Ringing or Tinnitus is one of the most common and disturbing patient
symptoms. There are two types of ringing--objective and subjective.
tinnitus are noises which can be heard by other individuals (although they usually are
not). Usually this type of tinnitus pulsates with the patient's heartbeat. It can be caused by ear infections, blockage in the major artery to
the brain (which can lead to stroke) or by a vascular growth or
tumor in the ear (this is a rare cause). In the elderly, the most
common cause of pulsatile tinnitus is a carotid bruit caused by plaques in the
tinnitus can only be heard by the patient. It is generated by the
spontaneous firing of nerves when they have lost their connections to the ear
end-organ, much like an amputee's phantom limb sensation. The type of
sound and loudness has little diagnostic significance. Although, it is
believed that the "crickets" people hear are from tinnitus
produced simultaneously from two different frequencies. It is almost
always associated with a hearing loss from the
loss). It can be made worse if the patient is in a quiet environment, at
night when he tries to sleep. If the patient has a disease of the eardrum
bones (causing a conductive hearing loss), outside sounds that are
not as loud will make the
tinnitus worse. In this case,
surgery may be beneficial to correct the conductive hearing loss.
the hearing loss is equal on both sides, the tinnitus is usually benign. If
a unilateral or one-sided hearing loss is present, then one must search further
for the cause. Rarely, a benign intracranial (next to the brain) growth
such as an acoustic neuroma is found. Other causes of tinnitus are possible and an
evaluation by a physician is indicated.
of tinnitus is very difficult. If a hearing loss is present, correction of
the hearing loss will often lessen the tinnitus. Unfortunately, this is
usually only possible in a conductive loss. Maskers are often used at
night to allow the patient to sleep. Many drug treatments have been tried
which use anti-depressants or seizure medications. These have been
reported to be effective in some patients but there are potential side effects
from these medications.
Injection of steroids into the middle ear has been found to have
no effect in the treatment of tinnitus.
However, melatonin has been reported to be beneficial in
improving sleep and decreasing tinnitus by at least one author.
As the name implies, Tinnitus Maskers produce noise which
masks the tinnitus. These can be obtained from most novelty stores and
produce a wide range of sounds from waterfalls, rain, ocean waves and running
water. One may also use a fan or an HEPA Filter to produce white
noise and mask tinnitus.
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