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| | Tinnitus PATIENT INFORMATION | Tinnitus is a medical term for noise in the ear or head noise. It is usually a benign condition. However, it can be a symptom of a more significant problem. Tinnitus is almost always accompanied by hearing loss. This is most commonly seen associated with a high tone nerve hearing loss. The character of your tinnitus is important in determining the cause of your tinnitus. The quality of sound can vary a great deal. Sometimes this is perceived as a ringing noise, buzzing noise, or roar. Most people experience the noise continuously. However, some people experience intermittent tinnitus. Broadly, tinnitus can be defined in two categories: subjective tinnitus, or objective tinnitus. By far most people experience subjective tinnitus that is heard only by the patient. Occasionally, one can experience noise in the head that can be heard by other people.
Objective Tinnitus
Most forms of objective tinnitus are due to an irregular blood flow in or around the ear. The most usual cause is pulsatile tinnitus due to blood flow through the jugular vein which runs through the ear. This jugular vein collects blood from the brain and takes it back to the heart. With pulsatile tinnitus, one experiences a rhythmic swooshing sound in the ear that coincides with the heartbeat. If it is due to flow through the jugular vein, this can easily be stopped by gentle pressure on that side of the neck. Pulsatile tinnitus of this nature usually goes away with time. Rarely, this can be due to a blood flow disservice through the carotid artery, which also courses through the ear. The carotid artery carries blood to the brain. This is a more serious condition and requires further testing. This pulsatile tinnitus is not stopped by gentle pressure on the neck. Other problems such as aneurysms and blood vessel malformations can also cause pulsatile tinnitus. Sometimes pulsatile tinnitus can be the sign of a tumor growing in the ear or skull. For this reason, you may require testing such as head scans and blood vessel studies to evaluate the cause of your pulsatile tinnitus.
A rare type of objective tinnitus is called muscular tinnitus. One hears a rhythmic twitching noise or fluttering noise in the ear. This can be caused by an irregular contraction of one of the two ear muscles in the middle ear that are attached to the hearing bones. This is very similar to the twitching of the eyelids that some people experience upon occasion. Muscular tinnitus can be related to caffeine intake, lack of sleep, and stress. It can also occur independent of any apparent cause. Also, the muscles in the throat that open and close the Eustachian tube from the nose to the ear can have a similar spasm and cause muscular tinnitus. This form of tinnitus usually resolves with time. If it does not resolve in a short time, low doses of anti-seizure medications can usually stop the contractions. If these prove ineffective, the muscles in the middle ear can be cut to stop their contractions by a minor surgical procedure.
Subjective Tinnitus
Subjective tinnitus is by far the most common type of tinnitus. It can be induced in almost anyone by taking a great deal of aspirin. It is also something that most of us have experienced after being around a very loud noise for a while, such as a concert or shooting a gun. This is due to a temporary shift in our hearing. If our hearing was measured at this time, it would also be diminished. Fortunately, in most cases, this is a temporary problem that resolves, and the tinnitus goes away. We all lose some of our hearing as we get older, and, as they get older and lose some hearing, most people experience tinnitus as well. Hearing loss from being around loud noises is also often accompanied by tinnitus. For most people the tinnitus or noise is not a great bother. Masking the noise the ear makes with other noises such as having a radio, television, or fan on will mask over the noise the ear makes. This is usually satisfactory. In some cases, however, the tinnitus can be very severe and bothersome, and there are some people in which the tinnitus can be debilitating.
Most people notice the tinnitus early in their hearing loss, and often times it comes on abruptly. It is believed that this is due to a threshold of hearing nerves being affected. As with anything new in the body, this is very annoying and bothersome at first. However, it usually becomes less notice able as time goes on, much as the sensation of wearing eyeglasses, a watch, or ring becomes less noticeable as time goes on.
Some medications can exacerbate or even cause tinnitus. Many of the anti-inflammatory medications such as aspirin or Ibuprofen and other medicines in that class can cause tinnitus or make it worse. Medications that induce hearing loss such as some strong antibiotics or chemotherapeutic agents can also induce tinnitus.
