Ringing in the ear.
Tinnitus is the perception of sound for which there is no identifiable sound source. The sound may be perceived as a ringing, buzzing, whistling or as a generally unpleasant sound.
There are two major types of Tinnitus: Primary tinnitus, in which the cause is not known but may involve physiologic and genetic mechanisms, and Secondary tinnitus, for which a known cause exists.
Ringing type and their causes:
High pitched (most common) | Age related hearing loss, noise induced hearing loss, Acoustic Neuroma, medicines (NSAIDS, Diuretics, certain antibiotics, cancer drug etc. |
Low pitched | Ear canal blockage (wax, discharge), Meniere’s disease, Otosclerosis. |
Pulsing, rushing, and humming | Vascular cause (high blood pressure), atherosclerosis, Glomus Tumor. |
Clicking sound | Muscle contractions in and around the ear, Temporo-Mandibular Joint disorders. |
Other causes | Eusthachian Tube Dysfunction, Diabetes, Thyroid disbalance, Migraine, Anemia, Depression etc. |
Risk factors
• Loud noise exposure,
• Aging, male>female
• Tobacco and alcohol use
Complications
• Complications of Tinnitus are more of a psychogenic features – such as sleep problems, trouble concentration, headaches, anxiety and depression.
Workup
• Each patient with the symptoms of tinnitus deserves audiology testing with pure tone audiometry (PTA), and Speech discrimination scores.
• Blood tests for Syphilis, a complete blood count, an autoimmune panel, and thyroid function tests for hyper metabolism may be useful.
• For pulsatile tinnitus, a MRI scan may be needed to look for a Glomus Tumor, AV malformation, vascular anomalies etc.
Treatment
Treatment of Tinnitus may not be so awarding. Not all patients benefits from the treatment.
• There are no definite drugs for treatment of Tinnitus. Some drugs have properties which may reduce tinnitus.
• If the cause of tinnitus is know, treat the causes (ear wax removal, treatment of vascular disease, changing drugs)
• Hearing Aid, Noise suppression, Tinnitus masker, Tinnitus Retaining Therapy (TRT) are effective in reducing tinnitus.
• Treat anxiety and depression.
• Other therapies: Electrical Stimulation of the inner ear, and Transcranial Magnetic Stimulation has met with mixed success.
Precautions
• Use hearing protections in noisy environment.
• Decrease volume.
• Regular health follow ups for chronic diseases (Diabetes, Hypertension)
• Limit alcohol, caffeine and nicotine.
If you have any medical problems always consult a qualified health workers for advices and take medicines only with the prescription of a Doctor.
Dr Sudin Kayastha is a ENT Head & Neck Surgeon at ENT Healthcare, Shankhamul, Kathmandu
To book appointment with Dr Sudin, please click 👉