Tinnitus

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Tinnitus

ICD-10	H931
ICD-9	388.3
OMIM	[1]
DiseasesDB	27662
MedlinePlus	003043
eMedicine	ent/235
MeSH	{{{MeshNumber}}}

Tinnitus (IPA pronunciation: [tɪ'naɪtəs] or ['tɪnɪtəs],^[1] from the Latin word for "ringing"^[2]) is the perception of sound in the human ear in the absence of corresponding external sound(s).

Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise, but in some patients it takes the form of a high pitched whining, buzzing, hissing, humming, or whistling sound, or as ticking, clicking, roaring, "crickets" or "locusts", tunes, songs, or beeping.^[3] It has also been described as a "whooshing" sound, as of wind or waves.^[4]

Tinnitus is not itself a disease but a symptom resulting from a range of underlying causes, including ear infections, foreign objects or wax in the ear, and injury from loud noises. Tinnitus is also a side-effect of some oral medications, such as aspirin, and may also result from an abnormally low level of serotonin.

The sound perceived may range from a quiet background noise to a signal loud enough to drown out all outside sounds. The term 'tinnitus' usually refers to more severe cases. Heller and Bergman (1953) conducted a study of 80 tinnitus-free university students placed in a soundproofed room found that 93% reported hearing a buzzing, pulsing or whistling sound. However, it must not be assumed that this condition is normal -- cohort studies have demonstrated that damage to hearing from unnatural levels of noise exposure is very widespread in industrialized countries.^[5] (see noise health effects)

Because tinnitus is often defined as a subjective phenomenon, it is difficult to measure using objective tests, such as by comparison to noise of known frequency and intensity, as in an audiometric test. The condition is often rated clinically on a simple scale from "slight" to "catastrophic" according to the practical difficulties it imposes, such as interference with sleep, quiet activities, or normal daily activities.^[6] For research purposes, the more elaborate Tinnitus Handicap Inventory is often used.^[7]

Contents 1 Objective tinnitus 2 Causes of subjective tinnitus 3 Mechanisms of subjective tinnitus 4 Prevention 5 Treatment 6 Tinnitus as form of pain 7 See also 8 References 9 External links

[edit] Objective tinnitus

In a minority of cases, a clinician can perceive an actual sound (e.g., a bruit) emanating from the patient's ears. This is called objective tinnitus. Objective tinnitus can arise from muscle spasms that cause clicks or crackling around the middle ear.^[8] Some people experience a sound that beats in time with the pulse (pulsatile tinnitus^[9]). Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear (such as from atherosclerosis or venous hum^[10]), but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.^[9] Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm^[11] or dissection.^[12]

[edit] Causes of subjective tinnitus

Tinnitus can have many different causes, but most commonly results from otologic disorders - the same conditions that cause hearing loss. The most common cause is noise-induced hearing loss, resulting from exposure to excessive or loud noises. Ototoxic drugs can cause tinnitus either secondary to hearing loss or without hearing loss, and may increase the damage done by exposure to loud noise, even at doses that are not in themselves ototoxic.^[13]

Causes of tinnitus include:^[14]

• Otologic problems and hearing loss:
  • conductive hearing loss
    • external ear infection
    • cerumen (earwax) impaction
    • middle ear effusion
  • sensorineural hearing loss
    • excessive or loud noise
    • presbycusis (age-associated hearing loss)
    • Meniere's disease
    • acoustic neuroma
    • ototoxic medications
      • analgesics:
        • aspirin
        • nonsteroidal anti-inflammatory drugs
      • antibiotics:
        • aminoglycosides e.g. gentamicin
        • chloramphenicol
        • erythromycin
        • tetracycline
        • vancomycin
      • chemotherapy drugs:
        • bleomycin
        • cisplatin
        • mechlorethamine
        • methotrexate
        • vincristine
      • loop diuretics:
        • bumetanide
        • ethacrynic acid
        • furosemide
      • others:
        • chloroquine
        • quinine
        • mercury
        • lead

• neurologic disorders:
  • multiple sclerosis
  • head injury
    • skull fracture
    • closed head injury
    • whiplash injury
    • temporomandibular joint disorder

