Tinnitus is a subjective manifestation, perceived by the patient as an abnormal noise in the ears in the form of whistling, clicking, clicking or whistling. The conditions that favor the appearance of tinnitus and the duration of its evolution determine the acute or chronic nature of this manifestation.
The neuroscientific studies carried out so far attest to the fact that the neural changes associated with tinnitus are initiated at the level of the cochlear nucleus and later expand affecting the cerebral cortex, being directly responsible for the appearance of unpleasant auditory sensations in the ear.
Tinnitus is a manifestation that affects the quality of life of millions of people worldwide, being more frequently encountered in people over 60 years old and in young people in military service that involves the use of firearms. It is estimated that approximately 2% of the general population is affected by tinnitus and calls on the medical services of various specialties – family doctor, otolaryngologist, psychiatrist or neurologist to treat this manifestation.
Pulsatile tinnitus manifests itself in the form of rhythmic pulsations perceived by the patient in the ear. This type of tinnitus is frequently determined by vascular pathologies involving obstruction of blood flow to the neck and head, brain tumors or cerebral vascular anomalies.
What can cause tinnitus?
The pathological mechanisms favoring the occurrence of tinnitus have not been fully elucidated, but currently, it is considered that this manifestation may be due to the brain’s inability to adapt to the physiological loss of the number of auditory sensory cells that occurs with age.
Another theory that can explain the way tinnitus occurs refers to the disturbances in the neural circuits in the brain areas involved in the perception of sounds as a result of damage to the inner ear and its inability to transmit information to the auditory cortex.
Tinnitus is a manifestation that can be found in over 200 conditions, among the most common pathologies that cause the sensation of noise in the ear to be found:
- Ear infections due to bacterial or viral causes that cause chronic inflammation and pressure changes at the level of the eardrum
- Serous otitis – pathology of the ear that involves the accumulation of liquid in the tympanic cavity
- Meniere’s disease – a pathology found in all age groups that develop with tinnitus, vertigo and hypoacusis
- Dysfunction of the Eustachian tube, the organ that ensures the connection between the ear and the nasopharynx
- Otosclerosis: pathology characterized by an abnormal growth of bones inside the ear
- Abnormalities of the temporomandibular joint
- Vestibular neuronitis – an inflammatory condition of the vestibular nerve of viral or idiopathic etiology (unknown)
- Muscle spasms in the inner ear due to a neurological pathology – multiple sclerosis, stroke
- Acoustic neuroma – a benign tumor formation at the level of the cranial nerve that ensures the transmission of information from the brain to the inner ear
- Tumors of the brain or of the cervical area that have a compressive character on the vasculature of the head and neck
- Arterial hypertension
- Atherosclerotic disease
- Diabetes mellitus
- Thyroid disorders
- Systemic lupus erythematosus
- Rheumatoid polyarthritis
- Anemic syndromes
- Syphilis
The sudden onset and increased intensity of noises perceived by the patient unilaterally (at the level of only one ear) may indicate the presence of a severe pathology with unfavorable spontaneous evolution, sometimes life-threatening – stroke that requires the provision of specialized medical care as quickly as possible.
In certain situations, tinnitus can be of genetic cause and manifests itself in the form of an inherited sensitivity at the level of the auditory nerve, which is associated hypoacusis in various degrees.
Tinnitus risk factors
The risk factors that predispose to the occurrence of tinnitus are represented by:
- Practicing professions that involve repeated and/or prolonged exposure to high-intensity noises is the case of factory workers, weavers, construction workers, and military personnel who use firearms and explosive materials.
- Lifestyle – frequenting clubs and listening to music in headphones at high volume. Learn more about audio headphones – how do we use them?
- Gender – men are more prone to this type of manifestation compared to women.
- Aging – the tinnitus that accompanies the gradual decrease in hearing acuity is more frequently perceived by the elderly compared to the young population.
- Administering certain types of drug therapies that include antibiotics, nonsteroidal anti-inflammatory drugs, chemotherapy, antiepileptics, antidepressants, or diuretics.
- Low-intensity bilateral tinnitus can be favored by a sudden drop in blood pressure or glycemic values or repeated professional exposure to noise above 70-80 dB. Another factor predisposing to the occurrence of tinnitus is accidental damage to the auditory nerve during surgical excision of acoustic neurinomas.
The diagnosis of tinnitus
The diagnosis of tinnitus is established by the ENT doctor based on the information obtained after the patient’s history and clinical examination, which includes the auditory system, nose and throat. In certain situations, the attending physician may recommend the performance of additional investigations represented by:
- Audiometry
- Tone audiometry
- Eye, jaw, and neck movement tests
- Imaging tests – Doppler ultrasound, Computer Tomography (CT) or Nuclear Magnetic Resonance (NMR) of the head and neck
The laboratory investigations requested by the attending physician of the patient who complains of tinnitus have as their main purpose the identification of the causes that determine the appearance of unpleasant manifestations in the ear and may include:
- Determination of thyroid hormones
- glucose
- CBC
- Specific antibodies for a series of autoimmune diseases, inflammatory factors
- Lipid profile and serology
- Early diagnosis and treatment of the causes that favor the appearance of ringing in the ear prevents the appearance of memory disorders, concentration difficulties, depression or anxiety syndromes, and complications of chronic tinnitus, which significantly reduce the patient’s quality of life in the long term
Tinnitus treatment
The treatment of tinnitus is etiological and addresses the causes that induce its appearance.
In the case of tinnitus that occurs secondary to the accumulation of earwax, the ENT doctor will clean the external auditory canal and instruct the patient on the correct way to clean the ear.
The severity of the symptoms can be improved in certain situations by administering antidepressants and benzodiazepines.
In the case of patients who associate tinnitus due to a cardiovascular disease, it is possible to opt for the modification of the background treatment, in accordance with the recommendations of the cardiologist.
Patients who complain of tinnitus accompanied by hearing loss may receive a recommendation for the use of a hearing aid from the ENT specialist, depending on the degree of hearing impairment and the patient’s quality of life.
Electrical stimulation is a treatment method for improving tinnitus with an efficiency of up to 80% of cases, which involves the “correction” of hyperreactivity in certain brain areas by applying an electric current of reduced intensity (2mA).
Repetitive transcranial magnetic stimulation, resetting the tonotopic map, cognitive behavioral therapy or hypnosis represent other therapeutic options that can be considered for tinnitus relief.
Another treatment method that can be recommended for patients with tinnitus is represented by the cochlear implant, a medical device that directly stimulates the auditory nerve, generating changes in neural circuits and improving symptoms.
The ENT doctor can recommend the use of anti-noise devices during activities that involve exposure to loud noises, to prevent the occurrence of tinnitus and/or hearing loss in patients who associate this type of risk factors.
References:
- Characterization of Tinnitus by Tinnitus Patients, J. L. Stouffer, Richard S. Tyler – https://pubs.asha.org/doi/abs/10.1044/jshd.5503.439
- General Review of Tinnitus – Prevalence, Mechanisms, Effects and Management, James A. Henry, Kyle C. Dennis, Martin A. Schechter – https://pubs.asha.org/doi/abs/10.1044/1092-4388%282005/084%29
- The neuroscience of tinnitus, Jos J. Eggermont, Larry E. Roberts, Science Direct – https://www.sciencedirect.com/science/article/abs/pii/S0166223604002760
- Tinnitus, Alan H. Lockwood, Richard J. Salvi, Robert F. Burkard, The New England Journal of Medicine – https://www.nejm.org/doi/full/10.1056/NEJMra013395
