Mr Nigam ENT Treatments - Tinnitus
Tinnitus (pronounced "tin-it-us") is a noise heard by the patient which is not caused by any sound in the environment. Tinnitus is common, more than half of the normal population has intermittent tinnitus. About 6% of the general population has what they consider to be severe tinnitus. Tinnitus can come and go, or be continuous. It can sound like a low roar, or a high pitched ring. Tinnitus may be in both ears or just in one ear. Some people are so severely affected that they cannot lead normal lives.
Tinnitus is commonly accompanied by hearing loss. Less commonly, it may be accompanied by hyperacusis (an abnormal sensitivity to sound).
The most common types of tinnitus are ringing or hissing ringing and roaring (low-pitched hissing). Some persons hear chirping, screeching, or even musical sounds.
Tinnitus always consists of fairly simple sounds; for example, hearing someone talking that no one else can hear would not ordinarily be called tinnitus: this would be called an auditory hallucination.
There is also a specific type of tinnitus known as pulsatile tinnitus. With pulsatile tinnitus, people hear something resembling their heartbeat in their ear. The cause is usually vascular, tumor-related, or muscular in nature. A blood vessel may be close to the eardrum, a vascular tumour such as a glomus tumour may fill the middle ear, or a vein similar to a varicose vein may make enough noise to be heard. Other possibilities include dehiscence of the jugular bulb, and an aberrantly located carotid artery. An enlarged jugular bulb on the involved side is common in persons with venous type pulsatile tinnitus.
Tinnitus is usually static noise in the auditory system that is associated with loss of sound from the external environment. Therefore, tinnitus is common and in most, but not all, cases it is associated with some degree of hearing loss. The most common causes of tinnitus are damage to the high frequency hearing by exposure to loud noise or elevated levels of common drugs that can be toxic to the inner ear in high doses. For example, after you have been to a loud rock concert you may experience tinnitus for a while in association with dulling of hearing. If the tinnitus goes away and hearing seems to come back, this is called a temporary threshold shift. Some permanent damage to the delicate hair cells in the inner ear has probably occurred from the noise trauma, so it is important that you prevent further injury from noise exposure.
People who take large amounts of aspirin may experience tinnitus which goes away if they stop the aspirin. This also is usually a temporary hearing loss. Also, other medications have been known to cause tinnitus. Tinnitus may be heard when there is a temporary conductive hearing loss due to ear infection or due to blockage of the ear with wax, or may be associated with any other cause of conductive hearing loss. Tinnitus is typically associated with the fluctuation in hearing that occurs with Meniere's disease. Therefore, diagnosis is important to identify the cause and determine if treatment is indicated.
Most tinnitus comes from damage to the inner ear (see Figure 1), specifically the cochlea. Tinnitus can also arise from damage to the nerve between the ear and brain (8th nerve, also called the vestibular nerve); from injury to the brainstem and, rarely, to the brain itself.
Pulsatile tinnitus (tinnitus that beats with your pulse) can be caused by aneurysms, increased pressure in the head (hydrocephalus), and hardening of the arteries. Anything that increases blood flow or turbulence such as hyperthyroidism, low blood viscosity (for example, anaemia), or tortuous blood vessels may cause pulsatile tinnitus. Vitamin B12 deficiency is common in tinnitus patients.
Many medications can cause tinnitus. Generally this is thought to arise from their effect on the cochlea (ear). The following is a list of some common medications that may contribute to tinnitus:
- Nonsteroidal anti-inflammatory drugs (NSAIDS), such as naproxen
- Aspirin and other salicylates
- Frusemide and other "loop" diuretics
- Antibiotics ending in - mycin (such as erythromycin)
- Quinine and related drugs
- Chemotherapy