What are the common signs of tinnitus. How is tinnitus classified. What causes tinnitus. How does tinnitus affect daily life. What treatments are available for tinnitus. Can medications cause tinnitus. Is tinnitus always associated with hearing loss.

What is Tinnitus and How Does It Manifest?

Tinnitus is an auditory perception not directly produced by external sources. It manifests as a variety of sounds in one or both ears (tinnitus aurium) or in the head (tinnitus cranii). These sounds can be described as:

• Hissing
• Roaring
• Ringing
• Whooshing

The characteristics of tinnitus can vary significantly from person to person. The pitch may range from high to low, and the sound can be a single tone, multi-tonal, or noise-like without any tonal quality. Tinnitus may be constant, pulsing, or intermittent, and its onset can be sudden or gradual.

Types of Tinnitus: Objective vs. Subjective

Tinnitus is broadly classified into two main categories:

Objective Tinnitus

Objective tinnitus accounts for less than 5% of all cases. It is unique because the sound can be heard by an observer, either with a stethoscope or by listening in close proximity to the ear. This type of tinnitus is often described as pulsatile or synchronous with the patient’s heartbeat. What causes objective tinnitus? It is frequently associated with vascular or muscular disorders. In many cases, the underlying cause can be determined, and treatment options may include medical or surgical interventions.

Subjective Tinnitus

Subjective tinnitus is far more common, representing 95% of all cases. Unlike objective tinnitus, this form is audible only to the patient. It is a symptom associated with virtually every known ear disorder and is reported in over 80% of individuals with sensorineural hearing loss, which results from nerve and/or hair cell damage.

The Impact of Tinnitus on Daily Life

The severity of tinnitus largely depends on an individual’s reaction to the condition. Two people may experience identical tinnitus in terms of loudness and pitch, yet be affected in significantly different ways. Many tinnitus sufferers report:

• Difficulty sleeping or concentrating
• Feelings of depression or anxiety
• Additional problems at work or home contributing to tinnitus-related distress
• Correlation between tinnitus perception and stress levels

It’s often challenging to determine whether a patient’s emotional state pre-existed or resulted from the tinnitus. How does tinnitus affect quality of life? The persistent nature of the condition can lead to sleep disturbances, concentration problems, and emotional distress, significantly impacting daily activities and overall well-being.

Unraveling the Causes of Tinnitus

While the exact mechanism underlying tinnitus remains unknown, it is likely that multiple factors contribute to its development. In most cases, tinnitus is related to an abnormality in the hearing or neural system. What are the common causes of tinnitus? Let’s explore the various factors linked to this condition:

Outer Ear Disorders

• Accumulation of ear wax
• A hair touching the eardrum
• Presence of a foreign body
• Perforated eardrum

Middle Ear Disorders

• Negative pressure from eustachian tube dysfunction
• Fluid accumulation
• Infection
• Otosclerosis
• Allergies
• Benign tumors

Inner Ear Disorders

• Sensorineural hearing loss due to noise exposure
• Age-related hearing loss
• Inner ear infections
• Meniere’s disease (often accompanied by hearing loss and dizziness)

Medications and Systemic Disorders: Hidden Culprits of Tinnitus

Can medications cause tinnitus? Yes, certain medications can temporarily induce tinnitus as a side effect. These include:

• Anti-inflammatories (e.g., aspirin, ibuprofen, nonsteroidal anti-inflammatories, and quinine)
• Sedatives
• Antidepressants
• Certain antibiotics and chemotherapeutic agents

Beyond medications, various systemic disorders can contribute to tinnitus:

• High or low blood pressure
• Anemia
• Diabetes
• Thyroid dysfunction
• Glucose metabolism abnormalities
• Vascular disorders
• Growth on jugular vein
• Acoustic tumors
• Head or neck aneurysms

Additionally, non-auditory disorders can play a role in tinnitus development:

• Trauma to the head or neck
• Temporomandibular (jaw joint) disorders
• Neck misalignment

The Brain’s Role in Tinnitus Perception

Current research suggests that while tinnitus may initially be triggered by an injury to the ear, the condition ultimately establishes itself as an auditory pattern in the brain. This understanding has led to a shift in treatment approaches, with many now targeting the brain rather than the ear.

How does the brain contribute to tinnitus perception? The brain’s plasticity allows it to adapt to changes in sensory input. In the case of tinnitus, it’s believed that the brain may be compensating for the loss of certain frequencies by “filling in” the missing sound. This neuroplastic change can result in the persistent perception of sound even in the absence of an external stimulus.

