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Tinnitus is a condition where the patient hears ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head.
Tinnitus is defined as either objective or subjective. In objective tinnitus, the doctor can hear the sounds as well as the patient. Objective tinnitus is typically caused by tumours, turbulent blood flow through malformed vessels, or by rhythmic muscular spasms. Most cases of tinnitus are subjective, which means that only the patient can hear the sounds.
Causes & Symptoms
Subjective tinnitus is frequently associated with hearing loss and damage to the cochlea or inner ear. About 90% of patients have sensorineural hearing loss; 5% suffer from conductive hearing loss; and 5% have normal hearing.
The causes of subjective tinnitus include:
* impacted ear wax * ear infections * hardening of the structures of the inner ear * hearing-loss related to age * prolonged exposure to excessive noise * ototoxic medications, including aspirin, quinine, some diuretics, heavy metals, alcohol and certain antibiotics * Ménière's syndrome * head trauma * systemic diseases, including syphilis, hypertension, anaemia and hypothyroidism ? tumours of the ear
Dietary adjustments, including the elimination of coffee and other stimulants, may be useful in treating tinnitus. Reducing the amount of fat and cholesterol in the diet can help improve blood circulation to the ears. Consumption of vitamin C, vitamin E, B vitamins, calcium, magnesium, potassium and essential fatty acids can be helpful.
Zinc supplements have been recommended for patients diagnosed with tinnitus. A recent Turkish study has confirmed that older people whose diets have been deficient in zinc may benefit from supplements of this mineral as a treatment for tinnitus, but that younger patients eating well-balanced diets do not find that their symptoms improve when they take zinc supplements.
Gingko biloba, a herbal extract, has been shown to decrease tinnitus symptoms in controlled animal studies and may be helpful in treating humans, since it is believed to enhance circulation to the brain in situations where reduced circulation is the cause. Individuals taking such blood thinners as coumadin or heparin should not take Ginkgo biloba, as the herb can interfere with platelet activating factor, the chemical that enables blood to clot.
Acupuncture treatment may help decrease the level of tinnitus sounds the patient hears.
Tinnitus Retraining Therapy, or TRT, has been successful in treating some subjective tinnitus patients. This therapy is based on the assumption that the severity of tinnitus is determined not by the patient's auditory system, but by the parts of the brain that control emotion (the limbic system) and body functions (autonomic nervous system). TRT focuses on habituating the patient to his or her tinnitus, retraining the brain to, in effect, "become used to" the tinnitus so that it does not perceive it as an annoyance.
Some cases of tinnitus can be treated by removal of the underlying cause. These include surgical treatment of impacted ear wax, tumours, head injuries and malformed blood vessels, discontinuance of ototoxic medications and antibiotic treatment of infections.
Patients whose tinnitus is related to temporomandibular joint disorder, or TMJ, which is caused by dysfunction of the temporomandibular joint in the jaw, usually experience improvement in or complete disappearance of the tinnitus when the dental problem is corrected.
Subjective tinnitus, especially that associated with age-related hearing loss, can be treated with hearing aids, noise generators or other masking devices, biofeedback, antidepressant medications, or lifestyle modifications.
One mainstream form of psychotherapy that is recommended to patients with tinnitus is cognitive-behavioral therapy, or CBT. CBT works by changing the patient's emotional reaction to the tinnitus. The patient keeps a symptom diary and works on an individual basis with a counsellor to identify negative thought patterns and behaviours related to the tinnitus and then changes them. The latest innovation in CBT for tinnitus is therapy via the internet. According to a 2002 study by a group of Swedish researchers, 31% of patients who participated in a CBT program via the internet reported significant relief from tinnitus at 1-year follow-up.
The prognosis depends on the cause of the tinnitus and the patient's emotional response. Most patients with subjective tinnitus do not find it seriously disturbing, but about 5% have strong negative feelings. These patients are frequently helped by instruction in relaxation techniques. Studies indicate that CBT is most effective as a treatment for tinnitus when it is combined with masking techniques or medication.
One preventive measure is to wear earplugs when operating loud machinery or spending extended periods in such noisy environments as rock concerts. Prolonged exposure to noises of 90 decibels (about as loud as a running food-blender) or higher can cause permanent hearing loss and tinnitus. In some cases a change of occupation may be advisable; a recent study found that as many as 266,000 men and 84,000 women in the United Kingdom between the ages of 35 and 64 suffer from tinnitus resulting from work-related noise.