Tinnitus

Tinnitus is the perception of a sound that is not truly present. It is an extremely common complaint as 50 million people in the United States experience it. It can be any type of noise: ringing, buzzing, crickets, typing, pulsing and even musical. Tinnitus usually begins with hearing loss, but continues in the brain. Functional MRI studies in people with tinnitus demonstrate changes in the deep centers of the brain.

Causes

Most patients with tinnitus have a hearing loss. This may be so mild that it is asymptomatic, and may be in the ultra-high frequencies which are not normally even tested. Noise induced hearing loss is a common type of hearing loss that causes tinnitus, and tinnitus is the number one disability among service veterans. Other causes include many medications, tumors, metabolic and cardiovascular problems. Tinnitus that is present in only one ear needs evaluation to rule out the presence of an acoustic neuroma. Tinnitus that is pulsatile in nature, or like a heartbeat, also requires special evaluation.

What makes it worse?

Tinnitus usually starts with hearing loss, but is made worse by stress, fatigue and other illnesses or discomforts in the body. In particular, stress and tension in the neck, shoulders or jaw make tinnitus much worse. People who grind or clench their teeth may have significant tinnitus. Many people suffering from anxiety, depression and insomnia have severe tinnitus. Paradoxically, the medications taken for these conditions can also worsen tinnitus. Caffeine frequently worsens tinnitus, and high caffeine intake is sometimes the sole cause. Alcohol also usually worsens tinnitus. A 6 week detox from caffeine and alcohol are usually required to realize their impact.

Evaluation

An audiogram is necessary in the diagnosis of tinnitus. Other special tests of hearing and balance are sometimes indicated. Asymmetric and pulsatile tinnitus are usually evaluated with MRIs and other studies. Bloodwork is sometimes ordered.

Treatment

Although there is no cure for tinnitus, many recommendations can help.

Treat insomnia, anxiety and depression: These are frequent complications of tinnitus, but may also be causes. Counseling, cognitive behavioral therapy and psychiatric evaluations are sometimes required.
Diet: eliminating caffeine and alcohol are frequently beneficial
TMJ evaluation: as teeth grinding and jaw clenching are often present, a referral to a specialist for myofascial therapy is frequently helpful. Mouth guards, retainers, orthodontia, chiropractic and physical therapy are often helpful.
Hearing aids. Most people with tinnitus have a hearing loss. Wearing a hearing aid helps to decrease the severity of the tinnitus in the majority of patients.
Maskers: Maskers are small electronic devices that use sound to make tinnitus less noticeable. Maskers do not make tinnitus go away, but they make the ringing or roaring seem softer. For some people, maskers hide their tinnitus so well that they can barely hear it. Some people sleep better when they use maskers. Listening to static at a low volume on the radio or using bedside maskers can help. These are devices you can put by your bed instead of behind your ear. They can help you ignore your tinnitus and fall asleep.
Tinnitus retraining therapy: This treatment uses a combination of counseling and maskers and biofeedback therapy. After a while, some people learn how to avoid thinking about their tinnitus. It takes time for this treatment to work, but it can be very helpful.
Tinnitus Devices: There are other devices, like Neuromonics, that help with tinnitus but they are expensive and only recommended in the most severe cases.
Noise protection: Preventing further hearing loss and damage to your inner ears and hearing nerves is important for preventing tinnitus from further worsening.