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Swishing in head: Awakening the world to the whoosh: A patient’s crusade

Awakening the world to the whoosh: A patient’s crusade

Seven years ago, New York lawyer Emma Greenwood awoke to the beat of a pulse on one side of her head. The internet told her she had tinnitus, often called ringing in the ears. So did her doctor.

She knew that wasn’t right. When she listened to the “sounds of tinnitus” online, they reminded her of a whistling teakettle or squealing brakes. The sound dogging her days, by contrast, was a low-pitched rhythmic whoosh, pulsing in sync with her heartbeat.

It took a few months, but Greenwood finally found a doctor who understood what she was hearing and diagnosed her with a vascular condition. Her “whoosh” was,  in medical terms, a “bruit” — the sound of turbulent blood flow through a narrowed vein in her brain.

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Greenwood figured she couldn’t be alone: Many other patients hearing a whoosh had no doubt had been told they had tinnitus — for which there is no medical treatment. That’s a problem because whooshing can be treated — and sometimes, needs to be addressed quickly. The pulsing sound can indicate a condition that could lead to seizure, stroke, or death.

So Greenwood set out on a crusade to awaken the world to the whoosh.

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She started a website, whooshers.com, with links to medical research and tips to help physicians understand the symptom. In a bid to raise awareness among the general public, she sells $25 “Do You Whoosh?” T-shirts, with the question mark shaped like an ear. Some patients have given the T-shirts to their doctors.

Greenwood, who also runs a Facebook support group, encourages patients to share their stories through social media on “Whoosher Wednesdays.” And she posts recordings of people’s whooshes, which are sometimes loud enough to be captured with a smartphone. They’re the most popular part of the site.

At the heart of her activism: A quest to get whooshing (the common name is “pulsatile tinnitus”) recognized as a symptom separate from tinnitus within the medical coding system. It often heralds a vascular condition, after all, not an auditory problem like tinnitus. The sound isn’t a ringing, but a swishing, pulsing, or thumping that is sometimes even described as a bird flapping its wings.

“Pulsatile tinnitus is not tinnitus,” Greenwood said. “It’s a travesty that the two share a name.”

Over four years, she collected more than 2,500 signatures on an online petition to get whooshing its own medical codes — and it finally happened. In the latest update to the codes, which took effect on Oct. 1, pulsatile tinnitus gets its own designation.

“Awareness is key,” Greenwood said. When her whoosh first struck, “I didn’t even know it had a name,” she said. “I recognize the desperation people feel.”

A rare condition

Pulsatile tinnitus is far less common than regular tinnitus, which afflicts around 20 percent of adults in the United States. Information is scant, but one small study found that 4 percent of patients reporting tinnitus actually had pulsatile tinnitus.

Doctors often overlook the symptom. When patients start noticing a noise in the ear, they usually consult first with an otolaryngologist, or ENT. They’re routinely, and mistakenly, told nothing can be done medically. That’s true for tinnitus. But not for pulsatile tinnitus.

“If these patients are taking advice from doctors who know nothing about the distinction, they are not going to get the help they need,” Greenwood said.

Greenwood, 41, urges fellow whooshers to get the appropriate diagnostic imaging — often including an MRI — and circulate the films to doctors who might help. Many cases are fixable, often by a catheter-based procedure and occasionally by surgery.

(It’s important to make sure you have pulsatile tinnitus before getting an MRI, however, because the noisy scan can be dangerously loud for patients with regular tinnitus.)

A proper diagnosis also helps for insurance purposes. “If you have vague or outdated codes, it is difficult for payers to figure out what they’re paying for,” said Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association. “This could lead to a request for more information or a denial of reimbursement.”

Greenwood’s efforts have “really impacted how pulsatile tinnitus is viewed,” said Dr. Maksim Shapiro, an interventional neuroradiologist at New York University Langone Medical Center, who treats patients with vascular abnormalities.

“Patients are oftentimes educating doctors, and it’s a legitimate education,” Shapiro said. “Pulsatile tinnitus is typically not a concern of the ear per se. The ear is doing what the ear is supposed to do — picking up sound.”

His department now hosts regular information sessions on whooshing.

The crusade continues

Sometimes the whoosh can be heard with a stethoscope placed on the skull. Another way to identify it, Shapiro said, is to have patients tap to the beat of the crescendo they’re hearing while he takes their pulse. The pulsatile beat is always in sync with the heartbeat. When patients exercise, their heartbeats will quicken. So will the pace of their whoosh.

Even if the underlying condition isn’t life-threatening, it can be intensely annoying. “If I do a procedure purely based on relief of the sound, I tell the patient it’s very legitimate to treat a sound that is so disturbing that it ruins the quality of life,” Shapiro said.

Greenwood opted not to have any procedure to address her whoosh. She said her own condition is tolerable.

But she’s not yet done with her crusade.

She would dearly love to get the condition renamed so it doesn’t include the term “tinnitus” at all.

The four new codes — for pulsatile tinnitus of the right ear, left ear, both ears, and unspecified ear — are categorized under “diseases of the ear and mastoid process.” Because the pulsing can indicate so many conditions, Greenwood would much rather see them listed under “not elsewhere classified” category.

“That word ‘ear’ just irks me,” she said.

What Causes Pulsatile Tinnitus? | Weill Cornell Brain and Spine Center

Some cases of pulsatile tinnitus are caused by a narrowing of one of the large veins in the brain (red circles). The narrowing, or stenosis, disrupts the flow of blood and can lead to the whooshing sound or other noises of pulsatile tinnitus.

Pulsatile tinnitus can be caused by problems in the arteries or veins of the head, neck, or both. A 2013 review of the current literature indicated that about 28 percent of pulsatile tinnitus cases were due to venous causes, 23 percent were arterial, 18 percent were arteriovenous, and 31 percent were due to other or unknown causes. More than half of the venous cases of pulsatile tinnitus were due to idiopathic intracranial hypertension (also called pseudotumor cerebri), which has recently been associated with venous stenosis.

