Wednesday, August 29, 2001

Working with tinnitus

Tinnitus represents one of the most elusive mysteries facing audiologists and other hearing health care professionals. It refers to an auditory perception not directly produced by an external sound.

Tinnitus is commonly described as a "hissing, roaring or ringing." It may be constant, pulsed or intermittent. It may begin suddenly or may come on gradually. It can be perceived in one ear, both ears or in the head.

Recently in researching tinnitus, I came across the following information that I would like to share.

As many as 50 million adults experience tinnitus with more than 10 million seeking help for the condition. Because tinnitus, like pain, is subjective, two individuals may report similar tinnitus characteristics yet be affected in significantly different ways.

The severity of tinnitus and how it affects one's life is largely influenced by the individual's reaction to the tinnitus. Many tinnitus sufferers report interference with sleep, concentration and attention to detail. Some are depressed and anxious and may report additional problems at work or at home that compound the stress caused by tinnitus.

The onset of tinnitus often coincides with a change (emotional, physical or social) in one's life situation. Tinnitus has both a physiological and psychological component.

The exact mechanism underlying tinnitus is unknown. It is likely that theRe are many mechanisms. Some of the potential causes are:

Ear wax (cerumen) in outer ear canal touching eardrum.

Middle ear disorders such as Eustachian tube dysfunction, otosclerosis, vascular abnormalities, infections, and benign tumors.

Inner ear disorders such as sensorineural hearing loss (nerve damage) due to noise exposure, hearing loss from aging, Meniere's disease (associated with hearing loss and dizziness).

Temporary effects of high dosages of medications such as anti-inflammatories (including aspirin, ibuprofen and quinine), certain sedatives and anti-depressants; possible permanent effects from certain antibiotics and chemotherapeutic agents.

Systematic disorders such as high or low blood pressure, anemia, diabetes, thyroid dysfunction, hormonal changes.

Trauma to head or neck, cervical (neck) problems, temporomandibular (jaw joint) misalignment.

While the majority of tinnitus sufferers also have hearing loss, the presence of tinnitus does not necessarily mean that one is losing their hearing. While there is no cure for most forms of tinnitus, it is not true that "nothing can be done about it." Here are some options.

Counseling. Usually a trained professional will attempt to help the patient deal with the stress, distress and distraction associated with tinnitus. Cognitive-behavioral therapy, a procedure used for people suffering from chronic pain.

Hearing aids. Amplification is among the most effective tools for providing relief from tinnitus. It may relieve stress by improving communication abilities and mask tinnitus by improving one's ability to hear environmental sounds.

Masking. The use of an externally produced sound either to cover up, inhibit or alter production of tinnitus. Compact discs and tapes that provide various sounds may help with tinnitus.

Medications. While there is no one medication that works for all tinnitus patients some antidepressants and anti-anxiety medications provide relief for some patients.

Support-education groups. These offer a forum for sharing experiences and strategies. They also offer emotional support for clinical tinnitus patients.

Tinnitus habituation (re-training). This technique is based on the principles of neural plasticity, composed of educational counseling and sound therapy which can remove the fear and de-emphasize the importance of tinnitus.

Here is what you can do to minimize tinnitus:

Avoid loud noises.

Wear proper ear protection in high noise levels.

Control stress.

Avoid fatigue.

Learn to relax.

Maintain good nutrition such as lowering salt intake, reducing or eliminating stimulants such as coffee or alcohol.

Exercise.

Consult an audiologist who is knowledgeable about tinnitus to help develop your management program. The American Academy of Audiology's Web site (www.audiology.org) is a good source of information concerning tinnitus as well as The American Tinnitus Association.

Andrew Waits

Clinical audiologist