Rarely, one can have a disorder of the brain that causes tinnitus. The area of the brain that receives input from the ears can have seizure-like activity and produce tinnitus.
A rare but serious condition that can cause tinnitus is a growth on the hearing nerve known as an acoustic neuroma. The presenting symptom of acoustic neuroma is tinnitus in one ear. As the tumor grows, it causes hearing loss in addition to tinnitus, and eventually grows into the brain, giving it the potential to cause serious problems. For this reason, we are quick to order an MRI scan or other tests to look for an acoustic neuroma in the case of unilateral tinnitus.
Treatment of Tinnitus
The treatment of tinnitus varies somewhat depending on the cause of the tinnitus. In cases of pulsatile tinnitus due to irregularities in blood vessels, it is sometimes necessary to treat these lesions with surgery or radiological procedures. If the pulsatile tinnitus is due to flow through the jugular vein, it is often suggested to change head positions or put pressure on the neck and give this time. Most of the time the blood will start going another way, and the tinnitus will resolve.
For subjective tinnitus, it is best to try and make sure that there are no medications being taken that would exacerbate the condition, such as aspirin. Also, it is well known that stress and anxiety will exacerbate the level of tinnitus. Measures are taken to try and relieve stress and anxiety in these situations. However, most people in society today do experience a certain level of stress and anxiety that cannot be avoided.
The best treatment for tinnitus is masking. Usually one can drown out the noise their ear makes with other noises by turning on a radio, television, or fan. There are even special devices made for this such as the sleep machine found at Radio Shack. This device has a volume control and a selection of several different noises such as the ocean, a train, the wind, or a running stream. This especially helps at night. During the course of the day there is a lot going on to occupy the mind, as well as noise around. However, as one is trying to go to sleep, everything is quiet, and the noise in your ear is more noticeable. Noisemakers like the the sleep mate are helpful.
In some cases masking alone is not satisfactory, and medications are used. The most effective medication is one that was found by accident. Amitriptyline, which is an old antidepressant, was found to help with tinnitus in some patients that were taking it for depression. It is believed to work by decreasing the neurotransmitters, or chemicals that transmit nerve impulses, from the inner ear. If it is helpful, often only a small dose is needed. You will probably be asked to take ten milligrams nightly for five nights, and then increase this by ten milligrams every five nights until you are taking fifty milligrams a night. If no response is seen to fifty milligrams, it is unlikely that this medication will be effective for you. This medication can cause dry mouth, constipation, and sleepiness.
Another medication that is used that works in a much different way is Xanax. This is a medication that decreases anxiety. Essentially, the tinnitus is still there, but you simply don't care so much. This medication can be quite helpful in severe cases of tinnitus. However, as it can be habit forming, it is not given as a first line of treatment.
In those persons with significant hearing loss, hearing aids are very helpful in the treatment of tinnitus. They bring in natural sound so that the noise your ear makes is not heard. Of course they are not helpful when one is trying to go to sleep because you don't wear your hearing aids to sleep with.
Another device that is helpful is a tinnitus masker. This looks like a hearing aid but is designed to put noise in your ear at the same frequency but out of phase with the noise your ear makes. This helps to mask out and drown out the noise your ear makes. However, it compromises your hearing ability because of the device being in your ear. Some people like the tinnitus masker a great deal, while others do not like it at all.
Biofeedback is a method in which we train our brain to ignore the irregular signal from our ears. This method works well to relieve tinnitus. However, it is expensive and time consuming and requires training by skilled personnel. For this reason, we usually recommend this as one of the later treatments. Nevertheless, it is quite effective.
Summary
Tinnitus, or head noise, is a common accompaniment with hearing loss. Usually it is not of any great concern. However, in some people it can be debilitating. Fortunately, there are treatment measures to help combat the bothersome nature of tinnitus. We will do all we can to help you with any problems you are having with tinnitus at the Jackson Ear Clinic. If you have any questions please do not hesitate to ask us.
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