Tinnitus: Are you hearing crickets?

Speaking of Health

Tuesday, March 15, 2022

Topics in this Post

• Ear Health

Crickets, crickets, crickets.

I hear them all the time, even in the winter. I hear them more in one ear than the other. Sometimes they don’t sound like crickets, but a ringing, hissing and even chirping. At times, they’re loud — really loud. I have tinnitus.

I’m not alone. Nearly 45 million people suffer from tinnitus or head noises. The sound, or sounds, may be intermittent or annoyingly continuous in one or both ears.

Mine is intermittent, catching me off guard when I least expect it. It’s especially bothersome when I’m trying to have a conversation or fall asleep.

So what causes tinnitus? Experts believe it comes from damage to the hair cells in the inner ear. The health of these hair cells is important for sending signals to the auditory nerve and ultimately the brain. Injury to them brings on hearing loss and often tinnitus. In most cases, the tinnitus or noises will start years before any identifiable hearing loss.

There’s no specific cure for tinnitus, but it’s important that if you start experiencing these noises to be checked by an audiologist. The audiologist may refer you to an ear, nose and throat specialist. These health care professionals can rule out any worrisome problems and provide management options so the sounds no longer interfere with daily living.

Tinnitus can be made worse by external factors, such as stress, anxiety, poor sleep hygiene, caffeine or sodium intake, and even nicotine use or exposure. I’ve noticed how much worse my sounds are when I’m stressed from a busy workday or when I stayed up too late the night before.

I find a few moments of mindfulness or meditation help on those extra stressful days. I also try to get seven to eight hours of sleep each night and keep my caffeine consumption with reasonable limits. Technically, that’s 400 mg of caffeine or about four cups of brewed coffee, 10 cans of cola or two “energy shot” drinks.

Others use sound, like a fan or a sound machine playing ocean waves or music, when falling asleep. Some who wear hearing aids to treat hearing loss notice less tinnitus while wearing their devices.

Treatment for managing tinnitus isn’t a one-size-fits-all approach. Meeting with your health care team, especially an audiologist, can identify tools that are right for you and calm those annoying crickets.

Katie Kendhammer, Au.D., is an audiologist in Owatonna, Minnesota.

Topics in this Post

• Ear Health

Hyperbaric oxygen therapy restores hearing for Marge LaFrance

6 common questions about earaches and ear infections

Treating your child’s hearing loss

the cricket in my ear! – My Neurologist

Tinnitus: The Noise in My Ear!

Tinnitus is perception of an unformulated sound or noise, which does not exist, or a sound that is not normal. In some ways it is similar to vertigo, which is perception of motion that does not exist. It is different from auditory hallucination, which is perception of formulated sound that does not exist, like a musical note, a song, or a conversation. Patients may describe the noise as ringing, hissing, tinkling, whistling, pulsating, or just an unpleasant sound, in one or both ears. Tinnitus is not a disease; it is a symptom that may occur in a number of conditions.

How common is tinnitus?

Tinnitus is quite common, probably as common as migraine, but in most cases it is either not that severe or does not last long. About 5% of general population has it severe enough to seek a medical opinion, and about 1% is severely affected. It becomes a problem if it is severe or does not go away. In both cases it affects patient’s quality of life. It may cause anxiety, stress, insomnia, frustration, and depression.

What exactly causes tinnitus?

Tinnitus is associated with many ear and systemic conditions, but in most cases, its precise origin or mechanism is unknown. It is generally understood that the cause is either in the cochlear apparatus or the cochlear nerve. The malfunction is at microscopic level, and our technology is not sophisticated enough to provide that level of detail in a living person. MRI of brain may reveal some pathology that can cause tinnitus but in most cases of tinnitus no MRI finding in or around the cochlear system is identified.

Are their different types of tinnitus?

Tinnitus may be divided in the following different types:

Based upon its perception:

-Subjective: This is when a patient perceives a sound that is not there or not audible otherwise

-Objective: This is when a patient perceives a sound that exists and can otherwise be audible.

