Tinnitus is a condition that causes ringing in the ears. As a rule, this annoying sound leads to tension and discomfort. Treatment options are varied, from drugs to relaxation self-treatment. In general, cognitive-behavioural and tinnitus retraining therapy are good for reducing ringing. In advanced cases, doctors suggest cochlear implants.
Tinnitus is ringing in the ears (din, whistle, clicking, buzz or hiss). Ear noise is often harmless but creates discomfort and sometimes interferes with daily life.
The exact distribution of tinnitus is unknown. However, scientists assume that about 5% of the Earth's adult population suffers from this disease. Also, according to the data, 1 to 3% of people suffer from tinnitus so severe that it significantly negatively impacts the quality of daily life.
Tinnitus is not a disease but a symptom that only the patient hears. This sign might occur with such disorders:
- Meniere's disease;
- Decompression sickness (disease of divers);
- Altitude sickness;
- Hearing loss;
- Traumatic brain injury.
Each person perceives tinnitus differently. There is no single sound characteristic. The degree of noise tolerance depends on the type of personality. Some describe it as low noise, a thin, high-pitched ringing, others as a vibration, whistle or hiss.
ENT doctors distinguish several types of ear sounds. Depending on the spread of the lesion, it can be unilateral or bilateral. In addition, the noise can come from the brain and be heard in the head or start and be heard in the ears. Doctors determine several stages of tinnitus:
- The first is easily tolerated by the patient, does not bother at all or causes slight discomfort;
- The second is poorly tolerated in silence, and at night, during the day, it almost does not disturb;
- The third is heard both day and night. Noise is perceived as a significant burden, and sleep and concentration are disturbed. Headaches and muscle tension appear.
- The fourth is characterized by unbearable noise, depriving sleep. It seriously affects the condition of patients. They are restless, irritated and practically disabled. Psychiatric disorders such as depression or anxiety often appear.
What are tinnitus causes?
Otorhinolaryngologists divide the causes of tinnitus into two groups. The first is directly related to damage to the auditory system. These include:
- Noise injury. It can be a consequence of an occupational illness (production noise) or the influence of listening to blaring music with headphones for a long time;
- Meniere's disease (characterized by sudden temporary deafness, tinnitus, and episodes of dizziness);
- Damage by a shock sound wave (after a traumatic brain injury, a fall from a height, an explosion);
- Open Eustachian tube (ear tube connecting the middle ear and nasopharynx);
- The influence of certain drugs (antibiotics, diuretics, chemotherapy drugs);
- Tumours of the ear (glomangioma) and ear nerve (neurinoma);
- Ear inflammation and otosclerosis;
- Sensorineural hearing loss;
- Foreign object in the ear;
- Excess earwax.
The second reasons group of tinnitus is not related to hearing, such as:
- Head injury;
- Alcohol abuse;
- Diabetic vascular injury;
- Atherosclerosis of the arteries of the head;
- Endocrine diseases (diabetes mellitus, hypothyroidism);
- Changes in pressure in the ear (when immersed in water, during air travel);
- Diseases of the heart and blood vessels (high blood pressure, aneurysm, blood flow noises caused by vasoconstriction).
Tinnitus is common and manifests differently in each patient. For example, patients describe sounds in the ear as hum, buzz, whirr, noise, drone, rattling, murmur, clicking, screech, vibration, and throbbing.
The sound can be soft or loud, high or low, coming from one ear or two. Tinnitus signs can be persistent, intense, rhythmic, or transient.
- In the first stage, the noise is covered by surrounding sounds so that it does not bother the patient much.
- In the second step, patients note that the noise appears before bedtime when silence comes.
- Tinnitus causes sleep disturbance, anxiety, headaches, and even nausea in the third phase.
- The fourth stage is the most difficult, causing insomnia, loss of concentration, irritability, and depression.
Diagnostic tests for tinnitus
Diagnosis of possible causes of tinnitus should be made as early as possible, not only by an ENT doctor but also by other specialists (therapists, neurologists, oncologists, cardiologists, etc.).
First, the otorhinolaryngologist examines the ears and takes a thorough history. Instrumental diagnostic methods include:
- Otoscopy examines the outer ear, ear canal, and eardrum using an otoscope (unique tube).