Many cases of pulsatile tinnitus can be traced to stenosis in one of the large veins in the brain, most commonly the traverse and sigmoid sinuses. The narrowing of the veins causes a disturbance in the blood flow, contributing to the whooshing sounds of pulsatile tinnitus. A new clinical trial for pulsatile tinnitus shows great promise that inserting a stent to widen the veins will restore healthy blood flow and eliminate the symptoms (find out more about the clinical trial).

Other conditions that can lead to changes in blood flow and result in pulsatile tinnitus include:

  • Vascular malformations (including AVM and dural arteriovenous fistula): Pulsatile tinnitus is the result of abnormal connections between arteries and veins.
  • Idiopathic intracranial hypertension (pseudotumor cerebri): This is a condition that consists of high pressure in the fluid around the brain and is characterized by headaches, dizziness, hearing loss, and visual disturbances.
  • Venous sinus diverticulum: A small abnormal pouch on the wall of the vein transmits sound to the ear.
  • Atherosclerosis (hardening of the arteries): When major blood vessels close to the middle and inner ear lose some of their elasticity, blood flow becomes more forceful and easier to hear.
  • Head and neck tumors: A vascular neoplasm that presses on blood vessels in the head or neck can cause tinnitus and other symptoms.
  • High blood pressure: Hypertension and factors that increase blood pressure, such as stress, alcohol, and caffeine, can make tinnitus more noticeable.

It is critically important to identify the underlying condition causing the pulsatile tinnitus; treating and resolving that condition is the key to ending the noise.

On the following pages, you’ll discover more about the symptoms of pulsatile tinnitus, how pulsatile tinnitus is diagnosed and treated, and a promising new clinical trial to relieve it.

Request an Appointment | Refer a Patient

Reviewed by: Srikanth Boddu, MD, MSc
Last reviewed/updated: August 2020
Illustration by Thom Graves Creative, CMI

This woman’s struggle to diagnose the ‘whooshing’ in her ears

Seven years ago, New York lawyer Emma Greenwood awoke to the beat of a pulse on one side of her head. The internet told her she had tinnitus, often called ringing in the ears. So did her doctor.

She knew that wasn’t right. When she listened to the “sounds of tinnitus” online, they reminded her of a whistling teakettle or squealing brakes. The sound dogging her days, by contrast, was a low-pitched rhythmic whoosh, pulsing in sync with her heartbeat.

It took a few months, but Greenwood finally found a doctor who understood what she was hearing and diagnosed her with a vascular condition. Her “whoosh” was, in medical terms, a “bruit” — the sound of turbulent blood flow through a narrowed vein in her brain.

Greenwood figured she couldn’t be alone: Many other patients hearing a whoosh had no doubt had been told they had tinnitus — for which there is no medical treatment. That’s a problem because whooshing can be treated — and sometimes, needs to be addressed quickly. The pulsing sound can indicate a condition that could lead to seizure, stroke, or death.

So Greenwood set out on a crusade to awaken the world to the whoosh.

She started a website, whooshers.com, with links to medical research and tips to help physicians understand the symptom. In a bid to raise awareness among the general public, she sells $25 “Do You Whoosh?” T-shirts, with the question mark shaped like an ear. Some patients have given the T-shirts to their doctors.

Greenwood, who also runs a Facebook support group, encourages patients to share their stories through social media on “Whoosher Wednesdays.” And she posts recordings of people’s whooshes, which are sometimes loud enough to be captured with a smartphone. They’re the most popular part of the site.

At the heart of her activism: A quest to get whooshing (the common name is “pulsatile tinnitus”) recognized as a symptom separate from tinnitus within the medical coding system. It often heralds a vascular condition, after all, not an auditory problem like tinnitus. The sound isn’t a ringing, but a swishing, pulsing, or thumping that is sometimes even described as a bird flapping its wings.

“Pulsatile tinnitus is not tinnitus,” Greenwood said. “It’s a travesty that the two share a name.”

Over four years, she collected more than 2,500 signatures on an online petition to get whooshing its own medical codes — and it finally happened. In the latest update to the codes, which took effect on Oct. 1, pulsatile tinnitus gets its own designation.

“Awareness is key,” Greenwood said. When her whoosh first struck, “I didn’t even know it had a name,” she said. “I recognize the desperation people feel.”

A rare condition

Pulsatile tinnitus is far less common than regular tinnitus, which afflicts around 20 percent of adults in the United States. Information is scant, but one small study found that 4 percent of patients reporting tinnitus actually had pulsatile tinnitus.

Doctors often overlook the symptom. When patients start noticing a noise in the ear, they usually consult first with an otolaryngologist, or ENT. They’re routinely, and mistakenly, told nothing can be done medically. That’s true for tinnitus. But not for pulsatile tinnitus.

“If these patients are taking advice from doctors who know nothing about the distinction, they are not going to get the help they need,” Greenwood said.

Greenwood, 41, urges fellow whooshers to get the appropriate diagnostic imaging — often including an MRI — and circulate the films to doctors who might help. Many cases are fixable, often by a catheter-based procedure and occasionally by surgery.

(It’s important to make sure you have pulsatile tinnitus before getting an MRI, however, because the noisy scan can be dangerously loud for patients with regular tinnitus.)

A proper diagnosis also helps for insurance purposes. “If you have vague or outdated codes, it is difficult for payers to figure out what they’re paying for,” said Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association. “This could lead to a request for more information or a denial of reimbursement.”

Greenwood’s efforts have “really impacted how pulsatile tinnitus is viewed,” said Dr. Maksim Shapiro, an interventional neuroradiologist at New York University Langone Medical Center, who treats patients with vascular abnormalities.

“Patients are oftentimes educating doctors, and it’s a legitimate education,” Shapiro said. “Pulsatile tinnitus is typically not a concern of the ear per se. The ear is doing what the ear is supposed to do — picking up sound.”

His department now hosts regular information sessions on whooshing.

The crusade continues

Sometimes the whoosh can be heard with a stethoscope placed on the skull. Another way to identify it, Shapiro said, is to have patients tap to the beat of the crescendo they’re hearing while he takes their pulse. The pulsatile beat is always in sync with the heartbeat. When patients exercise, their heartbeats will quicken. So will the pace of their whoosh.