Based upon its side:

-Unilateral

-Bilateral

Based upon the type of noise:

 -Ringing, humming, buzzing or hissing

-Pulsatile tinnitus

-Typewriter tinnitus

-Fluttering tinnitus

What are different causes of tinnitus?

Exact cause of tinnitus can be difficult to figure out, and in many cases it is not. One way to understand this is to describe its association, i.e., conditions that are associated with tinnitus. Following is such a list:

Tinnitus associated with inner ear conditions:

-Meniere’s disease

-Otosclerosis

-Sudden hearing loss

-Loud noise exposure

-Superior canal dehiscence syndrome

-Autoimmune inner ear disease

Tinnitus associated with middle ear conditions:

-Otosclerosis

-Infection or inflammation

-Cholesteatoma

-Eustachian tube malfunction

Tinnitus associated with external ear condition:

-Ear wax

-Foreign body, i.e., an insect

Tinnitus associated with structures close to ear(s)

-Vestibular schwannoma

-AVM or an arterio-venous malformation

-Palatal myoclonus

-Idiopathic intracranial hypertension

-Glomus jugulare paragangioma

-TMJ syndrome

-Carotid stenosis

-Fibromuscular dysplasia

Tinnitus associated with systemic conditions. For example,

-Stress and anxiety

-Pregnancy

-Thyroid dysfunction

-Diabetes mellitus

-Hyperinsulinemia

-Hyper-viscosity syndrome

-Anemia

Tinnitus associated with environmental conditions. For example,

-Change in barometric pressure

-Exposure to loud noise

Tinnitus associated with drug exposure

 -Furosemide

-Ethyacrynic acid

-Aspirin or similar drugs

-Hydroxychloroquine

-Quinine

-Quinidine

-Methotrexate

-Cisplatin

-Gentamicin

-Azithromycin, clarithromycin

-ACE inhibitors

-Tinnitus of unknown cause

How is tinnitus evaluated?

The first consideration is to find its type, subjective or objective, its side, one-sided or bilateral, and the type of noise. Proper history with this information, and examination may help to figure out most likely cause. If needed, further testing is performed to find the underlying cause. Testing usually include an audiogram, imaging with CT or MRI (based upon the suspected cause), tympanometry, or rarely an angiogram. Most patients do not require more than examination and audiogram.

How is tinnitus treated?

The treatment is of the cause. If the cause cannot be eliminated, it may become chronic. Currently, there is no effective treatment to alleviate the noise. Mainstay of management is education, counseling, cognitive behavioral therapy, and treatment of anxiety and insomnia. Use of alternate or white noise may be an option to treat associated insomnia.

What should I do if I have tinnitus?

Start with talking to your medical doctor. It may just be earwax or common ear infection. If it is not explainable and is not going away, a consultation with an ENT doctor is appropriate. If there is no obvious ear issue, or if the tinnitus is of pulsatile or objective type, consultation with a neurologist may help. Tinnitus can be a source of frustration, both for the patient and the treating physician. It may also require help of an audiologist, therapist and a psychologist. Management of tinnitus is part of neuro-otology, a sub-specialty of neurology. Not all neurologists, and similarly not all ENT doctors, are comfortable managing it. Ask your primary care physician for the right specialist in your area.

Where can I get more information about tinnitus?

American Academy of Neurology

American Otolaryngology Society

why it appears and how to get rid of it

Tinnitus is the subjective perception of sound by a person in the absence of any real external stimuli. In the professional medical field, the pathology is known as tinnitus. Noises can appear in one or both ears, less often in the center of the head. Patients often hear sounds such as:

• high-pitched ringing;
• buzzing;
• hiss;
• whistle;
• ticking;
• hum;
• clicking;
• crickets;
• rustling of wind or waves;
• whisper.

Tinnitus is a fairly common problem. Approximately 15%-20% of audiologist patients complain of tinnitus. But the problem is especially common in older people.

