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What is Ringing in the Ears (Tinnitus)?

Tinnitus is a very common disorder, with an estimated 40 to 50 million Americans experiencing it every day.  It is an abnormal perception of sound that an individual may hear, not created by a sound source in the environment.  Tinnitus is usually described as a ringing in the ear or a variation of hissing, roaring, whistling, chirping, or clicking. Tinnitus can be intermittent or constant, with single or multiple tones.  It may occur with a hearing loss, dizziness or pressure symptoms in the ear, or it may occur alone.  Some tinnitus is normal, but tinnitus may also indicate that there is damage to some of the hearing structures.

Tinnitus is classified into subjective tinnitus (a noise perceived by the patient alone) or objective tinnitus (a noise perceived by the patient as well as by another listener).  Subjective tinnitus is common; however, objective tinnitus is relatively uncommon. The location of tinnitus may be in the ear, the head or both.

Tinnitus is a condition that may be difficult to quantify in terms of severity or impact on daily life.  The reported distress is usually subjective and difficult to appreciate by others.

Tinnitus may be produced in one or more locations, called sites of lesion. Tinnitus is thought to originate in the peripheral auditory system, such as the auditory nerve or cochlea in the inner ear, or in the central auditory system, which includes the brainstem and other portions of the auditory nervous system in the brain.

Tinnitus is a symptom, not a disease.  While the site of lesion may not be identifiable, tinnitus can be an indicator that something within the auditory system is unhealthy.  A complete evaluation by a physician specializing in the hearing system is necessary in all patients with tinnitus, especially in severe, disabling cases. The test battery is used to rule out any significant pathology which may require further treatment.

There are many factors that can contribute to tinnitus. Ear wax in the ear canal and middle ear abnormalities may result in tinnitus. Otosclerosis, which is a fixation of a bone in the middle ear, can cause tinnitus, as well as fluid in the middle ear. Meniere’s disease, trauma to the inner ear, such as exposure to excessively loud sounds, tumors on the hearing nerve or other problems in the brainstem or central nervous system may also cause tinnitus. In addition, other vascular abnormalities in the skull or base of the skull may result in varying degrees of tinnitus.

MEASUREMENT OF TINNITUS

Tinnitus is difficult to measure objectively.  A hearing test should always be performed to determine hearing sensitivity and possible problems that may contribute to the cause of the tinnitus.  Your hearing care specialist may try to match the pitch and loudness of the tinnitus.  In addition, your hearing specialist or audiologist will ask you for information on the nature of your tinnitus: is it constant or fluctuating, are there conditions that make it worse, what is the effect on your daily activities, and what is your description of the sound.  In discussing this information, the hearing care professional can give you information that will increase your understanding of tinnitus.

TREATMENT OF TINNITUS

Generally, most patients will not need any medical treatment for their tinnitus. For individuals who are greatly bothered by tinnitus and suffer no recordable hearing loss, a device called a tinnitus masker may be recommended.  This assistive device is built into a hearing aid case and generates a noise, much like that from a fan, or music which masks some of the tinnitus.  It is based on the principle that most individuals with tinnitus can better tolerate outside noise than they can noise within their own head.

If an individual suffers tinnitus in addition to a diagnosed hearing loss, a hearing aid may be recommended.  Some individuals with tinnitus have reported a decrease in tinnitus once they were fit with a hearing aid.

For individuals that suffer with tinnitus that interferes with sleep, other sound source generators can be obtained and be adjusted to sounds like environmental sounds or white noise.  These devices are placed within the environment to create extraneous noise.

Biofeedback training is effective in reducing the tinnitus in some patients. It consists of exercises where the individual learns to control various parts of the body and relax muscles. When a patient is able to accomplish this type of relaxation, tinnitus is reported to subside. Most patients have expressed that the biofeedback offers them better coping skills.

Other measures to control tinnitus include controlling anxiety and stress, obtaining adequate rest, reducing sodium intake and avoiding the use of nerve stimulants such as caffeine and smoking.  Additionally, some medications have been proven to decrease the intensity of tinnitus.  However, there is no drug to completely cure tinnitus at this time.  The use of medication for tinnitus should be discussed with a physician.

American Tinnitus Association

www.ata.org

American Speech-Language Hearing Association

http://www.asha.org/public/hearing/tinnitus/

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