Tinnitus

Introduction

Tinnitus is a perception of sound in proximity to head in the absence of an external source.

  • It can be perceived as being within one or both ears, within or around the head, or as an outside distant noise.
  • The sound is often a buzzing, ringing or hissing, although it can sound like other noises.
  • It may be continuous or intermittent (occasional), can be pulsing or steady, and can range in severity from a soft buzz to a loud ring.

The impact of tinnitus on an individual can be significant.

  • Some individuals "experience" tinnitus, while others "suffer from it."



Causes

Tinnitus becomes more common with age.

Tinnitus is often caused by damage to the tiny hairs on auditory cells within the inner ear.

  • Damage to the hair cells can be a result of normal aging, or it can occur after exposure to very loud noise, certain medications, injury or disease.

Occasionally, tinnitus can be a result of problems not related to the hearing system.



Management

For many patients, tinnitus is a chronic condition; goals of treatment are to lessen its impact and any associated disability, rather than to achieve absolute cure.

  • If possible, identify and treat the cause of the tinnitus.
  • If no cause is identified, reassure the patient and avoid drugs that can aggravate tinnitus.

Drugs that Exacerbate Tinnitus

NOTE: Often, tinnitus is the first sign that ototoxicity is occurring and can herald more severe injury to the inner ear. Discontinuing these medications can prevent progression to hearing loss and/or balance systems dysfunction in some patients even if tinnitus does not resolve.

Several behavioural therapy have been studied with some success

Masking techniques may help, including using a hearing aid if hearing loss is significant.

  • Use of background music, sound machines, radios on low volume, fans, and pillow speakers have been helpful to patients with tinnitus that is especially bothersome in quiet environments.

Surgery may be appropriate for certain underlying conditions, such as pulsatile tinnitus caused by vascular anomalies or otosclerosis.



Medications

Betahistine is an analogue of histamine and is claimed to improve the microcirculation of the labyrinth resulting in reduced endolymphatic pressure.

  • It is used to reduce the symptoms of vertigo, tinnitus, and hearing loss associated with Ménière's disease.

No good evidence supports drug therapy (e.g. antidepressants, benzodiazepines, antiepileptics) for tinnitus, other than for associated anxiety and depression.



Supplements

Ginkgo biloba, melatonin and zinc have been studied for use in treating tinnitus. While some patients report benefit from these types of treatment, there are no studies with high rates of improvement in tinnitus.



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