Tinnitus and Hearing Loss: Separating Fact from Fiction

Is tinnitus always associated with hearing loss? While the majority of tinnitus sufferers also experience hearing loss, it’s important to note that the presence of tinnitus does not necessarily indicate progressive hearing loss. This misconception often leads to unnecessary anxiety among those experiencing tinnitus.

What’s the relationship between tinnitus and hearing loss? In many cases, tinnitus is a symptom of underlying hearing damage. However, it can also occur in individuals with normal hearing. The complex relationship between tinnitus and hearing loss underscores the importance of comprehensive audiological evaluations for proper diagnosis and management.

Pulsatile Tinnitus: A Unique Variation

Pulsatile tinnitus is a rare form of tinnitus characterized by a thumping or whooshing sound that seems to follow a steady beat, often in sync with the patient’s pulse. Unlike regular tinnitus, the sound in pulsatile tinnitus originates from inside the body and may be audible to an external observer.

What distinguishes pulsatile tinnitus from other forms? The key difference lies in its rhythmic nature and potential for external detection. Pulsatile tinnitus is also referred to as rhythmic, vascular, or pulse-synchronous tinnitus. It may be heard in only one ear and is often associated with vascular abnormalities or increased awareness of blood flow near the ears.

How is pulsatile tinnitus diagnosed? Diagnosis typically involves a thorough medical history, physical examination, and specialized imaging tests to identify any underlying vascular abnormalities. These may include CT angiography, MRI, or ultrasound studies.

Tinnitus Management: Current Approaches and Future Directions

While there is no universal cure for tinnitus, various management strategies can help alleviate its impact on daily life. What treatments are available for tinnitus? Current approaches include:

1. Sound therapy: Using external noise to mask or distract from tinnitus
2. Cognitive Behavioral Therapy (CBT): Helping patients change their perception and reaction to tinnitus
3. Tinnitus Retraining Therapy (TRT): Combining sound therapy with counseling to habituate the brain to tinnitus
4. Hearing aids: Amplifying external sounds to reduce tinnitus perception in those with hearing loss
5. Medications: Managing associated conditions like depression or anxiety
6. Relaxation techniques: Reducing stress-related tinnitus exacerbation

What does the future hold for tinnitus treatment? Emerging research is exploring innovative approaches such as neuromodulation techniques, which aim to alter neural activity associated with tinnitus. These include transcranial magnetic stimulation (TMS) and vagus nerve stimulation. Additionally, pharmacological interventions targeting specific neurotransmitters involved in tinnitus perception are under investigation.

As our understanding of tinnitus continues to evolve, so too do the strategies for its management. The complex nature of this condition underscores the importance of a personalized approach, tailored to each individual’s unique experience and needs. By combining current best practices with ongoing research, the field of tinnitus management continues to advance, offering hope for improved outcomes and quality of life for those affected by this challenging condition.

Tinnitus Signs and Symptoms | UCSF Health

Signs & Symptoms
Audiology

Tinnitus is one of the most elusive conditions that health care professionals face. It is an auditory perception not directly produced externally.

It is commonly described as a hissing, roaring, ringing or whooshing sound in one or both ears, called tinnitus aurium, or in the head, called tinnitus cranii.

The sound ranges from high to low pitch and can be a single tone, multi-tonal, or noise-like, having no tonal quality. Tinnitus may be constant, pulsing or intermittent. It may begin suddenly or progress gradually.

Tinnitus can be broadly classified into two categories: objective and subjective.

Objective Tinnitus

This form is audible to an observer either with a stethoscope or simply by listening in close proximity to the ear. Objective tinnitus accounts for less than 5 percent of overall tinnitus cases and is often associated with vascular or muscular disorders. The tinnitus is frequently described as pulsatile, or synchronous with the patient’s heartbeat. In many instances, the cause of objective tinnitus can be determined and treatment, either medical or surgical, may be prescribed.

Subjective Tinnitus

This form is audible only to the patient and is much more common, accounting for 95 percent of tinnitus cases. Subjective tinnitus is a symptom that is associated with practically every known ear disorder and is reported to be present in over 80 percent of individuals with sensorineural hearing loss, which is caused by nerve and/or hair cell damage.

Because tinnitus, like pain, is subjective, two individuals may demonstrate identical tinnitus loudness and pitch matches yet be affected in significantly different ways. The severity of the tinnitus is largely a function of the individual’s reaction to the condition. That said, many tinnitus sufferers:

• Have difficulty sleeping or concentrating
• Feel depressed or anxious
• Report additional problems at work or at home that may contribute to the distress caused by tinnitus
• Describe a correlation of tinnitus perception with stress
• It is often difficult to determine whether a patient’s emotional state pre-existed, or is a result of the tinnitus.

