TINNITUS कान कराउने समस्या !

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