Even if the underlying condition isn’t life-threatening, it can be intensely annoying. “If I do a procedure purely based on relief of the sound, I tell the patient it’s very legitimate to treat a sound that is so disturbing that it ruins the quality of life,” Shapiro said.

Greenwood opted not to have any procedure to address her whoosh. She said her own condition is tolerable.

But she’s not yet done with her crusade.

She would dearly love to get the condition renamed so it doesn’t include the term “tinnitus” at all.

The four new codes — for pulsatile tinnitus of the right ear, left ear, both ears, and unspecified ear — are categorized under “diseases of the ear and mastoid process.” Because the pulsing can indicate so many conditions, Greenwood would much rather see them listed under “not elsewhere classified” category.

“That word ‘ear’ just irks me,” she said.

This article is reproduced with permission from STAT. It was first published on Oct. 6, 2016. Find the original story here.

The Causes Of Pulsatile Tinnitus | Arches Tinnitus Formula

By Barry Keate
Barry Keate, has lived with tinnitus over 40 years and has published 150+ research articles on numerous aspects of tinnitus. He is an expert on the condition and a well-known advocate for those with tinnitus.

Pulsatile tinnitus is the type of ear noise that is perceived as a rhythmic pulsing that is often in time with the heartbeat. It can be experienced as a thumping or whooshing sound. It is sometimes referred to as vascular tinnitus because in the majority of cases, it is related to disturbances in the blood flow. About 3% of tinnitus patients experience this type of tinnitus.

Pulsatile tinnitus usually originates within the blood vessels inside the head or neck region when disturbed blood flow occurs. This results from either increased blood flow or a narrowing of the opening of the blood vessel, both of which result in turbulent blood flow that can be heard in the ears. In this regard, it is totally different from and independent of continuous tinnitus which results from damage to the cochlea and/or hearing nerve.

It is very possible to have both pulsatile and continuous tinnitus together. People who have both of these generally say the pulsatile component is the more bothersome.

It is important to investigate all instances of pulsatile tinnitus. In some cases, a serious underlying condition could exist. In rare cases, this can lead to a catastrophic event such as stroke. A series of tests, beginning with an examination of the head and neck by a physician familiar with the condition, through complex imaging techniques, is performed. Individuals who find that the initial imaging results do not reveal abnormalities should insist on further examination and investigation. It is possible to misread or miss these trouble spots that may be tangled in other structures or hidden by bone or other tissue. Newer imaging techniques, such as Magnetic Resonance Angiography and Carotid Artery Ultrasonography, have been employed that help determine the site of the problem in the majority of pulsatile tinnitus cases. The cure rates for pulsatile tinnitus are quite high once the problem area has been identified. The correct specialist to consult on pulsatile tinnitus is a vascular surgeon.

The following section describes some of the more common causes of pulsatile tinnitus and relevant therapies.

1 – Benign Intracranial Hypertension (BIH). This is a condition where there is increased pressure of the cerebrospinal fluid that bathes the brain. The majority of these patients are young females who are generally overweight. Other symptoms of BIH may include hearing loss, ear fullness, dizziness, headaches and visual disturbances. Management of this condition includes weight loss and administration of a diuretic. Most patients improve dramatically with weight reduction alone.

2 – Glomus Tumor. This is a benign vascular tumor usually located in the ear or just below the ear at the skull base. It consists of a mass of intertwined blood vessels. Hearing loss is also a common symptom. Young patients are usually treated surgically, to remove the tumor, while older patients may need no treatment since they are very slow growing.

3 – Atherosclerotic Carotid Artery Disease. Atherosclerosis is the narrowing of the artery due to cholesterol build-up on the artery wall. This reduces the opening resulting in turbulent blood flow that produces pulsatile tinnitus. This usually occurs in older patients with a history of hypertension, elevated cholesterol, diabetes, angina and smoking. The condition can usually be controlled through medication.

4 – Intracranial Vascular Lesions. These include aneurysm and arteriovenous malformations, which is an abnormal connection between an artery and a vein.The blood flows directly from a high pressure artery to a lower pressure vein without going through the capillaries. Either aneurysm or arteriovenous malformation can lead to bleeding in the brain and can be extremely dangerous. Therapies include surgery and embolizing (closing off) the blood vessels.

5 – Middle Ear Effusion. The middle ear is normally an air-filled space. If fluid accumulates in the middle ear due to infection, inflammation or Eustachian tube dysfunction, pulsatile tinnitus can result. It is sometime accompanied by decreased hearing, a feeling of fullness, and may also include pain. This is most often treated with antibiotics, decongestants, nasal sprays, etc. or sometimes surgery.

6 – Venous Hum. Patients who are pregnant, anemic, or have thyroid problems, may develop increased blood flow through the jugular vein, the largest vein in the neck. The jugular vein traverses the middle ear and any turbulent flow in the vein can be heard in the middle ear as a “hum” which may or may not fluctuate with the pulse. Correction of the underlying problem generally results in improvement or resolution.

7 – Hypertension. There are reports of patients with high blood pressure whose pulsatile tinnitus started after they began taking blood pressure medication. Tinnitus subsided in most after four to six weeks. For the remainder, a change to another medication resolved the issue. Others developed tinnitus from elevated blood pressure and it resolved after medication reduced the pressure.

8 – Twisted Arteries. Twisted arteries in the head and neck cause turbulent blood flow leading to pulsatile tinnitus. It generally does not require treatment.

These are the primary causes of pulsatile tinnitus but not an exhaustive listing.

9 – Other Causes. Other causes can include Arnold-Chiari malformation where an elongation of the cerebellum is pushed down through the opening of the base of the skull, blocking the flow of cerebrospinal fluid. Hyperthyroidism, a condition where the thyroid gland overproduces hormones, can cause pulsatile tinnitus. Iron deficiency can cause pulsatile tinnitus in some cases. Iron deficiency thins the blood and it rushes through the bloodstream. Anything that increases blood flow can cause pulsatile tinnitus. Muscle spasm in the soft palate can cause a clicking sound which is rapid (60-200 beats per minute), repetitive and intermittent. This is associated with multiple sclerosis, small vessel disease, tumor or degenerative neurological disorders. The small muscle attached to the stapes bone in the middle ear can spasm which produces a crackling or rumbling noise. There are other, mostly rare, causes of pulsatile tinnitus as well as those mentioned here.