Causes

Although the exact mechanism underlying tinnitus is unknown, it is likely that there are many related factors. Tinnitus usually, but not always, has to do with an abnormality of the hearing or neural system.

There are a number of causes linked with tinnitus including:

• Disorders in the outer ear, such as ear wax, a hair touching the eardrum, a foreign body or a perforated eardrum
• Disorders in the middle ear, such as negative pressure from eustachian tube dysfunction, fluid, infection, otosclerosis, allergies or benign tumors
• Disorders in the inner ear, such as sensorineural hearing loss due to noise exposure, aging, inner ear infection or Meniere’s disease often accompanied by hearing loss and dizziness

Tinnitus also can temporarily result from certain medications, such as:

• Anti-inflammatories such as aspirin, ibuprofen, nonsteroidal anti-inflammatories and quinine
• Sedatives
• Antidepressants
• Certain antibiotics and chemotherapeutic agents

Other causes include:

• Systemic disorders such as high or low blood pressure, anemia, diabetes, thyroid dysfunction, glucose metabolism abnormalities, vascular disorders, growth on jugular vein, acoustic tumors and head or neck aneurysms
• Non-auditory disorders such as trauma to the head or neck, temporomandibular (jaw joint) disorders and neck misalignment

Current research suggests that even though tinnitus may initially be caused by an injury to the ear, ultimately an auditory pattern is established in the brain. Therefore, many treatment approaches are directed at the brain, not the ear.

Although the majority of tinnitus sufferers also have hearing loss, the presence of tinnitus does not indicate that one is losing hearing.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

Pulsatile Tinnitus: Symptoms, Causes, and Treatments

Written by Shawna Seed

In this Article

• Symptoms
• Causes
• Diagnosis
• Treatments

If you have a thumping or whooshing sound in one or both ears that seems to follow a steady beat, you may have this rare form of tinnitus. Like regular tinnitus, you hear a constant sound that others don’t. But with the pulsatile form of this condition, the noise comes from inside your body. Your doctor may be able to hear it, too, if they listen with a stethoscope. It’s also called rhythmic, vascular, or pulse-synchronous tinnitus.

You regularly hear a sound with a steady beat that seems in sync with your pulse. You may hear it in only one ear. For many people, the sound can be loud and distracting, sometimes even unbearable.

You might notice other symptoms if you also have high pressure in the fluid around your brain, a condition called idiopathic intracranial hypertension:

• Headaches
• Dizziness
• Vision problems
• Hearing loss

If you have idiopathic intracranial hypertension, you may need to lose weight, take medication, or have surgery.

Unlike with regular tinnitus, doctors often can pinpoint a specific health problem behind this type:

Irregular blood vessels. This is a common issue. When blood flows through damaged or kinked vessels in the brain near or around the ear, it can change pressure and noise. A narrow or kinked neck artery (the carotid artery) or vein (the jugular vein) also can cause the sound.

High blood pressure . This can lead to a change in blood flow, and things like stress, alcohol, and caffeine can make the noise more noticeable.

Severe anemia or an overactive thyroid gland. These can make your blood flow quickly and loudly.

Atherosclerosis. This is a hardening of your arteries. As cholesterol and other fats clog your blood vessels, they grow less flexible. That makes blood flowing near your middle and inner ear move with more force, like water through a narrowed streambed. You’ll usually hear it in both ears.

Head and neck tumors. These can press on blood vessels and make noise.

Connection problems between arteries and veins. This condition, called arteriovenous malformation, generally affects only one ear.

You may need to see an ear specialist called an otolaryngologist. You’ll have a hearing test, and the doctor will check your ears. They may also look at your jaw and check your eyes for signs of increased pressure in your brain.

Other tests might include:

• Brainstem auditory evoked response (BAER), which times electrical waves from your brain in response to clicks in your ear
• Electrocochleography, which is similar to BAER but uses an electrode placed on or in your eardrum
• Scans of your brain and blood vessels, such as an MRI or CT scan
• Blood tests

This kind of tinnitus is often the first clue that you have something else going on that needs to be treated. Your treatment plan will depend on what’s causing your tinnitus. You may need medication or surgery to repair a blood vessel. Once the condition that caused it is treated, the sound should stop.

If you’re still hearing the noise or your doctor can’t find a cause, you can try:

White noise. It can help make the sound less noticeable, especially at bedtime. You can get a special machine that makes it, or see if an air conditioner or fan in your bedroom helps. Some smartphone apps make white noise, too.