Possible reasons for rejection

Tinnitus is not an underlying medical condition, but merely a symptom of age-related hearing loss, injury, or a problem with the circulatory system. In most cases, tinnitus goes away after the underlying cause is treated. The task of the otolaryngologist is to find what exactly provokes the problem.

1. Aggressive noise exposure

Constant noise pollution (for example, in a manufacturing factory, construction site) leads to deformation of the eardrum. As a result, “hair cells”, receptors that cannot be repaired or replaced by surgery, are destroyed. About 90 percent of all tinnitus patients have some degree of hair cell damage.

2. Wax accumulation

A healthy body produces a small amount of earwax, which must be periodically removed with a cotton turunda. When a large amount of waste accumulates in the ear canal, hearing deteriorates and micro echoes appear in the ears. To get rid of the problem, it is enough to dissolve the accumulated sulfur. Do not use ear sticks at this stage. It is better to seek help from a professional.

3. Negative effects of certain medications

A certain group of medications adversely affects the state of the auditory system. If the instructions indicate tinnitus as a side effect, then you can expect that the complication will disappear on its own after stopping the medication.

4. Sinus infections

Many people, especially young children, experience noise in the head along with sinus infections. As soon as nasal congestion decreases, extraneous sounds will also disappear.

5. Problems with the temporomandibular joint

Displacement of the jaw, dislocation of the TMJ provokes characteristic clicks that can be heard not only by the big one. A jaw surgeon can help you deal with the cause of the problem.

6. Cardiovascular disease

Approximately 3 percent of patients with tinnitus are caused by vascular problems. The sound is usually characterized as pulsating, often in sync with the heartbeat. To eliminate the problem, it is necessary to normalize blood flow through the veins and arteries, eliminate heart murmurs, and normalize blood pressure. After treatment, you can also expect the elimination of dizziness.

7. Certain types of tumors

A malignant or benign neoplasm on the auditory, vestibular, or facial nerve causes tinnitus, partial deafness, paralysis, and imbalance. Similar symptoms appear with physical injuries of the head, especially in the area of ​​​​the ears.

More rare causes are thyroid disorders, Lyme disease, fibromyalgia, and chest outlet syndrome.

Indications for medical attention

Most people don’t seek medical attention because they don’t think background noise is a big deal. Indeed, in most cases, tinnitus is only a concomitant symptom and disappears on its own after the treatment of the underlying disease is completed.

To avoid complications, it is better to make an appointment with an otolaryngologist in the following cases:

• noises in the ear area appeared after an upper respiratory tract infection, a cold, but did not disappear within a month after recovery;
• in addition to noises, there is dizziness, blurred vision;
• auditory hallucinations are accompanied by anxiety and depression.

Tinnitus affects people in different ways. Someone will not even notice the problem, while someone’s quality of life will change significantly. If, in addition to the ears, headaches are bothering you, as well as problems with sleep, concentration, memory, then you definitely need to consult an audiologist.

Diagnosis of the true causes of tinnitus

Otorhinolaryngologists, audiologists, audiologists usually deal with the ears. You can also contact your family doctor to determine the primary causes of the problem and issue a referral to a specialist. Until an accurate diagnosis is made, symptomatic treatment may be prescribed.

The most popular diagnostic procedures

1. Ear examination followed by hardware diagnostics

First, the doctor will take an anamnesis, examine the ears using an otoscope. Next, the patient is seated in a soundproof room and put on headphones that transmit specific sounds to one ear at a time. It is necessary to press the button each time the sound appears. The computer will then compare the results with an average audio map for your age. A simple test will help you understand if the noises are constant or not, whether they are real or imaginary.

2. Motion test

The doctor may ask the patient to nod his head, clench his jaw hard, or actively move his neck, arms, legs. If tinnitus worsens after strenuous exercise, dizziness appears, then it is likely that cardiovascular disease treatment is required.

3. Imaging

If the most common causes of tinnitus are ruled out, CT or MRI of the ears is done. A clear image will reveal a tumor, pathologies in the structure of the hearing organs.

4. Laboratory tests

In addition, the patient is offered to donate blood to confirm or rule out anemia, thyroid problems, deficiency of certain vitamins and microelements.

