Tinnitus

By , November 17, 2014 1:14 am

 

 

Tinnitus ringing” is the perception of sound within the human ear (“ringing of the ears“) when no external sound is present. Despite the origin of the name, “ringing” is only one of many sounds the person may perceive.

Tinnitus is not a disease, but a condition that can result from a wide range of underlying causes. The most common cause is ototoxic tinnitus).

Tinnitus is usually a subjective phenomenon, such that it cannot be objectively measured. The condition is often rated clinically on a simple scale from “slight” to “catastrophic” according to the difficulties it imposes, such as interference with sleep, quiet activities, and normal daily activities.[3]

If there is an underlying cause, treating it may lead to improvements.[5]

Signs and symptoms

Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise, but in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound, or as ticking, clicking, roaring, “crickets” or “tree frogs” or “locusts ([8]

Most people with tinnitus have some degree of [11]

The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by one hearing the sounds of one’s own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one’s ear, changes within the canal of one’s ear or issues related to blood flow of the neck or face.[12]

Course

There has been little research on the course of tinnitus, and most research has been retrospective. An Australian study of participants aged 49–97 years found that 35% of participants reported that their tinnitus was present all the time and 4% rated their tinnitus as annoying. Findings from a retrospective National Study of Hearing found that for 25% of people surveyed, the perceived volume of their tinnitus increased over time, while for 75% it did not. The rate of annoyance decreased for 31% of people from onset of tinnitus to the middle time. A study of the natural history of tinnitus in older adults found that for women, tinnitus increased for 25%, decreased in 58%, leaving 17% unchanged. The study found that for men, tinnitus increased in 8%, decreased in 39%, leaving 53% unchanged. Information about the course of tinnitus would benefit from prospective studies investigating change over time as these studies may potentially be more accurate.[13]

Psychological

Persistent tinnitus may cause irritability, fatigue, and on occasions, clinical depression[16]

Tinnitus annoyance is more strongly associated with psychological symptoms than acoustic characteristics.[22]

Causes

Objective tinnitus

In some cases, others can perceive an actual sound (e.g., a [28]

Subjective tinnitus

Subjective tinnitus can have many possible causes, but most commonly results from [29]

Subjective tinnitus is also a side effect of some medications, such as aspirin, and may also result from an abnormally low level of serotonin activity. It is also a classical side effect of quinidine, a Class IA anti-arrhythmic. Over 260 medications have been reported to cause tinnitus as a side effect.[30] In many cases, however, no underlying physical cause can be identified.

Tinnitus can also occur due to the discontinuation of therapeutic doses of [32]

Causes of subjective tinnitus include:[33]

Pathophysiology

One of the possible mechanisms relies on citation needed]

Another possible mechanism underlying tinnitus is damage to the receptor cells. Although receptor cells can be regenerated from the adjacent supporting [38] Therefore, if these hairs become damaged, through prolonged exposure to excessive sound levels, for instance, then deafness to certain frequencies results. In tinnitus, they may relay information that an externally audible sound is present at a certain frequency when it is not.

The mechanisms of subjective tinnitus are often obscure. While it is not surprising that direct trauma to the inner ear can cause tinnitus, other apparent causes (e.g., temporomandibular joint dysfunction and dental disorders) are difficult to explain. Research has proposed there are two distinct categories of subjective tinnitus: otic tinnitus, caused by disorders of the inner ear or the acoustic nerve, and somatic tinnitus, caused by disorders outside the ear and nerve, but still within the head or neck. It is further hypothesized somatic tinnitus may be due to “central crosstalk” within the brain, as certain head and neck nerves enter the brain near regions known to be involved in hearing.[39]

It may be caused by increased neural activity in the auditory brainstem where the brain processes sounds, causing some auditory nerve cells to become overexcited. The basis of this theory is most people with tinnitus also have hearing loss,[9] and the frequencies they cannot hear are similar to the subjective frequencies of their tinnitus.[10] Models of hearing loss and the brain support the idea a homeostatic response of central dorsal cochlear nucleus neurons could result in them being hyperactive in a compensation process to the loss of hearing input.[11]

Diagnosis

The basis of quantitatively measuring tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient’s tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which they hear. The volume of the tinnitus will always be equal to or less than that of the sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above). For example: if a patient has a pulsatile paraganglioma in their ear, they will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible, and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.