Wearable sound generators. These masking devices look like hearing aids. They create a constant, low-level background noise.

Tinnitus retraining. You wear a device that plays music in a frequency that helps you tune out the tinnitus.

If these options don’t help, tell your doctor, who can check further to see what the problem may be.

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Tinnitus, ringing in the ears – symptoms, causes, treatment

What is tinnitus?

The word tinnitus comes from the Latin tinnire, “to tinkle” , but tinnitus can sound more like a hum, hiss, chirp or a thin squeak.

About 40% of adults experience tinnitus from time to time. About 8% suffer from it often or constantly. For 1% of people, tinnitus is a serious problem that interferes with a normal life. It almost never affects children and very often elderly people with hearing loss.

This noise is not associated with external sounds and is “heard” better in silence than with external noise. Tinnitus lasts for a long time (more than 5 minutes) and should be distinguished from a short, transient sound that lasts a few seconds or occurs after a strong sound stimulus. Such noise is in no way connected with the mechanical processes occurring in the ear, its cause is in the nerve cells.

IMPORTANT! Information from the article cannot be used for self-diagnosis and self-treatment! Only a doctor can prescribe the necessary examinations, establish a diagnosis and draw up a treatment plan for a consultation!

Why does tinnitus occur?

There are two theories about its origin.

1) Due to the constant high level of noise in the life of a city dweller, cells in the inner ear are constantly dying, turning sounds into nerve impulses. They do not die immediately, but for some time they are in a “death” state. They can still send information to the brain, but are no longer able to generate impulses specific to each sound. The result is “noise”.

2) According to another theory, tinnitus is something like phantom pains. The auditory cortex of the brain “remembers” that information about external sounds should be transmitted through the auditory pathways, but the corresponding auditory cells have already died, and the brain “has to” find information that is similar to sound impulses. This information travels along pathways through the mood center, which is why tinnitus sufferers have such a hard time with noise. Gradually, as a result of incorrect adaptation, this path becomes the main one for the brain, and the person, as it were, gets used to hearing noise.

What can cause tinnitus?

• Tinnitus is usually caused by hearing loss from constant exposure to loud noises (tractor, lawn mower, loud music on headphones) or acoustic trauma.
• Otitis media, atherosclerosis, traumatic brain injury, cervical osteochondrosis, and hearing loss due to aging or other causes can contribute to tinnitus.
• Much less commonly, tinnitus can be a symptom of diabetes, kidney disease, or head or neck tumors.
• Some drugs cause tinnitus: quinine, non-steroidal anti-inflammatory drugs, paracetamol, diuretics (furosemide…), a number of antibiotics (gentamicin, streptomycin, etc.), certain types of chemotherapy, some psychiatric drugs (amitriptyline, sertraline, anafranil, etc.). e.)

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How to “measure” strength tinnitus?

Since this is a subjective sensation, it cannot be measured in decibels. In fact, the most important thing is how much tinnitus causes discomfort to its “happy” owner.

Therefore, a qualitative scale is used that rates tinnitus from “mild” to “catastrophic”, based on whether the person hears it all the time, whether it interferes with sleep or does something that requires silence.

Severe tinnitus leads to nervous tension, insomnia, inability to concentrate and even depression.

How to cure tinnitus?

There is no cure for tinnitus. Drugs of different groups have been studied, including antiepileptics, antidepressants, tranquilizers, but none of them is able to significantly reduce tinnitus.

Based on the theory that the brain does not adapt properly to the death of nerve cells that conduct auditory impulses, tinnitus is treated with a method called tinnitus retraining therapy (TRT). This is a type of cognitive-behavioral therapy in which a person is taught to be distracted from the noise, to relax, not to hear it. Gradually, a positive feedback is formed, the brain “unlearns” to use the wrong way of conducting impulses, and the noise level really decreases.

In addition to training, the TRT course uses sound therapy individually selected by means of noise measurement – a person is empirically selected “white noise”, which he should listen to from time to time. It can be the sound of the sea, the wind or the rustle of leaves. Such noise is evaluated in the subcortical auditory pathways as a neutral sound, its perception is quickly blocked and it does not reach the cortex, and tinnitus is blocked along with it – the patient ceases to be aware of it.

Both parts of therapy are equally important, but the first is the main one: the patient must stop paying attention to tinnitus, learn to live with it and reduce its significance. The TRT method allows you to completely remove tinnitus in terms of three months to two years.

