What is it?
Tinnitus is the medical term for a variety of sounds heard in the ears when there is no outside source of the sound. The sounds may include ringing, hissing, buzzing, whistling, musical notes or any other type of sound.
Tinnitus may occur from time to time (usually not a source of concern), or be continuous. The sound itself may be pulsatile – occurring in time with the person’s pulse – and this can be associated with significant underlying conditions. Tinnitus lasting for more than six months is called chronic tinnitus, and can have a major impact on the quality of a person’s life.
It is a very common disorder (though figures for South Africa are not available, an estimated 12 million people in the US are affected severely enough to interfere with normal daily activities), and is more common in men than in women. It occurs more frequently with advancing age. Tinnitus is most often associated with some degree of hearing loss.
Most commonly, tinnitus is caused by damage to the tiny nerve endings in the inner ear, but any condition which physically interferes with the anatomy or functioning of the hearing system can cause tinnitus. This interference can occur at any point in the system, from the ear to the brain. The commonest known causes are:
Sensorineural hearing loss
This includes conditions such as the hearing loss accompanying old age, noise-induced hearing loss and drug-induced damage. Commonly cited drugs here are
- some diuretics, like furosemide
- some antibiotics like aminoglycosides or fluoroguinolones
- non-steroidal anti-inflammatories like COX2 inhibitors
- anti-malarials like chloroquin
- some anti-hypertensives like calcium channel blocker
Hypertension, diabetes and hypercholesterolaemia are implicated here as causing small-vessel disease.
German measles, meningitis and chronic inner ear infection can lead to tinnitus.
Diabetes mellitus is the most common here, but thyroid disease is another known association.
Otosclerosis and Paget's disease both lead to abnormal bone formation, whilst osteogenisis imperfecta (a genetic abnormality) leads to brittle bones and multiple fractures. Both these states can affect the ear apparatus and cause tinnitus.
Central nervous system conditions.
Stroke and tumours are common findings, but multiple sclerosis and abnormalities of brain blood vessels are often also encountered.
Injury to the Cochlea.
Trauma to the head/ear and injury to the sensory organ, the cochlea, on a microscopic scale can be associated with drugs (see list above) or even Meniere’s disease (tinnitus with progressive deafness).
The diagnosis of tinnitus is mainly clinical, but because it is so often associated with hearing loss, it is advisable for an audiologist to test the patient’s hearing. Appropriate tests must also be done to exclude any underlying causes, like tumours.
For pulsatile tinnitus, specialist advice must be sought, because there is usually a significant underlying medical condition causing it, and this will need appropriate investigation.
There is no specific treatment for tinnitus apart from treating any known underlying problems such as allergies or high blood pressure.
Some things can be done to relieve the situation though:
- hearing aids for those with proven hearing loss will makes the tinnitus less noticeable;
- masking devices generate a sound which masks the tinnitus, and can be very successful;
- counseling and relaxation therapy has been tried;
- avoid loud noises, smoking and alcohol, all of which worsen tinnitus. Earplugs may be needed for those whose work exposes them to very high noise levels; and
- Dexamethasone (injected behind the eardrum for some cases of cochlear damage)
(Dr AG Hall)