Objective tinnitus, however, is quite uncommon. Often patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise, that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods. However, pulsatile tinnitus can be a symptom of intracranial vascular abnormalities, and should be evaluated for bruits by a medical professional with auscultation over the neck, eyes, and ears. If the exam reveals a bruit, imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.[40]

The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week.[41] However, people with chronic tinnitus often experience the noise more frequently than this, and can experience it continuously or regularly, such as during the night, when there is less environmental noise to mask the sound.

Severity

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress (i.e. nature and extent of tinnitus-related problems), measured subjectively by validated self-report tinnitus questionnaires.[48]

Auditory evoked response

Tinnitus is the description of a noise inside a person’s head in the absence of auditory stimulation. The noise can be described in many different ways, but the most common description of the tinnitus is a pure tone sound. Tinnitus affects one third of adults at some time in their lives, whereas ten to fifteen percent are disturbed enough to seek medical evaluation.[49]

Tinnitus can be classified as either subjective or objective. Objective tinnitus can be detected by other people and is usually caused by [51]

Tinnitus can be evaluated with most auditory evoked potentials; however results may be inconsistent. Results must be compared to age and hearing matched control subjects to be reliable. This inconsistently reported may be due to many reasons: differences in the origin of the tinnitus, ABR recording methods, and selection criteria of control groups. Since research shows conflicting evidence, more research on the relationship between tinnitus and auditory evoked potentials should be carried out before these measurements are used clinically.

Differential diagnosis

Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects have been tested and found to hear high-pitched transmission frequencies that sound similar to tinnitus.[52]

Prevention

Prolonged exposure to Ear plugs can help with prevention.

Avoidance of potentially ototoxic medicines. Ototoxicity of multiple medicines can have a cumulative effect, and can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.[54]

Management

If there is an underlying cause, treating it may lead to improvements.[4]

Psychological

The best supported treatment for tinnitus is a type of counseling called [58]

Medications

There are no medications as of 2014 that are effective for tinnitus and thus none is recommended.[4]

Other

The use of [53]

Alternative medicine

[53]

Objective tinnitus

Prognosis

Most people with tinnitus get used to it over time.[5]

Epidemiology

Tinnitus is present in 10-15% of people.[5]

Research

As of 2013 many potential treatments are being investigated.[70]

Children

Tinnitus is commonly thought of as a symptom of adulthood; this may be why tinnitus in children is generally overlooked. Children with hearing loss have a high incidence of tinnitus, even though they do not express that they have tinnitus and the effect it has on their lives.[74]

 tinnitus remedy

See also

References

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  13. ^ Baguley D, Andersson g, McFerran D, McKenna L (2013). Tinnitus: AMultidisciplinary Approach (2nd ed.). Blackwell Publishing Ltd. pp. 16–17. 
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External links

Further reading

  • Baguley, David; 712915603. 
  • Hogan, Kevin; Battaglino, Jennifer (May 2010) [1998]. Tinnitus: Turning the Volume Down (Revised & Expanded ed.). Eden Prairie, MN, USA: Network 3000 Publishing. 779877737. 
  • Langguth, B.; Hajak, G.; Kleinjung, T.; Cacace, A.; Møller, A.R., eds. (December 2007). Tinnitus : pathophysiology and treatment. Progress in brain research 166 (1st ed.). Amsterdam ; Boston: Archived from the original on 2007. Retrieved 5 November 2012. 
  • help) (subscription required)
  • Tyler, Richard S. (2000). Tinnitus Handbook. A Singular audiology textbook. San Diego, CA, USA: Singular Publishing Group. 471533235. 

This article uses material from the Wikipedia article Tinnitus, which is released under the Creative Commons Attribution-Share-Alike License 3.0.

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