Tinnitus (Ringing in the Ears and Other Ear Noise)

What is tinnitus?

Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases it is not a serious problem, but rather a nuisance that eventually resolves. Rarely, however, tinnitus can represent a serious health condition.
It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise.

What causes tinnitus?

Tinnitus can arise in any of the following areas: the outer ear, the middle ear, the inner ear, or by abnormalities in the brain. Some tinnitus or head noise is normal. If one goes into a sound proof booth and normal outside noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body sounds, because outside noise masks them. Anything, such as ear wax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.
One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently chronic tinnitus.
Today, loud noise exposure is a very common cause of tinnitus, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms, and high intensity music.
Some medications (for example, aspirin) and other diseases of the inner ear (Meniere's syndrome) can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as a brain aneurysm or a brain tumor (acoustic tumor).

How is tinnitus evaluated?

A medical history, physical examination, and a series of special tests can help determine precisely where the tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent or pulsating (synchronous with the heart beat, referred to as pulsatile tinnitus), or is it associated with hearing loss or loss of balance (vertigo). All patients with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the doctor to the diagnosis.
Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography scan (CT scan) or, magnetic resonance imaging (MRI scan) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.

What is the treatment of tinnitus?

After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of the tinnitus (what has caused it, the person's specific symptoms, and options for treatment).

Tinnitus medications

In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a permanent disability that the patient will have to "live with." Some otolaryngologists (ear specialists) have recommended niacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing.
The drug gabapentin (Neurontin, Gabarone), was studied in high doses, and reduced the annoyance level of the tinnitus in some patients, but did not decrease the volume of the noise, and was not found to be better than placebo.
A 2005 study in Brazil using acamprosate (Campral), a drug used to treat alcoholism, showed a nearly 87% rate of relief of symptoms. Studies of this drug for treatment of tinnitus are currently ongoing in the United States.

What are tinnitus relief remedies?

Some common and easy remedies such as the following may be of benefit to some individuals.

• Reducing or avoiding caffeine and salt intake, and quitting smoking may help relieve tinnitus symptoms.
  
• Some tinnitus patients have been found to have lower zinc levels and may benefit from zinc supplementation.
  
• One study showed melatonin may help tinnitus sufferers, particularly those with disturbed sleep due to the tinnitus. However, this is not yet been verified in controlled studies.
  
• Ginkgo Biloba has been touted as a natural tinnitus remedy, but controlled studies to date have not shown it to be effective.
  
• There are some behavioral and cognitive therapies that have been successful in treating tinnitus. Seeking out a multidisciplinary program at a tinnitus center may improve chances of successful treatment. The types of therapies include tinnitus retraining therapy, masking, and behavioral therapy.

Can tinnitus be prevented?

Do not place objects in your ear such as cotton swabs (Q-tips) to clean your ear. This can cause a wax impaction against your eardrum which can cause tinnitus. Take blood pressure medicines and other prescribed medications as they are ordered by your doctor.
According to the American Tinnitus Association there are several things you can do to protect yourself from excessive noise related tinnitus:

• Protect your hearing at work. Your work place should follow Occupational Safety & Health Administration (OSHA) regulations. Wear ear plugs or earmuffs and follow hearing conservation guidelines set by your employer.
  
  
• When around any noise that bothers your ears (a concert, sporting event, hunting) wear hearing protection or reduce noise levels.
  
• Even everyday noises, such as blow drying your hair or using a lawnmower, can require protection. Keep ear plugs or earmuffs handy for these activities.

Is there anything to do to lessen intensity of the tinnitus?

It is important to realize that the hearing system is one of the most delicate and sensitive mechanisms in the body. Since it is a part of the general nervous system, it is sensitive, to some degree, by anything that affects the overall health of the individual (both physical and psychological). Therefore, in order to lessen the intensity of tinnitus, it is advisable to make every effort to:

• Avoid exposure to loud sounds and noises
  
• Control blood pressure
  
• Decrease salt intake
  
• Avoid nerve stimulants such as coffee and colas (caffeine) and tobacco (nicotine)
  
• Reduce anxiety
  
• Try to stop worrying about the tinnitus. Often, the more you worry and concentrate on the noise, the louder it will become.
  
• Get adequate rest and avoid fatigue.
  
• Exercise
  
• Utilize masking noise. Tinnitus is usually more bothersome when the surroundings are quiet, especially when you are in bed. A competing sound such as a ticking clock, a radio, a fan or white noise machine may help mask tinnitus. Small hearing aid like devices which generate a competitive sound may help reduce the awareness of the tinnitus.
  
• Biofeedback may help or diminish tinnitus in some patients.
  
• Avoid aspirin or aspirin products in large quantities

Tinnitus At A Glance

• Tinnitus is abnormal ear noise.
  
• Tinnitus can arise in any of the four sections of the ear: the outer ear, the middle ear, the inner ear, and the brain.
  
• Persisting unexplained tinnitus is evaluated with a hearing test (audiogram).
  
• Measures can be taken to lessen the intensity of tinnitus.

Additional resources from WebMD Boots UK on Tinnitus

REFERENCES:

Arda, H.N. et al. The role of zinc in the treatment of tinnitus. Otol Neurotol. 2003 Jan;24(1):86-9.

Azevedo, A.A. et al. Tinnitus treatment with acamprosate: double-blind study. Braz J Otorhinolaryngol. 2005 Sep-Oct;71(5):618-23. Epub 2006 Mar 31.

Megwalu, U.C. et al. The effects of melatonin on tinnitus and sleep. Otolaryngol Head Neck Surg. 2006 Feb;134(2):210-3.

Up-To-Date.com. Tinnitus.

Medical Author:

John P. Cunha, DO, FACOEP

Medical Editor:

William C. Shiel Jr., MD, FACP, FACR
Source:Medicinenet.com.