- Doctors evaluate the function and threshold of hearing perception using impedancemetry (which uses a sensitive probe) and tone audiometry (through headphones, signals are transmitted at different frequencies, and the response is recorded).
- Balance check (vestibular diagnostics). If the sense of balance is disturbed, the reason for tinnitus may be in the inner ear.
- The auditory brainstem response (ABR), called brainstem evoked response audiometry (BERA), tests the auditory nerve.
Physicians use additional diagnostic options when they have not found the cause of tinnitus:
- Dopplerography of the temple's vessels (checking the temporal artery for atherosclerosis or hypertension).
- Imaging (MRI, CT and X-ray) is recommended for suspected tumours and structural abnormalities.
Since tinnitus can have many different reasons, it is essential to know what caused the acoustic sounds to begin effective treatment. Conservative therapy involves:
- Drugs: hormones - have anti-inflammatory and decongestant effects; antihypertensive - to reduce pressure; drugs that promote circulation.
- Physiotherapy is used for noise-related diseases (injuries, incorrect position, etc.).
- Psycho- and cognitive-behavioural therapy help patients to get used to constant noises so that patients hardly perceive them. They are also valuable in relieving anxiety and depression.
Hearing aids and cochlear implants are designed for patients with heavy chronic tinnitus. Hearing defeat compensation with a hearing aid reduces tinnitus and makes the patient hardly perceives ear noises over time.
Hearing therapy is an exercise that explicitly practices the skills of directed hearing, focusing and differentiating in noise.
Tinnitus retraining therapy (TRT) is a long-term treatment that combines acoustic and behavioural therapy to adapt to the disorder. TRT teaches to cope with ringing, reduces stress levels and improves the quality of life.
Doctors recommend some self-treatment strategies to better deal with ringing ears:
- Avoid silence (play soft music and nature sounds);
- Avoid stress, and relax (yoga, meditation, tai chi);
- Be active (hobbies, sports and work help to focus on positive things and take your mind off the noise).
The prognosis for tinnitus treatment is favourable; the noise disappears in about 80% of those with an acute form. However, it is impossible to forecast how long tinnitus will persist. Sometimes the sounds disappear after a short time or only after months and years.
As a rule, in many cases, the tinnitus disappears or improves with treatment. However, for some people, the disorder remains a lifelong companion.
What is the best tinnitus treatment?
The best treatment for tinnitus is to eliminate its cause. It could be drugs or surgery. Advanced treatments include cognitive behavioural therapy and tinnitus retraining therapy. Drugs affecting the causative factors are hormones, anti-anxiety, and antidepressants. Lifestyle changes are also suitable for this condition.
How to find a specialized tinnitus centre?
AiroMedical has already taken care of this and has found specialized clinics to treat tinnitus. You should call us or fill out an application form. The patient manager will help you choose the country and the leading hospital for treatment.
Why do patients come abroad for tinnitus treatment?
Treating tinnitus may require delicate surgery. Therefore, performing such operations in a specialized centre with the necessary equipment and experienced doctors is better. In addition, many psychotherapies, physiotherapy, and tinnitus treatment strategies are available exclusively in advanced tinnitus centres. Therefore, patients come abroad to eliminate ear ringing.
Can tinnitus lead to deafness?
No. Tinnitus does not cause deafness. However, there is a definite link between ear ringing and hearing loss. In addition, sometimes deafness can be accompanied by tinnitus.
What doctors specialize in tinnitus?
An otorhinolaryngologist specializes in tinnitus. A specialist treats the ear, throat, and nose (ENT doctor). Depending on the cause, another doctor (therapist, neurologist, oncologist, cardiologist, endocrinologist) can deal with ear noises.
Where can I get Tinnitus treatment?
What are the best clinics for Tinnitus treatment?
Who are the best doctors for Tinnitus?
Prof. Dr. med. Birgit Mazurek from University Hospital Charite Berlin
Prof. Dr. med. Heidi Olze from University Hospital Charite Berlin
Prof. Dr. Jordi Coromina from Teknon Medical Centre Barcelona
Prof. Dr. med. Markus Jungehulsing from MEOCLINIC Berlin
Prof. Dr. Sami Katircioglu from Memorial Sisli Hospital Istanbul