If you suffer from nocturnal tinnitus, there are Tinnitus Therapy Pro and Tinnitus Therapy Lite mobile apps to help relieve it while you sleep. Applications offer so-called sound maskers (white noise and others), as well as sound tracks developed by doctors lasting 8 hours. There are other apps and tracks, paid and free, that can make life easier and “mask” tinnitus that occurs day or night.

Objective pulsatile tinnitus – modern treatment methods

9
Aug
2019

9 Aug 2019 Causes, Causes of objective tinnitus Treatment

Content of the article:

• 2 Objective blowing or pulsating tinnitus : features of manifestation
  • 2.1 Myogenic murmur
    • 2.1.1 Neuromuscular causes
    • 2.1.2 Musculo-articular pathology
    • 2.1.3 Angioencephalopathy – permanent treatment
• 3 Complex help

Objective pulsatile noise in the ear: diagnosis, counseling, treatment according to the program TinitusNeuro

Sound affects people in different ways. The same noise level for some may be imperceptible, while for others it becomes a disaster. It is difficult to independently assess the sensations and understand that pathology is developing. The patient is not able to diagnose the cause and cannot accurately understand what kind of tinnitus he has – subjective or objective.

• If the discomfort resolves on its own and the person no longer encounters such sound sensations, then the problem can be forgotten.
• If the situation worsens, it is necessary to look for the cause, because tinnitus develops.

Turning to traditional healers will not bring relief. Do not delay or postpone your visit to the clinic!

Objective blowing or throbbing tinnitus : features

Tinnitus is a medical term for a symptom. It can be expressed by sound phenomena: from pulsation to the sensation of a blowing or whistling sound. In everyday life, they usually say “noise, ringing in the ears or head.” To one degree or another, every person is faced with these phenomena at least once in a lifetime.

At the end of the last century, a global statistical study was commissioned by the German Tinnitus League. Ordinary citizens took part in it – about three million Germans suffering from constant tinnitus, i.e. people with severe pathology.

The need for the study was due to the fact that the figure was steadily growing. Every year there were almost a quarter of a million more patients. As a result, it turned out:

• Almost half of the respondents do not experience any particular discomfort from tinnitus; quietly lives with him, not considering a serious problem.
• 20% of people diagnosed with tinnitus experience the phenomenon from time to time – it is too early to talk about the development of pathology.
• The remaining 30% of those surveyed are in need of serious treatment, including psychological help.
• A certain percentage of patients with an exhausting and asthenic course are the most severe cases, when severe discomfort leads to the need for hospitalization.

The study clearly demonstrates the fact that noise discomfort is the result of various causes. Scientists and doctors have adopted a single classification, identifying two main groups – objective and subjective.

Myogenic murmur

Intense myogenic murmur, which is part of the objective tinnitus group, is a rare case in which a patient’s symptom can be heard by a person standing nearby. It is similar to the clicking, the crunching of snow underfoot, the chirping of a grasshopper.

The occurrence of a symptom of a myogenic nature occurs against the background of multiple sclerosis, lesions of the cerebral vessels, intracranial tumors, with temporomandibular syndrome , when the doctor hears clicks in the region of the joints of the lower jaw. Other categories of factors leading to the occurrence of noise phenomena are diverse – psychogenic disorders and so on.

Neuromuscular causes

When considering this group, according to the results of the diagnostic process, the patient may be diagnosed with diseases: myoclonic twitches).

After counseling and identifying the true nature of the disorder, it is recommended to consult an ENT doctor or neurologist, since a conservative treatment of the disease is required – elimination of the cause.

Musculo-articular pathology

This group is associated with functional pathology of the temporomandibular joint, caused by muscular, occlusal and spatial disorders. Since pulsating ringing is included in the list of multidisciplinary pathologies in temporomandibular syndrome, the problem cannot be eliminated by a doctor of any one specialty.

After a comprehensive examination and consultation of the patient, we make an individual decision to refer the sick person to specialized doctors – dentists, neurologists, psychologists.

Angioencephalopathy – permanent treatment

Cerebral circulation disorders are common. The occurrence of a symptom against the background of vascular pathology is due to the fact that large vessels are compressed and audible sounds occur when blood passes through them.

At the Tinnitus Neuro Center, we offer not only consultation, but also treatment according to a special program. For example, in the diagnosis of arterial stenosis.

• In case of abnormal arrangement of blood vessels, arteriovenous shunts, heart defects, we provide consultation and refer to vascular specialists.
• If ear or brain tumors are detected, we are redirected to doctors of the appropriate profile.

Comprehensive care

In our clinic, we offer comprehensive diagnostics, as a result of which the causes of objective noise phenomena are accurately identified. After receiving the results of the analysis, a collegial decision is made on further actions.