If pulsatile tinnitus is caused by turbulent flow in arteries, pressure applied to the upper neck on the side of the tinnitus should alter or reduce it. If it is venous in origin, the Valsalva maneuver may improve it. This is performed by forcibly exhaling against closed lips and pinched nose, forcing air into the middle ear, provided the Eustachian tube is open. Neither of these is a fool-proof way of identifying or alleviating the problem but positive results may lead to a better diagnosis by a physician.

Arches Tinnitus Formula® is helpful in many cases of pulsatile tinnitus. The mechanism of action is Ginkgo biloba extract reduces the viscosity of the blood and arterial pressure which in turn reduces the throbbing or pulsing effect. People with pulsatile tinnitus should always undergo a thorough evaluation to ensure that serious consequences, such as stroke, will be prevented.

It Might Be More Than Just Noises In Your Head

Do you hear that ringing in your ears and wonder where it comes from? You’re not alone. The Hearing Health Foundation estimates 20 percent of Americans listen to that same annoying sound, or ones similar to it, daily. Only about 16 percent of them will talk to a doctor about the phantom noise even though it disrupts their lives. Ninety percent of people with tinnitus will also have hearing loss and maybe not even realize it. It is an escalating problem in this country, but what exactly is behind all the noise?

What is Tinnitus?

Tinnitus is the medical name for the ringing in your ears. There is no singular source for this sound – it’s actually a symptom of an underlying problem usually associated with loss of hearing.

Tinnitus is more of a sensation than an actual sound, too. That is why no one else hears the noise that is keeping you up at night. There are no sound waves causes this phenomenon, instead, it relates directly to tiny hairs inside the inner ear that produce an electrical signal telling the brain there is a sound. These cells are misfiring, sending random electrical impulses not based on any true noise.

It’s Not Just Ringing Either

It’s usually described as a high-pitched ringing in the ears, but the sounds vary. People with tinnitus report:

  • Buzzing
  • Roaring
  • Clicking
  • Hissing

Some say it sounds like you are pressing your ear up against a seashell to hear the waves. The variety of sounds involved with tinnitus makes this condition so much more confusing for those who don’t get medical treatment or a hearing test.

What Causes Tinnitus?

Tinnitus is simply a mechanical breakdown of a critical part of the human ear but what is behind this breakdown? For most people, it’s presbycusis, a form of hearing loss related to aging. Presbycusis is degenerative, so it tends to get worse as the person gets older. Other potential illnesses that present with tinnitus include:

  • Loud sounds – It might be a one-time bang or something that is a day to day problem like machinery, earphones or exposure to loud music
  • A build up of earwax – Earwax in the ear canal block sound waves interfering with your hearing
  • Ear bone growth – This is a genetic problem that changes the bones in the ear

There are other possibilities, although they are rare, such as Ménière’s disease, which refers to increased pressure inside the ear. Jaw problems may be a source of the ringing, as well. For some, the noise is a consequence of a head injury that damaged the nerves in the ear. It might also be a sign of high blood pressure, a rare tumor in the ear or a side effect of a medication.

What Can You Do About Tinnitus?

First, make an appointment for a hearing test and ear examination to figure out the cause of the ringing. Once you treat the underlying hearing loss with something like a hearing aid, the ringing may resolve over time. Tinnitus is usually a sign of hearing loss that may be affecting your life in other ways, too, like isolating you during conversations or leaving you feeling like you are missing things. Once you identify your hearing loss, then getting hearing aids increases real sounds so the phantom ones are less of an issue.

There are other things you can do at home, too, to help deal with what can be an annoying and distracting problem. White noise machines produce environmental sounds that sooth your mind, especially if tinnitus is keeping you awake. You can fall asleep listening to the rain, for example, instead of that buzzing in your head.

You can create your own background noise, too, to deflect some of the tinnitus chaos. A fan blowing in the room might help or a humidifier – anything that produces a soft, but persistent sound to keep the hair cells in the ear busy so they don’t misfire.

It’s important to remember, though, that the ringing is trying to tell you something. Most likely the message is about hearing loss, so it’s worth a trip to the doctor to get a hearing test and find out more about your ear health.

Superior Canal Dehiscence Clinical Presentation: History, Physical, Causes

Author

Wayne T Shaia, MD Director, The Balance and Ear Center

Disclosure: Nothing to disclose.

Coauthor(s)

Jack M Kartush, MD Clinical Professor, Department of Otolaryngology, Wayne State University School of Medicine; Professor Emeritus, Michigan Ear Institute at Providence Hospital; Clinical Professor, Oakland University William Beaumont School of Medicine

Jack M Kartush, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Otological Society, American Neurotology Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance Institute; Board of Directors, Ponchartrain Surgery Center

Gerard J Gianoli, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Neurotology Society, American Otological Society, Society of University Otolaryngologists-Head and Neck Surgeons, Triological Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;Cliexa, eMedevents, Neosoma, MI10<br/>Received income in an amount equal to or greater than $250 from: , Cliexa;;Neosoma<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Neosoma, eMedevents, MI10.

Additional Contributors

Robert A Battista, MD, FACS Assistant Professor of Otolaryngology, Northwestern University, The Feinberg School of Medicine; Physician, Ear Institute of Chicago, LLC

Robert A Battista, MD, FACS is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, Illinois State Medical Society, American Neurotology Society, American College of Surgeons

Disclosure: Nothing to disclose.

Acknowledgements

Angela Shu-Yuen Peng, MD Resident Physician, Department of Otolaryngology/Head and Neck Surgery, Virginia Commonwealth University Medical Center

Angela Shu-Yuen Peng, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Virginia Society of Otolaryngology-Head and Neck Surgery

Disclosure: Nothing to disclose.