Sometimes several specialists develop a treatment program at the same time. Therefore, it is better to contact a private clinic, where all doctors can quickly exchange information, collect consultations. It is really possible to get rid of the problem forever if you strictly follow all the instructions and engage in prevention and do not forget about periodic medical examinations.

Tinnitus (ringing in the ears)

Definition of tinnitus

Tinnitus is described as a sound that a person hears and is produced by the body, not from an external source. Tinnitus is often defined as the presence of a high-pitched ringing or buzzing that is usually only audible to the person affected.

In most cases, tinnitus is subjective, which means that the examiner cannot hear it and there are no tools to check or hear it. However, objective tinnitus can result from an aneurysm and be heard by a doctor.

Tinnitus is one of the most common and unpleasant otological diseases, causing many physical and psychological diseases that impair the quality of life.

Tinnitus is also a common symptom in children with hearing loss. Tinnitus is a subjective experience that is difficult to scientifically analyze because it is measured, quantified, and reported only on the basis of patient responses.

Although tinnitus can be caused by many factors, it is most commonly caused by otologic conditions, with noise-related hearing loss being the most common cause. Because different treatments for tinnitus produce different results, it is widely believed that tinnitus has multiple physiological causes.

Causes of tinnitus

There are many causes of tinnitus:

• Noise trauma is the most common cause of subjective tinnitus. For example, a person working in a loud sector may become deaf at a tone of 4000 Hz. After that, a person hears a sound comparable to a tone of 4000 Hz.
• Tinnitus is associated with metabolic disorders such as heart disease, hypertension and diabetes. Various medications are ototoxic for some people, or at high enough doses. Tinnitus, for example, is caused by high doses of aspirin, and the problem disappears when the aspirin is stopped.
• Tinnitus is caused by diseases of the ear, such as Meniere’s disease, or lesions of the eighth cranial nerve.

20% of people who visit tinnitus clinics have normal hearing. Some people suffer from somatosensory tinnitus. In this case, stimulation of the cervix or TMJ involved the dorsal cochlear nucleus, which transmits impulses to the auditory region. Whiplash or TMJ injuries have been found to cause structural changes in the dorsal cochlear nucleus.

Triggers

Tinnitus can be caused by slight temporary changes in the outer hair cells (EHC) after noise exposure by increasing the central auditory system. Tinnitus is a threshold event in which any single trigger, such as chronic progressive hearing loss, is not enough to cause it—two or more triggers (such as psychosocial stress, noise exposure, and somatic factors) can act synergistically, causing symptoms. Approximately 75% of new cases are caused by emotional stress, and not by factors affecting cochlear lesions.

Epidemiology

Tinnitus affects almost everyone at some point in their lives. According to the American Tinnitus Association, ten million people suffer from tinnitus. It is also widespread in less developed countries.

Tinnitus is common among military personnel as a result of loud explosions and gunfire. It is also found in film and stage workers who prepare explosives and shoot. Tinnitus affects musicians who hear loud noises, such as drummers and those who perform in front of loudspeakers.

Tinnitus can occur in children, although it is often not diagnosed because they do not identify the problem. A typical situation involves a worker who was exposed to extremely loud industrial noise, forcing the workers to scream to be heard. Many employees suffer from high-pitched hearing loss, but few additionally experience tinnitus.

Tinnitus may be accompanied by hyperacusis. Some everyday sounds, such as closing doors, moving chairs, and falling books, are so loud and powerful in these circumstances that they are very uncomfortable, if not painful.

Pathophysiology

Tinnitus is not a disease in itself, but rather a symptom of a number of underlying conditions. Noise-induced hearing loss, presbycusis, otosclerosis, otitis media, damaged sulfur dust, severe deafness, Meniere’s disease, and other causes of hearing loss are all otologic.

Head trauma, whiplash, multiple sclerosis, vestibular schwannoma (also known as acoustic neuroma), and other pontine tumors are all neurological causes. Infectious causes of hearing loss include otitis media and the effects of Lyme disease, meningitis, syphilis, and other infectious or inflammatory diseases.

