Tinnitus

Description
Tinnitus is quite common and experienced by an estimated thirty-six million Americans. It is reported as a high pitched whistling, buzzing, hissing or beating sound in a person's head or ear(s). Some experience the presence of tinnitus only on occasion after a quick movement, while others will report the sudden, oftentimes unexplainable, arrival of loud, persistent and distressing tinnitus. Many who experience tinnitus are able to allow it to be present and not be concerned; however, others realize much discomfort, fear and frustration from its constant presence.

The condition known as Tinnitus is pronounced two different ways: "TIN-a-tus" or "Tin-EYE-tus". Both pronunciations are correct. Tinnitus is a symptom, not a disease, and is frequently related to a disorder of the inner ear or auditory nerve. The noises may be heard in the head or in one ear or both. Sometimes the person has a hearing problem as well, but often the hearing is normal. There are two types of tinnitus: subjective tinnitus, which is audible only to the person experiencing it and objective tinnitus, which is actually audible to another person as well as to the person who is experiencing it. Nearly everyone experiences ringing in the ears at some time particularly after exposure to loud noise, something we all should avoid.

Causes/Diagnosis
Tinnitus may be the result of excessive noise exposure, a blow to the head, medication or food allergy. On rare occasions, it may result from the presence of an acoustic tumor. Often, however, it is not possible to know the cause. After thorough medical and audiological testing, the person who experiences tinnitus must try to find relief from its ever-present annoyance.

In addition to loud noise exposure, the causes of tinnitus include: alcohol and nicotine used to excess, aspirin in heavy doses, caffeine, earwax which is impacted or resting on the eardrum, high blood pressure, hardening of the arteries, infection or inflammation in the ear canal or middle ear, certain medications, Meniere's disease, meningitis, otosclerosis or a tumor on the auditory nerve.

Tinnitus cannot be measured objectively. Rather, the audiologist relies on information you provide in describing the tinnitus. The audiologist will ask you questions like:

• Which ear is involved? Right? Left? Both?
• Is the ringing constant? Do you notice it more at certain times of the day?
• Can you describe the sound or the ringing?
• Does the sound have a pitch to it? High pitch? Low pitch?
• How loud does it seem? Does it seem loud or soft?
• Does the sound change or fluctuate?
• Do you notice conditions that make the tinnitus worse, e.g., when drinking caffeinated beverages, when taking particular medicines, or after exposure to noise?
• Does the tinnitus effect your sleep? Your work? Your ability to concentrate?
• How annoying is it? Extremely so? Not terribly bothersome?

In discussing your answers to these questions, the audiologist can give you information that will increase understanding of your tinnitus. Understanding what is happening is often the relief in itself.

Knowing the cause of your tinnitus is also relief instead of having to live with the uncertainty of the condition. When your tinnitus is "demystified," your stress level (which can make tinnitus worse) is frequently reduced, and you have a feeeling of greater control and hope. You can "take charge" by anticipating, preventing, and changing situations that make your tinnitus worse.

Prevention
The Occupational Safety & Health Act (OSHA) suggests that noises above 90 decibels over the course of an eight-hour workday should be avoided. And for some people, 90 decibels is still too loud. The next time you are around a noise that bothers your ears - either in the workplace or at a sporting or recreational event - wear earplugs. And be aware of other activities or situations that include loud noises, like hair drying or lawn mowing. Make it easy for yourself to protect your ears by hanging earmuffs over the lawn mower handle, or keeping ear plugs in the bathroom next to your hair dryer. Repeated exposure to loud noises can have a cumulative effect on your hearing.

Treatment
There is no cure for tinnitus at the present time. In fact, it is not usually possible to say exactly where in the hearing system it is produced. Some people adapt to the noises and learn to ignore them, while others find them almost unbearable. They are often worse at night when you are tired, before going to sleep and first thing in the morning. It is important not to be alarmed as the noises are usually not a sign of a serious medical condition, but it is advisable that you have a thorough medical check-up to determine if there is any treatable medical problem causing your tinnitus.

The variety of treatments for tinnitus include:

• maskers,
• hearing aids,
• drug therapy,
• biofeedback,
• electrostimulation
• other medical and surgical procedures,
• cognitive and behavioral interventions (relaxation training),
• adjustment of diet,
• dental care for evaluation and adjustment of bite,
• sound machines.

Many receive relief from one or a combination of these treatments.

Research
For the first time, scientists have located an area in the brain involved in the production of tinnitus. Tinnitus is a ringing, roaring, buzzing, or clicking sound that occurs inside the head. These findings are in a new study by Alan H. Lockwood, M.D., of the State University of New York in Buffalo and his colleagues, in the January 22, 1998, issue of Neurology.

Using positron-emission tomography (PET), Dr. Lockwood's group was able to map brain regions of individuals who had tinnitus in only one ear. These individuals also had the ability to change the loudness of their tinnitus by performing special movements of their face and mouth. Cerebral blood flow, an indication of increased brain activity, was measured while these individuals were at rest, and performed the movements that affected their tinnitus, and while listening to loud beeps or pure tones that were presented using ear phones. The PET scan detected changes in the auditory cortex, that part of the brain that processes sounds, on the side of the brain opposite the tinnitus. In contrast, the auditory cortex on both sides of the brain reacted to pure tones presented to one ear at a time. Since external tones presented to one ear affect both sides of the brain, the fact that the internal tones of tinnitus affect only one side of brain indicate that tinnitus may be initiated by brain activity rather than by the ear.

"This work represents a breakthrough and moves us a step closer to understanding the phenomenon of tinnitus. We feel certain that this study will lead to further research that will ultimately translate into treatment options for the millions of people who suffer with this difficult condition," said James F. Battey, M.D., Ph.D., Acting Director of the National Institute on Deafness and Other Communication Disorders (NIDCD), which funded the study.

The authors suggest that this study may improve knowledge of how tinnitus occurs and may lead to finding treatments. "Without objective information on how and where the condition originates, developing effective treatments has been difficult. We have taken a critical step down the road toward a cure for this disabling condition," said Lockwood. Ultimately, this study opens the door to further research such as the development of drugs to change the brain activity in the involved areas. Dr. Lockwood's colleagues are R.J. Salvi, Ph.D., M.L. Coad, B.A., M.L. Towsley, M.A., D.S. Wack, M.A., and B.W. Murphy, M.S., from the VA Western New York Health Care System and State University of New York, both in Buffalo.

As the nation's focal point for research in human communication, the NIDCD conducts and supports biomedical and behavioral research and research training on normal mechanisms as well as diseases and disorders of hearing, balance, smell, taste, voice, speech and language that affect 46 million Americans.

More Information
A small number of clinics specialize in the treatment of tinnitus. Check with your physician or contact the American Tinnitus Association for a list of such facilities in your area. Self-help groups, run by people who share this problem are being formed in many parts of the country as well. Check with the Vestibular Disorders Association and Self-Help for Hard of Hearing People, Inc. (SHHH) for more information.

Sources: National Institute on Deafness & Other Communication Disorders, 2002
American Tinnitus Association, 2002
American Speech-Language-Hearing Association, 2002