Tinnitus – NHS

Tinnitus is the name for hearing noises that are not caused by sounds coming from the outside world. It is common and not usually a sign of anything serious. It might get better by itself and there are treatments that can help.

Check if you have tinnitus

Tinnitus can sound like:

  • ringing
  • buzzing
  • whooshing
  • humming
  • hissing
  • throbbing
  • music or singing

You may hear these sounds in 1 or both ears, or in your head. They may come and go, or you might hear them all the time.

Non-urgent advice: See a GP if:

  • you have tinnitus regularly or constantly
  • your tinnitus is getting worse
  • your tinnitus is bothering you – for example, it’s affecting your sleep or concentration, or is making you feel anxious and depressed
  • you have tinnitus that beats in time with your pulse

Urgent advice: Call 999 or go to A&E if you have tinnitus:

  • after a head injury
  • with sudden hearing loss, weakness in the muscles of your face, or a spinning sensation (vertigo)

What happens at your appointment

The GP will look in your ears to see if your tinnitus is caused by something they can treat, like an ear infection or a build-up of earwax.

They might also check for any hearing loss.

You may be referred to a specialist for further tests and treatment.

Things you can try to help cope with tinnitus

Don’t

  • do not have total silence – listening to soft music or sounds (called sound therapy) may distract you from the tinnitus

  • do not focus on it, as this can make it worse – hobbies and activities may take your mind off it

The British Tinnitus Association (BTA) has more information about sound therapy, and runs support groups and a free helpline on 0800 018 0527.

RNID also has a free helpline on 0808 808 0123.

Treatments for tinnitus

If the cause of your tinnitus is unknown or cannot be treated, your GP or specialist may refer you for a type of talking therapy.

This could be:

  • tinnitus counselling – to help you learn about your tinnitus and find ways of coping with it
  • cognitive behavioural therapy (CBT) – to change the way you think about your tinnitus and reduce anxiety
  • tinnitus retraining therapy – using sound therapy to retrain your brain to tune out and be less aware of the tinnitus

Tinnitus retraining therapy may be available on the NHS for people with severe or persistent tinnitus. It’s unclear if tinnitus retraining therapy works for everyone. It’s widely available privately.

If tinnitus is causing you hearing loss, hearing aids may be recommended.

Causes of tinnitus

It’s not always clear what causes tinnitus, but it’s often linked to:

Video: tinnitus (BSL version)

In this video, learn about tinnitus, its possible causes and the effects and how to deal with it.

Media last reviewed: 19 June 2018
Media review due: 19 June 2021

Page last reviewed: 02 October 2020
Next review due: 02 October 2023

90,000 I hear a ringing – where is it from? Why there is noise in the head | Healthy life | Health

Reason: severe stress

With emotional experiences, severe fear, anxiety in a person, the temporal muscles are strained. Constant tightness of these muscles can lead to squeezing of the vessels of the ear canal, which causes a sensation of noise, ringing, hum in the ears.

What to do?

Acupressure will help – a light massage of active points with your fingertips.It should be carried out in a circular motion with slight pressure.

Press the point located in the fossa above the upper lip with your index finger for 7 seconds. Then, with medium effort, press the point at the end of the root of the nose, near the eyebrows – also for 7 seconds. Repeat these techniques several times a day.

For 7 seconds, press firmly with your ring finger on the place where the earlobe meets the face. Then another 7 seconds – just in front of the uvula (there, if you touch, you will feel a small fossa).And in conclusion, another 7 seconds – at the beginning of the upper part of the cartilage of the auricle (there you should also feel the fossa). There is usually a pleasant warmth after exercise, which indicates improved circulation.

Cause: sulfuric plug in the ear

It is formed, as a rule, only on one side and, in addition to a hum in the head, can cause dizziness and a slight violation of the coordination of movements.

What to do?

Consult an otolaryngologist who, using a special syringe, will flush the ear canal and process the ear to restore its damaged integument.

Cause: osteochondrosis

Nerves associated with the auditory brain can be compressed in this disorder. This often happens during sleep if you have taken an uncomfortable position. The result is an unpleasant high, continuous hum of varying intensity in the head. It can sound like a working refrigerator or the hum of cars during a traffic jam.

If the hum in the head is associated with osteochondrosis, it should decrease or disappear altogether when assuming an upright position.

What to do?

Be attentive to the conditions of your sleep. The pillow should fit you exactly, not too high or too low.

After waking up, it is good to do some exercises for the cervical spine. Rotate your head, stretch your ear to your shoulder, push an imaginary ball under your chin towards your chest.

Cause: cerebral arteriosclerosis

Usually, the sensation of hum or noise in the head associated with atherosclerosis is similar to the sound of the sea, that is, it has a low tonality and rhythmic structure.Sometimes this noise increases after sleeping in an uncomfortable position.

What to do?

It is necessary to undergo an examination by a neurologist as soon as possible, to do an MRI or Doppler ultrasonography of the vessels of the brain. If the diagnosis is confirmed, you should limit the consumption of animal fats that cause deposits of atherosclerotic plaques on the walls of blood vessels. They are found in butter, meat, sausages, complex sweets, sour cream, cream. Also, the doctor will prescribe drugs that lower cholesterol levels and improve the condition of the vascular wall, vasodilators and other drugs.

Cause: vegetative-vascular dystonia

In this condition, the regulation of the tone of the blood vessels is impaired, and the pressure often decreases. This can cause mild, uniform or pulsating tinnitus, dizziness, and poor coordination.

What to do?

See your doctor to confirm the diagnosis. If the matter is in vegetative dystonia, move more: walk, swim, dance, take bike rides.Cool douches and general strengthening massage are also useful. Make sure you get enough sleep. It is necessary that there is an influx of fresh air into the bedroom at night. Give up bad habits.

It is important to learn how to relieve stress. For example, before going to bed, you can, lying on your back, imagine how all the muscles of the body, from the toes and hands to the muscles of the face, relax in turn, a feeling of pleasant warmth appears in them. It is also helpful to take a few deep breaths and slow exhalations.