Some oral medications such as salicylates, non-steroidal anti-inflammatory drugs, aminoglycoside antibiotics, loop diuretics and chemotherapy drugs can cause tinnitus (eg cisplatins and vincristine).

When faced with danger or threat, people often respond with the classic fight-or-flight response. This is why the onset of tinnitus can be so annoying. This reaction is not always caused by a broken finger, but it is caused by tinnitus. Cognitive therapy is used to prevent an unwanted reaction.

On the other hand, tinnitus is not caused by stress. The etiology of tinnitus is unknown as people cannot objectively measure it. Tinnitus can be caused by damage that puts pressure on the eighth cranial nerve. Tinnitus is caused by an increase in fluid pressure in the inner ear. Hearing loss, dizziness, tinnitus, and a feeling of pressure in the ear are all symptoms of increased pressure in the inner ear.

According to MRI, tinnitus affects various areas of the brain, including cognitive, emotional and auditory areas. Sound first enters the brain through the amygdala region. As a result, understanding that tinnitus is not dangerous is therapeutic.

Many modern anticancer drugs, including bleomycin, cis-platinum, methotrexate, and bumetanide, are ototoxic. This can lead to permanent hearing loss and tinnitus.

• Ethacrynic acid, acetazolamide – diuretics listed as ototoxic.
• Tinnitus is caused by taking too much aspirin. Fortunately, this is reversible. Other NSAIDs can also cause tinnitus.

Due to the relatively high prevalence of tinnitus in the community, care must be taken when evaluating tinnitus from a new drug. Tinnitus can be reported in the placebo group in a double-blind study. When anticancer drugs are taken, hearing tests are often done to monitor for the development of hearing loss or tinnitus so that treatment can be stopped if possible.

Signs and symptoms

Tinnitus

Symptoms of tinnitus include ringing, buzzing, roaring, hissing or whistling in the ears. The noise may be intermittent or constant. In most cases, only the person with tinnitus can hear it.

The ear and nervous system should be the focus of the physical examination. Inspect the ear canal for secretions, foreign bodies, and wax. Infection and tumors should be looked for on the eardrum.

People with tinnitus can hear anything from faint background noise to noise that can be heard over loud external sounds. Tinnitus is classified into two types: objective and subjective.

Tinnitus that is heard by another person as a sound emanating from the ear canal is defined as objective tinnitus, while subjective tinnitus is audible only to the patient and is generally considered to be devoid of acoustic etiology and associated movements in the cochlear septum or cochlea. liquids. Many physicians use the term tinnitus to refer to subjective tinnitus and somatosound to refer to objective tinnitus.

Most tinnitus is reported to be similar to the sounds of cicadas, crickets, breezes, falling tap water, grinding steel, escaping steam, fluorescent lamps, running engines, etc. This perception is believed to be the result of aberrant neural activity on subcortical level of the auditory system.

Tinnitus has a pattern that is associated with a library of patterns recorded in auditory memory and is also associated with emotional states through the limbic system. The symptoms of tinnitus are usually unrelated to the type or severity of the underlying hearing loss, so the latter is of limited diagnostic value.

Most people with tinnitus attribute their tinnitus to a pitch above 3 kHz. The roaring noise in the ears that characterizes Meniere’s disease corresponds to a low-frequency tone, which is usually in the range from 125 to 250 Hz. On the other hand, tinnitus in the advanced stage of Meniere’s disease, “burnout”, is often higher in pitch and tone.

Most tinnitus patients with hearing loss indicate that the frequency of the tinnitus matches the severity and frequency characteristics of their hearing loss, and that the strength of the tinnitus at this frequency is typically less than 10 dB above the patient’s hearing threshold.

Some people with central auditory processing problems who have difficulty understanding speech in noise report hearing tinnitus with normal pure-tone audiometric thresholds.

Less common types of tinnitus, such as those involving well-known musical tunes or voices without intelligible speech, are found in older people with hearing loss and are thought to represent a central type of tinnitus associated with reverberant activity in the nerve loops on high level and processing in the auditory cortex.

