sound can be perceived by others, either unaided, using a stethoscope or a microphone and amplifier. Mostly, the sounds reported are simple sounds: whistling, humming, ringing or tones. More complex sounds are sometimes described including voices or music.

What causes Tinnitus?

Contrary to popular belief, tinnitus isn’t a condition on its own. It’s actually a symptom of a larger problem - usually hearing loss or circulatory damage. Tinnitus can also be caused by injuries to the ear or ear canal. Before we can treat tinnitus, we need to figure out the underlying issue.

It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus.

But it can also be the result of a number of health conditions, such as:

• Noise-induced hearing loss - Working in factories and other noisy places damages tiny sensory hair cells in the inner ear that help transmit sound to the brain

• Exposure to bomb blast / gun-shot noises - Army men exposed to bomb blasts can develop tinnitus if the shock wave of the explosion squeezes the skull and damages brain tissue in areas that help process sound. In fact, tinnitus is one of the most common service-related disabilities among army veteran

• Presbycusis - Hearing loss due to old age

• Ear and sinus infections

• Ménière’s disease - Associated with dizziness, hearing loss and ear fullness

• Otosclerosis – Fixation of stapes bone

• Skull base tumours like vestibular schwannoma

• Hormonal changes in women

• Thyroid abnormalities

• Anxiety and depression

• Tympanomandibular joint dysfunction

• Side effects of drugs like quinine, salicylates, anti-cancer drugs

• Smoking / alcohol intake

• Vascular tumours, arteriovenous malformations in head neck region - It can cause pulsatile tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal.

• Idiopathic tinnitus - No detectable cause

When to see a doctor regarding Tinnitus?

Some people are not very bothered by tinnitus. For other people, tinnitus disrupts their daily lives. If you have tinnitus that bothers you, see your doctor.

Make an appointment to see your doctor if you develop tinnitus after an upper respiratory infection, such as a cold, and your tinnitus does not improve within a week.

See your doctor as soon as possible if you have hearing loss or dizziness with the tinnitus OR you are experiencing anxiety or depression as a result of your tinnitus.

How is Tinnitus treated?

The treatment for tinnitus varies depending on what is causing it. To help identify the cause of tinnitus, thorough medical history is taken and examination of the ears, nose, head and neck is performed. Common tests include:

• Hearing (audiological) exam – Pure Tone Audiometry (PTA) results will be compared with results considered normal for that age. This can help rule out or identify possible causes of tinnitus due to hearing loss.

• Tinnitus loudness / pitch matching – To identify the frequency and loudness of the tinnitus

• Balance tests – To identify causes when tinnitus is associated with giddiness

• Imaging tests (MRI) – in cases of unilateral tinnitus with hearing loss, dizziness we may suspect a rare skull base tumour (vestibular schwannoma) for which MRI scans are mandatory.

• Lab tests – To check for anaemia, thyroid problems, heart disease or vitamin deficiencies

Can Tinnitus be cured?

Once the cause for tinnitus is identified, we treat the root cause. Examples include:

• Ear wax removal - Removing an ear wax blockage can decrease tinnitus symptoms

• Treating ear or sinus infections

• For hearing loss associated with tinnitus – Hearing Aids help in amplifying the environmental sounds and masking the tinnitus

• For Drug induced tinnitus – Stopping or reducing the dosage can help

• Surgical management of the root cause of tinnitus – In cases of otosclerosis (stapes bone fixation), Menieres disease (endolymphatic sac decompression), vestibular schwannoma / skull base tumour (lateral skull base surgery by translabyrinthine / retrosigmoid approach)

What happens if the Tinnitus cannot be cured?

Many times, tinnitus can not be cured. But there are treatments that can help make the symptoms less noticeable. It is often suggested to use an electronic device to suppress the noise. Devices include:

• White noise machines - These devices, which produce a sound similar to static, or environmental sounds such as falling rain or ocean waves, are often an effective treatment for tinnitus. Patients may want to try a white noise machine with pillow speakers to help them sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also produce white noise and may help make tinnitus less noticeable at night.

• Masking devices - Worn in the ear and similar to hearing aids, these devices produce a continuous, low-level white noise that suppresses tinnitus symptoms.

Role of Cochlear Implants in Tinnitus

When tinnitus is associated with profound hearing loss, tinnitus suppression has been seen as a secondary benefit of cochlear implantation. Improvement of tinnitus occurs in up to 86% of implanted patients and, interestingly, in up to 67% the benefit applies to the other ear as well as the implanted ear!

Counselling patients with Tinnitus

Tinnitus can start affecting the quality of life of a patient so a great extent. It increases depression, leads of inability to sleep well, lack of concentration and other cognitive symptoms specially when associated with hearing loss in geriatric population. Behavioural treatment options aim to help you cope with the symptoms of tinnitus you change the way you think and feel about your symptoms. Over time, your tinnitus may bother you less. A common report of patients seen in specialist tinnitus clinics is that clinicians who they have previously consulted have offered a very pessimistic view of tinnitus outcome. Reports such as "the doctor told me that I would have it forever and nothing can be done" are all too common. This negative counselling is damaging for patients with tinnitus and should always be avoided.

Counselling options include:

• Tinnitus retraining therapy (TRT)
  TRT is an individualised program that is usually administered by an audiologist or at a tinnitus treatment centre. TRT combines sound masking and counselling from a trained professional. Typically, a device is worn in your ear that helps mask your tinnitus symptoms while you also receive directive counselling. Over time, TRT may help you notice tinnitus less and feel less distressed by your symptoms.

• Cognitive behavioural therapy (CBT) or other forms of counselling
  A licensed mental health professional or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counselling can also help with other problems often linked to tinnitus, including anxiety and depression.

• Medications
  Drugs can not cure tinnitus, but in some cases they may help reduce the severity of symptoms or complications like Gingko biloba. Antidepressants and anti-anxiety medications often help to reduce associated mental health conditions thus leading to a better quality of life.

Potential future treatments

Researchers are investigating whether magnetic or electrical stimulation of the brain can help relieve symptoms of tinnitus. Examples include trans-cranial magnetic stimulation (TMS) and deep brain stimulation.

How can I prevent of Tinnitus?

In many cases, tinnitus is the result of something that can not be prevented. However, some precautions can help prevent further damage to cochlear hair cells and nerve of hearing.

• Use hearing protection
  Over time, exposure to loud sounds can damage the nerves in the ears, causing hearing loss and tinnitus. Factory workers, army personnel exposed to sounds of gun-shots / bomb explosions need ear muffs and other protective devices to limit the exposure to loud noise.

• Turn down the volume
  Long-term exposure to amplified music with no ear protection or listening to music at very high volume through headphones can cause hearing loss and tinnitus.

• Take care of your cardiovascular health
  Regular exercise, eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to obesity and blood vessel disorders.

• Limit alcohol, caffeine and nicotine
  These substances, especially when used in excess, can affect blood flow and contribute to tinnitus.