Cause: cochlear neuritis

This is damage to the auditory nerve, which threatens deafness. The sensations during the disease are rather sharp – a high ringing, a squeak in the ear, more often on one side (but maybe on two sides), a distinct hearing loss. Sometimes this is accompanied by dizziness, nausea.

What to do?

Urgently consult an otolaryngologist who will prescribe a course of medications. If you apply within a week, or preferably three days, the onset of deafness can be avoided, if the delay is over, the chances are small.

Treatment of tinnitus and headaches

Clinical treatment of tinnitus and headaches

Symptoms of some diseases are sometimes very similar, but they require different treatment methods. Only a specialist after a diagnostic examination can establish an accurate diagnosis and prescribe a course of treatment. To find out the cause of the ailment and start treatment, sign up for a consultation with a neurologist.

Why “Movement”

  1. The clinic is located in the Vyborg district of St. Petersburg, near the Ozerki metro station.
  2. Receptions are conducted by qualified doctors with many years of experience in the treatment of various neurological diseases and problems of the musculoskeletal system.
  3. Comprehensive treatment programs developed by our specialists, in the overwhelming majority of cases, make it possible to do without surgical intervention, even in very difficult clinical situations.
  4. Prices for medical services are available.

Methods of treatment of tinnitus and head noise

The doctor proposes specific methods of treatment to the patient individually, based on the data of the diagnostic study.but all the techniques used in the clinic are effective and time-tested. they can be divided into several types:

  • Hardware – resonant wave UHF therapy, laser therapy, magnetic laser therapy, vacuum laser therapy.
  • Medication – blockade (drugs “Diprospan” and “Dexamethasone”), intravenous infusion based on “Dexamethasone” or another drug according to indications, pharmacopuncture.
  • Manual – manual therapy, massage.
  • In addition to the above methods, our clinic also uses plasma lifting and reflexology.

Noise and ringing in the ears, head, headache, dizziness – such symptoms, if they recur, are worth paying attention to, because they may be caused by serious problems indicating a disease that requires treatment:

  • cerebrovascular accident ;
  • compression of the vessels located at the level of the cervical spine;
  • increased or, conversely, decreased intracranial pressure;
  • anomalies in the development of the vessels of the cervical spine.

What diseases the body signals by noise in the ears and head:

  • osteochondrosis; 90 080
  • scoliosis;
  • dorsopathy;
  • disc herniation;
  • disc protrusion;
  • periarthritis of the shoulder scapula; 90,080 90,079 listeses; 90 080
  • spondylosis;
  • spondyloarthrosis;
  • radiculopathy;
  • myositis;
  • muscle-tonic syndrome;
  • vegetative-vascular dystonia;
  • progressive hypertension.
  • Discomfort in the head and ears also occurs as a consequence of a compression fracture of the spine, due to post-traumatic deformities of the spine, birth trauma.

What the noises in the head are talking about

Bells, sea surf and squeak – it happens that only sounds are not heard in the head of a person. And each of them signals a serious illness. How to decipher the noises in your head and keep your health?

The hum in the ears begins suddenly, at first it is weak, then the noise grows and turns a person’s life into a real torment.Depression and neurosis are the result of noise attacks, and this is just the tip of the iceberg. Tinnitus often indicates other, more serious medical conditions.

And hums and chirps

Every disease has its own noise. If it looks like the sounds of the tide, there is no time for romance, doctors warn. This is one of the signs of vascular atherosclerosis and hypertension. The fact is that atherosclerotic plaques deposited on the vascular walls narrow the lumen of the vessels and increase the blood pressure, which causes tinnitus and pressure in the head.

Noises that increase during physical exertion, during stress, can be a symptom of vascular diseases of the head.

Osteochondrosis is another common cause of noise in the ears and head, it manifests itself in the form of an unpleasant hum of different heights. Tinnitus (a high-pitched sound, reminiscent of a bell ringing) signals thyroid disease – a lack or excess of hormones.

In case of diseases of the inner ear, the patient develops congestion in the ears and noise in the head in the form of chirping and squeaking.

Severe tinnitus is one of the symptoms of a brain tumor. Such patients have attacks of dizziness, seizures resembling epileptic, attacks of nausea and vomiting caused by increased intracranial pressure. In this case, you should immediately consult a doctor.

Symptom of what?

Noise in the ears and head is not a disease, but a response to existing pathologies. If you identify and eliminate the cause of the extraneous sounds, they will disappear.

Usually, for complaints of noise, the doctor prescribes magnetic resonance imaging to the patient.This is one of the most effective modern diagnostic methods, moreover, operational. Specialists do tomography of the head or other organs, since the reason is not always the brain.

The examination for a noise in the head includes a scan of the brain and blood vessels, sometimes it may be necessary to examine the inner ear and cervical spine. MRI results enable the doctor to make a correct diagnosis. The information content of these surveys is 98%.

Tinnitus is the medical term for ringing or tinnitus.A person describes this unpleasant sensation in the form of ringing, buzzing, hum, squeak, or other sounds perceived by the ear in the absence of auditory stimuli from the outside. The intensity of the noise at different time intervals can vary from a faint barely noticeable ringing to a strong hum. As practice shows, along with tinnitus, the patient develops hearing impairment, and the strength of the noise increases in proportion to the hearing loss. Most often, this symptom manifests itself in middle-aged and elderly people (40–80 years old).If you hear tinnitus all the time, you should consult a cardiologist, neuropathologist, endocrinologist.

90,000 Betahistine for tinnitus | Cochrane

Relevance

Tinnitus (noise, ringing in the ears) is characterized by “ringing”, “whistling” or “hissing” that is heard in the absence of any external sound. Between 5% and 43% of people experience this symptom, and for some, it has a significant negative impact on their quality of life. Tinnitus can be controlled through education and counseling, prescription hearing aids, over-the-counter devices that produce background sounds, and psychological and relaxation therapies.Medication is used to treat tinnitus-related complaints such as sleep problems, anxiety, or depression. There is no drug therapy that can cure tinnitus. However, betahistine is often prescribed for tinnitus. The purpose of this review is to evaluate the results of high quality clinical trials regarding the efficacy of betahistine in people with tinnitus. In particular, we wanted to look at the effects of betahistine on tinnitus (tinnitus) and the side effects of betahistine.