Somatic tinnitus is a type of subjective tinnitus in which the frequency or severity changes due to body movements such as clenching the jaw, shifting gaze, or pressure on the head and neck. The tinnitus has been reported to become louder upon awakening, suggesting the involvement of somatic processes such as bruxism.

Tinnitus disappears during sleep but reappears within a few hours, suggesting that psychosomatic variables such as upright neck contraction or jaw clenching have etiological roles.

Associated symptoms

Problems concentrating, insomnia and decreased speech discrimination are the most common associated symptoms or subjective discomfort. Tinnitus irritation is not related to acoustic characteristics, but is associated with psychological symptoms.

The difference between mere hearing in the ears and the restlessness or distress caused by it is determined solely by the activation of the limbic and autonomic nervous systems. Most patients with significant tinnitus have trouble falling asleep due to comorbid restlessness, which also makes it difficult to return to sleep during periods of wakefulness at night.

The auditory system constantly monitors the sound environment, so during sleep there is significant neural activity in the auditory pathways. Noise, being in a quiet place, emotional stress, lack of sleep, and physical fatigue are all common bad habits and/or circumstances.

Patients with Meniere’s disease experience more irritation, sadness and sleep disturbance, and their tinnitus is louder than patients with tinnitus for other reasons. In addition, proper treatment of vertigo in people with Ménière’s disease can cause them to pay more attention to and be more bothered by tinnitus.

Diagnostics

• X-rays and MRI are rarely used to diagnose tinnitus unless there is significant change in hearing and balance in the ears.
• An audiogram is a hearing test that measures hearing levels to diagnose hearing loss. The patient is asked to determine which of the tones corresponds to his tinnitus. The audiologist evaluates the sound by loudness, and the patient evaluates the level of tinnitus. The air bone test compares hearing through the ear bone to hearing through headphones. If the patient hears better after examining the bones, this indicates a treatable disease called otosclerosis.
• Patients with otosclerosis who cannot move the stirrup properly may have surgery to correct the otosclerosis and restore air conduction. For some people, tinnitus gets better. Tinnitus persists or worsens in others.
• The audiologist determines how long the masking tone takes to relieve tinnitus. The longer the tinnitus is suppressed, the better the prognosis.

Tinnitus treatment

Tinnitus treatment can be divided into two categories:

1. which aim to directly reduce the intensity of tinnitus and
2. which aim to relieve irritation associated with tinnitus.

Pharmacotherapy and electrical current suppression are examples of the former, while pharmacotherapy, cognitive and behavioral therapy, sound therapy, addiction therapy, massage and stretching, and hearing aids are examples of the latter.

The American Academy of Otolaryngology has issued guidelines for the clinical practice of tinnitus. This includes:

• Stress reduction: this includes the use of biofeedback, controlled breathing and other techniques. Although stress is not the cause of tinnitus, as with any illness, stress and anxiety can make it worse.
• Cognitive therapy: the more the patient understands what tinnitus is and what is not, the less negative the effect. Symptoms of tinnitus are reduced if the patient fully understands – realizes that tinnitus is akin to itching.
• Masking: when the body hears the same sound from a mobile phone or audio device, the symptoms disappear. There are different types of camouflage. These masking noises essentially take attention away from the inner tinnitus and replace it with soothing tones.
• Improved sleep : tinnitus can interfere with normal sleep, therefore therapy should be aimed at improving sleep hygiene.

Official guidelines emphasize that no medication can cure tinnitus. However, numerous combinations of magnesium, alpha-lipoic acid, N-acetylcysteine, and other compounds have been tried to protect against noise. When they are helpful, it is difficult to distinguish between a placebo effect and a program in which the patient feels in control by engaging the brain in the healing process.

Deep brain stimulation has recently been shown to produce positive results. This, in principle, changes the unwanted pathways of the brain.

