Dealing with the sounds of Tinnitus

By Ayesha Inoon

Many of us have heard it at some time or the other - a persistent ringing or buzzing sound that seems to come from inside the head, particularly when the surroundings are quiet. Tinnitus, defined as 'the perception of sound in the absence of external stimuli' is a fairly common condition, and can vary in severity from being merely annoying, to interfering with the ability to concentrate or continue with normal activities. It may be subjective - where it is heard only by the patient - or objective, where the doctor may hear it by means of a stethoscope or other special instrument. Occasionally, tinnitus is associated with hearing loss.

It is not a disease, but a symptom that can be caused by a number of medical conditions, say Dr. Chandra Jayasuriya, Consultant ENT Surgeon and Dr. Daminda Domingoarachchi, Registrar in ENT, explaining the underlying causes of Tinnitus and how to cope with the condition.

Why does tinnitus occur?

Inside the inner ear, thousands of auditory cells maintain an electrical charge. Microscopic hairs form a fringe on the surface of each auditory cell. Under normal conditions, these hairs move in relation to the pressure of sound waves. When these delicate hairs are damaged in any way, the auditory cells do not function properly, causing tinnitus.

Tinnitus may be pulsatile or non-pulsatile. In pulsatile tinnitus, the noise is synchronous with your heartbeat, and can be caused by several factors associated with disorders of the blood vessels:

• High blood pressure - Hypertension and factors that increase blood pressure, such as stress, alcohol and caffeine, can make the sound more noticeable.
• Atherosclerosis - With age and build-up of cholesterol and other fatty deposits, major blood vessels close to your middle and inner ear lose some of their elasticity. That causes blood flow to become more forceful and sometimes more turbulent, making it easier for your ear to detect the beats.
• Anaemia
• Hyper dynamic circulation - when there is an increased need for blood flow, for instance, during pregnancy.
• Over-functioning of the thyroid gland.
• Malformation of capillaries - A condition called A-V malformation, which occurs in the connections between arteries and veins, can result in tinnitus.

Tumours in the head and neck - tinnitus may be a symptom of these. Usually, repositioning the head causes pulsatile tinnitus to disappear.
Non-pulsatile tinnitus may be caused by:

• Age related hearing loss, a process which usually begins around age 60.
• Earwax build-up may both cause as well as worsen existing tinnitus. Excess wax in your ear canal can reduce your ability to hear outside noises and amplify internal noises.
• Noise-related damage to the inner ear - this deterioration of hearing ability may result from excessive exposure to loud noise over a long period of time. It is estimated that portable music devices such as walkmans, MP3 players or iPods may become a common cause of noise-related hearing loss in the future.
• Long-term use of certain medications. Aspirin can cause reversible tinnitus - it is cured when the drug is stopped. However, other medications such as certain antibiotics, anti-malarial drugs, anti-cancer drugs and anti-depressants can cause permanent tinnitus.
• Injury to the head or neck, which can damage the inner ear.

Diagnosis and treatment

Treatment of tinnitus depends on identifying the cause. Doctors usually first discuss the signs and symptoms with the patient to ascertain if the tinnitus is pulsatile or non-pulsatile. The quality, pitch, and loudness of the noise, the onset, alleviating and aggravating factors are all taken into consideration. An audiogram or assessment of hearing is also usually conducted. Other tests include blood tests, lipid profiles and thyroid studies.

Depending on the results of these examinations, an MRI or CT scan may be necessary to rule out the possibility of tumours in the inner ear.

When tinnitus has a specific cause - such as earwax, tumours or anaemia - the tinnitus can be cured by treating the underlying cause.

However, there are no proven drugs for the treatment of tinnitus alone, and when there is no identifiable cause, patients are advised to try various techniques to reduce the severity of the noise. These include:

• Avoidance of dietary stimulants such as caffeine and alcohol.
• Wearing hearing aids - if tinnitus is accompanied by hearing loss, hearing aids can amplify outside sounds, possibly making the tinnitus less obvious.
• Masking the noise - tinnitus is usually worse in quiet settings. A fan, soft music or low volume radio static can help cover up the noise from tinnitus. There are also special devices called 'tinnitus maskers' that may be used.
• Getting adequate rest and avoiding fatigue.
• Psychological adjustments - stop worrying about the noise and learn to ignore it, or avoid thinking of it as an annoyance.