Research characteristics

Our review identified five randomized controlled trials with a total of 303 to 305 participants who suffered from tinnitus. These studies compared participants taking betahistine with those taking a placebo. Four studies assigned participants to parallel groups. In one study, participants agreed to take all study drugs in a predetermined sequence. The outcomes we evaluated included tinnitus severity and obsession, tinnitus symptoms, and side effects.

Main results

The included studies showed no differences in tinnitus severity, symptom severity, or side effects between participants taking betahistine and those taking placebo. There were no significant side effects. We planned to measure changes in obsessional tinnitus, depression, anxiety, and quality of life, but these were not measured. Research results indicate that betahistine is generally well tolerated and the risk of side effects is similar to placebo.

Quality of evidence

The quality of the evidence ranged from moderate to very low. The risk of bias in all included studies was uncertain. Results were obtained from only one or two studies. In some studies, the participants who were included did not fully represent the entire population of people with tinnitus, and therefore we cannot draw general conclusions.

Tinnitus has been identified as a sign of serious health problems

https: // ria.ru / 20210115 / vitamin-1593115563.html

Tinnitus was called a sign of serious health problems

Tinnitus was called a sign of serious health problems

Regular tinnitus may indicate serious health problems. Express writes about this with reference to the data of American researchers. RIA Novosti, 15.01.2021

2021-01-15T00: 57

2021-01-15T00: 57

2021-01-15T12: 15

science

vitamins

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MOSCOW, 15 January – RIA Novosti. Regular tinnitus can indicate serious health problems. Express writes about this, citing data from American researchers. Scientists have found that ringing in the ears – tinnitus – indicates a lack of vitamin B12 in the body. It is a water-soluble vitamin also called cobalamin. He is not only responsible for the functioning of the nervous system, but is involved in the production of red blood cells and DNA.According to experts, B12 is also required for the production of myelin, the protective and insulating sheath that surrounds nerves. Lack of vitamin A leads to poor communication between nerves, which can contribute to ringing in the ears. B12 deficiency can also cause tingling and numbness in the arms and legs, muscle weakness and loss of reflexes. Tinnitus is ringing or tinnitus without external acoustic stimulus. This sensation can be characterized by patients as hum, hiss, whistle, ringing, noise of falling water, chirping of grasshoppers.There is still no cure for tinnitus. However, in practice, conservative methods of treatment are used: drug therapy, physiotherapy, reflexology and hearing aids. Earlier it became known that a thick and reddened tongue can be a sign of vitamin B12 deficiency, the lack of which increases the risk of pernicious anemia.

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https://ria.ru/20191106/1560639641.html

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vitamins, the whole world

MOSCOW, January 15 – RIA Novosti. Regular tinnitus may indicate serious health problems. Express writes about this, citing data from American researchers. Scientists have found that ringing in the ears – tinnitus – indicates a lack of vitamin B in the body 12 .It is a water-soluble vitamin also called cobalamin. He is not only responsible for the functioning of the nervous system, but is involved in the production of red blood cells and DNA.

December 4, 2020, 17:12

Myasnikov explained how to recognize dangerous diseases by a blood test

According to experts, B 12 is also necessary for the production of myelin, a protective and insulating sheath that surrounds nerves. Lack of vitamin A leads to poor communication between nerves, which can contribute to tinnitus.

B deficiency 12 can also cause tingling and numbness in the arms and legs, muscle weakness and loss of reflexes.

Tinnitus – ringing or tinnitus without external acoustic stimulus. This sensation can be characterized by patients as hum, hiss, whistle, ringing, noise of falling water, chirping of grasshoppers.

There is still no cure for tinnitus. However, in practice, conservative treatment methods are used: drug therapy, physiotherapy, reflexology and hearing aids.

6 November 2019, 15:55

Rospotrebnadzor told how to take vitamins correctly

Earlier it became known that a thickened and reddened tongue may be a sign of vitamin B12 deficiency, the lack of which increases the risk of pernicious anemia.

Tinnitus

Tinnitus is common. It affects up to 30% of the adult population.

The most common causes of tinnitus:

1) Changes in the outer, middle or inner ear, most often associated with inflammatory diseases

diseases (otitis media) or Meniere’s disease

2) Pathology of the autonomic nervous system (autonomic dysfunction)

3) Mental illnesses

4) Frequent nervous experiences, stress (psychogenic causes)

5) Osteochondrosis of the spine (vertebral artery syndrome)

6) High blood pressure (vascular spasms)

7) Migraine (vascular headaches)

8) Atherosclerosis (narrowing or blockage of a vessel by plaque, which disrupts blood flow in the arteries of the brain).

In case of cerebral circulation disorders, acute stroke, along with tinnitus, speech, sensitivity, balance are rapidly impaired. Weakness appears in the arm or half of the body, facial asymmetry.

Noise or ringing in the ears is a symptom of the formation of a neuroma – a tumor of the auditory nerve. Dizziness, movement disorders appear. A neuroma can lead to complete deafness. A brain tumor is manifested by vomiting in the morning, impaired vision and hearing.

Osteochondrosis in the cervical spine is also a common cause of tinnitus. Age-related degenerative disorders occur in the spine. In this case, a person is worried about dizziness, headache and heaviness in the back of the head.

With arterial hypertension, high blood pressure may be accompanied by ringing in the ears. If the flashing of flies joins, a headache, this indicates the formation of a hypertensive crisis. Also, pathology can be caused by vascular pathology (constrictions, aneurysms, arteriovenous connections).

The causes of tinnitus can be pathological movements in the joints of the cervical vertebrae, dysfunction of the temporomandibular joint. In this case, a person hears a click or crunch in the joint when opening the mouth, chewing, turning the head. Sounds can form moving fluids with exudative inflammation of the middle and inner ear.

Tinnitus is often associated with a migraine attack. A characteristic symptom of this disease is severe throbbing pain in half of the head.Young women are more likely to suffer from migraine.

Atherosclerosis of the vessels of the head causes disturbances in blood flow through them. There is a ringing or pulsating noise that matches the frequency of the heartbeat. Problems associated with the development of atherosclerosis are typical for older people.