The most important aspect of treatment is never to advise patients with tinnitus to live with it. The emphasis should be on reducing stress and staying on schedule. Tinnitus treatment and neuronomy are two typical programs used in therapy by people trained in their use.

Tinnitus retraining includes patient adaptation to hearing tinnitus; Neuronomics suggests that the patient learns to ignore tinnitus.

When tinnitus is accompanied by hearing loss, a hearing aid is usually helpful. Some assistive devices make soothing or masking sounds. Success is a moving target.

Medicines such as alprazolam may relieve symptoms but may also have negative side effects such as addiction. Patients who do not respond to conventional treatment may benefit from antidepressants.

Cognitive and behavioral therapy

Cognitive therapy is based on how a person thinks about tinnitus and how to prevent negative thoughts, while behavioral therapy uses a method of systematic desensitization used to treat many phobias. Cognitive therapy teaches people to live with tinnitus by replacing negative thinking with more optimistic thinking. Counseling and cognitive restructuring are components of cognitive therapy. The consultation should contain the following:

1. Informing patients that their irritation from tinnitus is unlikely to be significantly reduced;
2. Educating patients about the benefits of self-help groups for tinnitus;
3. Helping patients minimize time spent on activities and/or situations that increase the severity of tinnitus and maximize time spent on activities and/or conditions that reduce tinnitus and
4. Emphasizing the importance of prevention exposure to noise, as hearing loss and tinnitus are linked.

Cognitive restructuring entails a change in thinking associated with tinnitus. In this setting, patients are urged to accept the idea that tinnitus does not deserve the attention it is receiving. Positive imagery, attention management, and relaxation training are key components of behavioral therapy. Positive imagery entails focusing your thoughts on something pleasant, thereby diverting attention from tinnitus.

When tinnitus becomes annoying, you need to divert attention from it. This procedure may begin by comparing two images and then presenting two auditory stimuli (eg fan noise and spoken voice) coming from an adjacent room.

The picture and tinnitus then join, followed by thought and tinnitus. Relaxation training includes a guided procedure to teach people to use progressive muscle relaxation, which involves tensing and relaxing the arms, face, neck, shoulders, abdomen, legs, and feet.

Sound Therapy

Sound Therapy reduces the intensity of neuronal activity in the auditory system associated with tinnitus by using sounds that are naturally present, such as sounds associated with streams, rain, waterfalls and wind. To this end, the background neural activity of the auditory system is enhanced by exposing the patient to a low-level, continuous, neutral sound that is unobtrusive, not unpleasant, and easy to ignore.

The sound should not be significant, pleasant or exciting enough to detract from watching TV, listening to the radio or listening to music. Neutral sounds should be even and not overpowering; hence wave sounds are not recommended. Some patients are easily distracted by the sounds of birds, crickets, or thunderstorms, so be careful when using these sounds.

Differential

• Cytomegalovirus
• Hypercholesterolemia
• Lyme disease
• Measles
• Meningitis
• Neoplasm
• Neurosyphilis
• Rubella

900 07 Sickle cell disease

• Small vessel disease
• Stroke
• Tumor

Conclusion

Tinnitus is often symptom of another disease. Recent studies have used advanced imaging and measurement technologies to study tinnitus-associated activity in the ear, auditory nerve, and brain auditory pathways. The complexity of the nervous system changes associated with tinnitus may explain why the disease has proven so resistant to therapy.

Tinnitus is diagnosed and treated by a multidisciplinary team that includes a family doctor, a nurse practitioner, an ENT surgeon, an audiologist and an internist. Tinnitus should be treated according to the American Academy of Otolaryngology guidelines. At the same time, the patient should be informed about the benefits of good sleep hygiene.

There is currently no medicine that can treat tinnitus. Several drugs have been studied, but their effectiveness is still controversial. Deep brain stimulation has been promoted in the last decade, but this therapy is not only invasive and expensive, but can also cause effects that are worse than tinnitus.

Patients should be strongly advised to reduce their stress levels, and some may benefit from a hearing aid that can mask other sounds. Tricyclic antidepressants are sometimes used, but they have many side effects that are not always well tolerated.