Tinnitus
Disease/Disorder Name: Tinnitus
ICD-9: 388.30 tinnitus, unspecified;
388.31 subjective
tinnitus;
388.32 objective tinnitus
Types of Tinnitus
There are two types of tinnitus; objective and subjective. The
objective type is where sounds are also heard by the physician and other
people, and is not so common. Subjective tinnitus are sounds that a person
hears but no one else can. It is subjective tinnitus that is most difficult
to treat. These subjective sounds can be perceived in one ear, two ears,
or within the head.
Causes of Tinnitus
-
Trauma to the middle or inner ear
Many of the people suffering from tinnitus have somehow damaged the ossicles of
the middle ear or some part of the inner ear. If the trauma damages the
inner hairs of the cochlea, the fluid chambers, or causes the nerve fibers
leading from the cochlea to the brain to discharge repetitively, then
tinnitus may be the result.
Some of the underlying
middle ear pathologies include otosclerosis,
Eustachian tube malfunction, and middle ear tumors such as glomus jugulare.
Some of the underlying
inner ear pathologies include auditory nerve disorders such as labyrinthitis,
Meniere’s disease, vestibular schwanoma
(a disease of the myelin sheath of the auditory nerves). diabetes mellitus, anemia,
hyperthyroidism, and hypertension.
- Presbycusis or hearing Loss Due to Aging
Presbycusis is the condition where people
experiences hearing loss while aging and this condition sometimes triggers tinnitus.
It has also been found out that sinusitis and allergy also triggers tinnitus.
- A Blocked
Eustachian tube
If the Eustachian tube is blocked due to a cold or
other infection or an allergy, it causes pressure buildup in the ear,
triggering tinnitus. If the cause is an infection,
then once the infection is past, the Eustachian
tube will open and the tinnitus should recede.
If the cause of a blocked Eustachian (and
subsequent tinnitus) is an allergy, the tinnitus
may persist for as long as the the Eustachian tube
is blocked. The allergic reaction within the body
is an immune response to a specific
allergy-causing agent. This agent could be pollen,
dust mites, food, or pets. Even the use of
anti-histamines such as epinephrine-based
medications may exacerbate the problem by drying
out the middle ear cavity, but not reducing the
swelling of the Eustachian tube.
Thyroid Disorder
The thyroid gland is one of the glands of
the endocrine system. It is wrapped around the esophagus near the top of
the breastbone. One of the functions of the thyroid gland is regulate the
heartbeat. If the thyroid produces too much thyroid hormone (T3 and T4), the body goes into
a condition known as hyperthyroidism, or "too much thyroid hormone
production". When this condition occurs, the
heart beats faster and harder, which causes a pulsating noise that can be
heard through through the inner ear i.e. the ear picks up sounds of the
blood pressure and the heartbeats from inside the body.
People with Type II diabetes are known to
have high incidences of tinnitus. The exact causes are thought to be
combinations of obesity, and an overworked endocrine system.
People with iron deficiencies are known to also have high incidences of tinnitus.
The exact causes are unknown.
Studies of patients who have been in starvation situations, or have been in environments where they have not
been able to eat foods that are high in vitamin A or B12 were shown to have high incidences of tinnitus.
Known prescription drugs that can cause tinnitus are antidepressants, anti-malarials, antibiotics
and antidepressants. Cancer treatment medications such as cisplatinum are also known to cause tinnitus. Even aspirin and compounds having aspirin
can also induce tinnitus. Needless to say, if you are on any of these medications and you begin to suffer the symptoms of tinnitus, see your
physician to get alternate treatment.
Acoustic Neuroma (Vestibular Schwannoma)
Acoustic neuromas are
benign tumors of the eighth cranial nerve in the
brain. These tumors usually cause hearing loss,
ringing in the ears or balance problems. Without
treatment, acoustic tumors will grow so large that
they eventually cause deafness in most patients.
Subjective Tinnitus Variations
Pulsatile (Pulsating) Tinnitus (Hearing the Heartbeat in the
Ear)
Pulsating tinnitus is a form of tinnitus that
produces a high-pitched hissing or squealing sound
in the ear and it pulsates in tandem
with the heart beat. The intensity of the noise
ranges from low, background and tolerable to extreme
intensity that can interfere with the normal
activities in daily living.
Causes of Pulsating Tinnitus:
There is a clear connection between this form of
tinnitus and blood flow, implying circulatory
problems. Some of these problems may be:
- Hypertension (High blood pressure)
- Atherosclerosis (Buildup of white
blood cell plaque on the walls of
arteries due to a chronic inflammation)
Causes the arteries to become restricted
to blood flow.
- Capillary abnormality - Genetic
disorder where the capillaries are formed abnormally.
- Vein Thrombosis - blood flow is
restricted due to blood clots, usually
in the legs. Causes can be advanced age,
obesity, infection, immobilization,
estrogen-based contraceptions,
tobacco usage and air travel
Treatment for Tinnitus
From the above causes, the treatment for tinnitus will
depend a lot on what the cause is. The
treatments can range from "let nature take its
course" to surgical intervention.
Pulsatile Tinnitus definitely requires a trip to the
doctor and/or the hospital for a complete blood
pressure diagnosis.
For acoustic neuromas, the standard protocol is surgery
to remove the tumor. Such treatment has resulted in
elimination of further tumor growth or reduction in
tumor size in more than 90 percent of patients.
Useful hearing can be preserved in about 35 percent
of cases but progressive hearing loss can also occur
after treatment. Sometimes if one of the facial
nerves is damaged or severed during the operation, a
permanent numbness or weakness of the face can
happen. This occurs very rarely (fewer than two
percent of cases). Periodic MRI scans are obtained (usually at one
year intervals) to monitor patient progress.
Can Hearings Aids
help with Tinnitus?
The
December 2008
issue of the Hearing Review reported a study done in the
United States as to the effectiveness of hearing
aids in overcoming the effects of tinnitus. The
following chart shows the results of the study:
Referring to
above figure, the hearing care professionals report
that:
- 60% of patients report some relief of
their tinnitus when using hearing aids;
- 22% actually report major relief of their
tinnitus when using hearing aids;
- 56% of respondents to the survey reported
they had taken at least one course on
tinnitus;
- The median time spent in tinnitus
counseling was 10 minutes;
- 18% of respondents indicated they
distributed a self-help book on tinnitus to
their patients.
Are there other technology solutions for minimizing timnnitus?
In March 2008, an
Australian company called
Neuromonics
announced a listening protocol using a customized
audio player that they claim can treat people
suffering from tinnitus. Using a portable audio
player that plays music and accompanying sounds, it
gradually changes the frequencies and sounds over
time to allow the brain to adjust to the changes.
For the first two months, the music mix
includes a noise, which some describe as water in
a shower, to cover the tinnitus. In the third
month, the shower sound is removed and patients
are instructed to turn up the music just loud
enough so the tinnitus is audible only during the
quiet parts. The idea is the brain will be
gradually trained to ignore the tinnitus. After
six months, patients use the device as needed.
Cost, which includes the
initial fitting and counseling on tinnitus
management, ranges from $3,500 to $6,000 for the
six-month treatment. It isn't generally covered by
insurance.
The FDA approved the use of
the device in 2005, and the company published its
own study findings as to the effectiveness, but
there is yet to be an independent assessment from a
third party.
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