Tinnitus

Tinnitus is hearing ringing, buzzing, or other sounds without an external cause. Patients may experience tinnitus in one or both ears or in the head.

Description

Tinnitus affects as many as 40 million adults in the United States. It 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 tumors, 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 and symptoms

Subjective tinnitus is frequently associated with hearing loss. About 90% of patients have sensorineural hearing loss; 5% suffer from conductive hearing loss; 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 or excessive noise
• ototoxic medications, including aspirin, quinine, some diuretics, heavy metals, alcohol, and certain antibiotics
• meniere's syndrome
• head trauma
• systemic diseases, including syphilis, hypertension, anemia, or hypothyroidism
• tumors of the ear

Diagnosis

Diagnosis of tinnitus includes a physical examination of the patient's head and neck. The doctor will use an otoscope to examine the ears for wax, infection, or structural changes. He or she will also use a stethoscope to listen to the blood vessels in the neck. Additional tests may include the following:

Tuning fork tests

The Rinne and Weber tests are commonly used to evaluate the type and severity of hearing loss. In the Weber test, the doctor holds a tuning fork against the patient's forehead or front teeth. If the hearing loss is sensorineural, the sound radiates to the ear with better hearing; if the hearing loss is conductive, the sound will be louder in the damaged ear. In the Rinne test, the tuning fork is placed alternately on the mastoid bone (behind the ear) and in front of the ear. In conductive hearing loss, bone conduction (BC) is greater than air conduction (AC). In sensorineural hearing loss, AC is greater than BC.

Diagnostic imaging

Magnetic resonance angiography or venography (MRA and MRV) can be used to evaluate malformations of the blood vessels. Computed tomography scans (CT scans) or magnetic resonance imaging scans (MRIs) can be used to locate tumors or abnormalities of the brain stem.

Blood tests

The doctor may order a complete blood count (CBC) with specific antibody tests to rule out syphilis or immune system disorders.

Treatment

Some cases of tinnitus can be treated by removal of the underlying cause. These include surgical treatment of impacted ear wax, tumors, head injuries, or malformed blood vessels; discontinuance of ototoxic medications; and antibiotic treatment of infections.

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 (elimination of smoking, coffee, and aspirin).

Alternative treatment

A variety of alternative therapies may be helpful in the treatment of tinnitus. Dietary adjustments, including the elimination of coffee and other stimulants, may be useful, since stimulants can make tinnitus worse. In addition, reducing the amount of fat and cholesterol in the diet can help improve blood circulation to the ears. Nutritional supplementation with vitamin C, vitamin E, B vitamins, calcium, magnesium, potassium, and essential fatty acids is also recommended. Gingko (Gingko biloba) is often suggested, since it is believed to enhance circulation to the brain. Acupuncture treatments may help decrease the level of tinnitus sounds the patient hears, and constitutional homeopathic treatment may also be effective.

Prognosis

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.