The cause of tinnitus can be otosclerosis – the growth of bone tissue at the junction of the middle and inner ear. The cause of this chronic condition is unknown. Women are more often susceptible to this pathology.Otosclerosis leads to hearing loss and can only be treated with surgery.

Pathology is also detected in multiple sclerosis with a measured course. Its main symptoms are blurred vision, poor speech, impaired swallowing, hum and ringing in the ears, stiffness in the limbs. Coordination is impaired, there is a feeling of creeping on the skin. Urinary incontinence may develop.

Ringing, hum or tinnitus may not only be a sign of a medical condition. Auditory hallucinations can be caused by taking medications such as gentamicin, furosemide, streptomycin.

The cause of tinnitus can be stress, poisoning, foreign body. The ingress of water or a small insect into the external auditory canal is the reason for the appearance of rustling and hum.

Tinnitus may occur due to changes in weather or atmospheric pressure during flight in an airplane, diving. An increase in temperature and intense physical activity can cause ringing and discomfort in the head.

Symptoms and types of ringing in the ear

Often ringing, hissing, whistling, hum, clicks in the ears are accompanied by dizziness, hearing loss, or vice versa, intolerance to sounds, increased sensitivity to them.These symptoms can be accompanied by headaches, intolerance to bright light.

Pathology can be of varying intensity. Sometimes it is tolerated calmly, does not affect the general well-being of a person, and in some cases it is accompanied by an unbearable headache and sleep disturbance.

It happens that the sounds in the ears become constant, significantly disturb the night’s rest, worsen the mood. Rarely, there is a strong ear noise, which reduces a person’s performance.

In case of inflammation of the outer or middle ear (otitis media), noise and ringing are combined with itching, redness of the ear canal, soreness when touched.Purulent discharge, hearing loss may be observed. To avoid injury and infection, do not clean your ear canals with sharp objects.

Diagnostics and treatment of pathological sounds in the ear canal

Tinnitus usually does not exist on its own, but is a symptom of various diseases, so it is better to seek examination and help from a medical institution. A person should be especially alerted if he has sound effects in the ear accompanied by vomiting, nausea, dizziness, severe headache, unsteady gait, hearing loss.

Necessary consultations and examinations for tinnitus:

  • ENT doctor consultation
  • neurologist consultation (including vascular neurologist, vegetologist)
  • examination of cerebral vascular
  • potentials (used in the early diagnosis of a brain tumor, acoustic neuroma and multiple sclerosis)

  • others – according to indications.

Treatment of tinnitus consists in correcting the underlying disease. In addition to the main methods of treating the ailment, physiotherapy, including intra-ear electrophoresis, and massage are perfect.

Sign up for a neurologist’s consultation by phone. 8-9655-99-75-07.

Ear Noise | Centrum Słuchu i Mowy MEDINCUS

What is tinnitus and why does it occur?

These are the sounds that we hear in one ear, in both ears or in the head, and sometimes in the ears and in the head at the same time.People with tinnitus describe it in different ways: as a squeak, ringing, knocking, hum, rustling, whistling, hiss. Regardless of the nature and type of sound, they are all called tinnitus.

Nearly all of us experience occasional ringing in our ears. This phenomenon occurs especially often in silence. There is such a saying “so quietly that even in my ears it rings.” Such short-term, passing sounds should not cause concern and do not require medical advice.

How does tinnitus occur?

Ear murmur is associated with abnormalities in the auditory analyzer and is the result of changes in activity in the fibers of the auditory nerve, most often as a result of changes in the inner ear.In most cases, it is believed that irreversible damage to the outer hair cells of the cochlea is the source of tinnitus. Simply put, the activity in the pathway of the auditory analyzer changes.

Why are we concerned about tinnitus?

For some people, the appearance of extraneous sound in the ears, even the quietest, is a serious problem that interferes with a normal life, while for others, ear noise does not interfere at all. This indicates that the degree of irritation is determined not by the place of origin and characteristics of the noise, but by the consequences that the signal causes in the human nervous system.

Most often, tinnitus is a subjective sensation of the patient. This means that no one around you can hear this sound. Hence the misunderstanding of the patient’s problem by others.

Is tinnitus a disease and a threat?

Tinnitus is not a disease, but only a symptom of various changes in the inner ear. To find out the cause of tinnitus, an audiological diagnosis should be carried out in order to exclude organic pathologies that require a doctor’s surgical intervention. In addition to the fact that tinnitus is not a disease, it often leads to nervous strain, anxiety, unexplained fears, discomfort, often causes depression, so tinnitus must be treated.

There are many causes of tinnitus and it is extremely difficult to make a correct diagnosis. To identify the cause of the disease, you will need to undergo a thorough diagnosis. The doctor interviews the patient in detail and conducts an otorhinolaryngological examination.Important information is whether the noise occurs constantly or intermittently, whether it appeared suddenly, from one or both sides, what character, frequency and loudness it has. The next step will be to conduct audiological examinations. Some patients with tinnitus may have hearing loss. In some cases, it will be necessary to carry out additional examinations to make a correct diagnosis, for example, angiography of the cerebral vessels, computed tomography of the brain, magnetic resonance imaging or ultrasound examination of the carotid and vertebral arteries to assess the presence and direction of flow within the vessels.

How is tinnitus treated?

To date, there is no single treatment that is appropriate and effective for all types of tinnitus. How tinnitus is treated depends on the cause and location of the noise. Tinnitus can occur at any level in the auditory analyzer pathway, from the external auditory canal to the auditory cortex. Treatments for tinnitus depend on what caused the tinnitus, such as tinnitus caused by auditory tube dysfunction or otosclerosis, is treated differently than tinnitus caused by years of work in noisy environments.Tinnitus does not appear for no reason. Noise is not a disease, but it can be a symptom of various pathological conditions. Ear noise is always a signal that something in the body is not functioning properly.

In the case when tinnitus becomes unbearable, leads to depression and an inexplicable feeling of fear, it is worth seeking help from a psychiatrist.

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