• metabolic disorders:
  • thyroid disorder
  • hyperlipidemia
  • vitamin B12 deficiency

• psychogenic disorders:
  • depression
  • anxiety

• other disorders:
  • fibromyalgia
  • hypertonia (Muscle Tension)
  • thoracic outlet syndrome
  • lyme disease

[edit] Mechanisms of subjective tinnitus

The inner ear contains thousands of minute hairs which vibrate in response to sound waves and cells which convert neural signals back into acoustical vibrations. The sensing cells are connected with the vibratory cells through a neural feedback loop, whose gain is regulated by the brain. This loop is normally adjusted just below onset of self-oscillation, which gains the ear spectacular sensitivity and selectivity. If something changes, it's easy for the delicate adjustment to cross the barrier of oscillation and tinnitus results. This can actually be measured by a very sensitive microphone outside the ear.

One of the possible mechanisms of how things can change in the ear is damage to the receptor cells. Although receptor cells can be regenerated from the adjacent supporting Deiters cells after injury in birds, reptiles, and amphibians, in mammals it is believed that they can be produced only during embryogenesis. Although mammalian Deiters cells reproduce and position themselves appropriately for regeneration, they have not been observed to transdifferentiate into receptor cells except in tissue culture experiments.^[15][16] Therefore, if these hairs become damaged, through prolonged exposure to excessive decibel levels, for instance, then deafness to certain frequencies occurs. In tinnitus, they may falsely relay information at a certain frequency that an externally audible sound is present, when it is not.

The mechanisms of subjective tinnitus are often obscure. While it is not surprising that direct trauma to the inner ear can cause tinnitus, other apparent causes (e.g., TMJ and dental disorders) are difficult to explain. Recent research has proposed that there are two distinct categories of subjective tinnitus: otic tinnitus, caused by disorders of the inner ear or the acoustic nerve, and somatic tinnitus, caused by disorders outside the ear and nerve but still within the head or neck. It is further hypothesized that somatic tinnitus may be due to "central crosstalk" within the brain, as certain head and neck nerves enter the brain near regions known to be involved in hearing.

While most discussions of tinnitus tend to stress physical mechanisms, there is strong evidence that the level of an individual's awareness of their tinnitus can be stress-related, and so should be addressed by improving the state of the nervous system generally, using gradual, unobtrusive, long-term treatments.^{[citation needed]}

[edit] Prevention

Because tinnitus and hearing loss can be permanent conditions, precautionary measures are advisable. If a ringing in the ears is audible after exposure to a loud environment, such as a rock concert or work place, it means that damage is being done. Prolonged exposure to noise levels as low as 70 dB can result in damage to hearing (see noise health effects). If it is not possible to limit exposure, earplugs or ear defenders should be worn. For musicians and DJs, special musicians' earplugs can lower the volume of the music without distorting the sound and can prevent tinnitus from developing in later years.

It is also important to check medications for potential ototoxicity. Ototoxicity can be cumulative between medications, or can greatly increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.^[17]

[edit] Treatment

There are many treatments that are effective for tinnitus resulting from a particular cause, but none are effective in every case. Conversely, tinnitus may resolve without any treatment. Effective treatments include:

Objective tinnitus:

• Gamma knife radiosurgery (glomus jugulare)^[18]
• Shielding of cochlea by teflon implant^[19]
• Botulinum toxin (palatal tremor)^[20]
• Propranolol and clonazepam (arterial anatomic variation)^[21]

Subjective tinnitus:

• Drugs and nutrients
  • Lidocaine, injection into the inner ear found to surpress the tinnitus for 20 minutes, according to a Swedish study. [2]
  • Benzodiazepines (xanax, ativan, klonopin)
  • Avoidance of caffeine, nicotine, salt^[22][23]
  • Avoidance of or consumption of alcohol^[24][23]
  • Zinc supplementation (where serum zinc deficiency is present)^[25][26][27]
  • Acamprosate^[28]
  • Etidronate or sodium fluoride (otosclerosis)^[29]
  • Lignocaine or anticonvulsants (usually in patients responsive to white noise masking)^[30]
  • Carbemazepine^[31]
  • Melatonin (especially for those with sleep disturbance)^[32]
  • Sertraline^[33]
  • Vitamin combinations (lipo-flavonoid)^[34]
• Electrical stimulation
  • Transcranial magnetic stimulation or transcranial direct current stimulation^[35][36]
  • Transcutaneous electrical nerve stimulation^[37]
  • Direct stimulation of auditory cortex by implanted electrodes^[38]
• Surgery
  • Repair of perilymph fistula^[39]
• External sound
  • Low-pitched sound treatment has shown some positive, encouraging results.(UC, Irvine press release)
  • Tinnitus masking^[40] (white noise)
  • Tinnitus retraining therapy^[41][42]
  • Auditive stimulation therapy (music therapy)^[43]
  • Compensation for lost frequencies by use of a hearing aid.^[44]
  • Ultrasonic bone-conduction external acoustic stimulation^[45][46]
  • Avoidance of outside noise (exogenous tinnitus)^[47]
• Psychological

Main article: Psychological research and treatment of Tinnitus

Many types of tinnitus are temporary and will cease spontaneously while others are permanent in nature. Although there are no specific cures for tinnitus, anything that brings the person out of the "fight or flight" stress response helps symptoms recede over a period of time. Calming body-based therapies, counselling and psychotherapy help restore well-being which in turn allows tinnitus to settle. Chronic tinnitus can be quite stressful psychologically as it distracts the affected individual from mental tasks and interferes with sleep, particularly when there is no external sound. The affected individual may have to generate artificial noise that masks the tinnitus sound. White noise is particularly effective in masking tinnitus. In terms of tinnitus treatment a combination of external masking and psychological counseling known as tinnitus retraining therapy is widely practiced. While it does not actually cure the tinnitus, many report that it becomes much less disturbing and in some cases the offending sound is no longer heard at the conscious level (Habituation of Perception).

• • Cognitive behavior therapy^[48]

Although there are no specific cures for tinnitus, anything that brings the person out of the "fight or flight" stress response helps symptoms recede over a period of time. Calming body-based therapies, counseling and psychotherapy help restore well-being, which in turn allows tinnitus to settle. Chronic tinnitus can be quite stressful psychologically, as it distracts the affected individual from mental tasks and interferes with sleep, particularly when there is no external sound. Additional steps in reducing the impact of tinnitus on adverse health consequences include: a review of medications that may have tinnitus as a side effect; a physical exam to reveal possible underlying health conditions that may aggravate tinnitus; receiving adequate rest each day; and seeking a physician's advice concerning a sleep aid to allow for a better sleep pattern.

[edit] Tinnitus as form of pain

Tinnitus has been hypothesized as a form of chronic pain.^[49] The signal that forms the interpretation by the brain as sound, may in fact be pain generated by damage to certain parts of the cochlea.

[edit] See also

• Absolute threshold of hearing
• Auditory system
• Audiologist
• Ear
• Ear disorders
• Hearing impairment
• Hyperacusis
• Noise health effects

[edit] References

[edit] External links

• American Academy of Audiology
• Tinnitus ENT information
• American Tinnitus Association
• British Tinnitus Association
• AudioNoise Software Noise Generator
• USA Today - For iPod users, a budding problem
• Famous people with tinnitus
• Tinnitus Articles by Tinnitus Victims
• Tinnitus Research
• Somatic Craniocervical Tinnitus and the Dorsal Cochlear Nucleus Hypothesis
• Useful information about tinnitus from RNID
• personal story
• Tinnitus Association of Canada Links
• http://www.tinnitusresearch.org Tinnitus Research Initiative
• Tinnitus Support Group
• Tinnitus in animals exposed to loud sound

Template:Diseases of the ear and mastoid process

This page uses content from the English-language version of Wikipedia. The original article was at Tinnitus. The list of authors can be seen in the page history. As with Psychology Wiki, the text of Wikipedia is available under the GNU Free Documentation License.