What are Tinnitus?
Tinnitus is defined as the perception of a sound without an external sound source. Approximately 15% of the population has experienced tinnitus at some point, but fortunately, only 20% of them require therapeutic intervention for its management.
It is not considered a disease per se; rather, it is a symptom that can be associated with multiple causes and aggravating factors.
Tinnitus can be perceived in one or both ears, both inside and outside the head, and is often associated with hearing loss. The quality of tinnitus can also vary, appearing as a buzzing, ringing, or pulsating sound, like the beating of the heart, among others.
On the other hand, the way tinnitus affects the quality of life of individuals who experience it also varies greatly: while it may be manageable for most people, some may experience significant anxiety, depression, and changes in their behavior.
A “problematic” tinnitus is considered one that persists for six months or more and has a negative impact on the patient’s quality of life.
Classification of Tinnitus
- Primary Tinnitus: Used to describe idiopathic tinnitus and may or may not be associated with hearing loss.
- Secondary Tinnitus: Used to describe tinnitus associated with a specific underlying cause or identified organic condition.
- Pulsatile Tinnitus: This is a noise perceived as the heartbeat. It can be secondary to variations in anatomical normality, such as a bulging jugular vein, or pathologies such as hypertension, benign intracranial hypertension, arteriovenous malformations, otosclerosis, or vascular neoplasms, among others.
Causes of Tinnitus:
Multiple hypotheses have been proposed regarding the etiology of tinnitus, but its exact mechanism remains a subject of research. What is known so far is that it results from aberrant activity at any point along the auditory pathway, from the cochlea to the auditory cortex. The leading theories suggest damage to hair cells with overstimulation of the auditory nerve or a lack of suppression of auditory cortex activity on the auditory nerve.
In any case, there are many conditions, both otological and non-otological, that are associated with tinnitus, such as:
- Otolaryngological Pathologies: Prolonged noise exposure, otosclerosis, presbycusis, sudden hearing loss, Meniere’s disease, middle ear infections, ear surgery.
- Neurological Pathologies: Acoustic neuroma, multiple sclerosis, head trauma.
- Infectious Pathologies: Meningitis, syphilis, tuberculosis, measles.
- Adverse Drug Effects: Some anti-inflammatories, aminoglycosides, loop diuretics, some chemotherapeutics, some opioids.
- Metabolic Disorders: Diabetes mellitus, anemia, vitamin B12 deficiency, zinc deficiency, hypothyroidism, and hyperthyroidism.
- Cardiovascular Disorders: Hypertension, cardiac arrhythmias, arteriosclerosis.
- Psychiatric Disorders: Depression and anxiety.
- Other: Temporomandibular joint dysfunction, stress.
When a patient experiences constant tinnitus, they should consult a doctor, who is recommended to initiate the investigation of non-otological causes by checking blood pressure, cervical auscultation, electrocardiogram, and conducting blood tests including complete blood count, biochemistry (glucose, kidney and liver function, lipid profile), autoimmune tests, thyroid hormones, serologies, and zinc and magnesium levels. Additionally, the patient’s medication should be reviewed for possible side effects.
If it is a constant tinnitus, especially if it is unilateral, evaluation by an otolaryngologist is necessary. During the clinical history, the doctor will inquire about the characteristics of the noise and whether it is associated with other otological symptoms, such as hearing loss, vertigo, or sound distortion. A standardized questionnaire will objectively assess the level of disability caused by tinnitus.
The standard otolaryngological evaluation in these cases includes otoscopy, fiberoscopy, impedance testing, audiometry, and, if necessary, other otoneurological tests such as otoacoustic emissions, auditory brainstem response testing, or auditory steady-state response testing.
A cranial imaging test (CT or MRI) is indicated if tinnitus is pulsatile, associated with unilateral or asymmetric sensorineural hearing loss, or if it is accompanied by any neurological focal findings.
In a high percentage of cases, all explorations and complementary tests are normal.
The first and most important aspect in any condition is prevention. In the case of tinnitus, prevention is essential due to the complexity and difficulty of its treatment. Therefore, it is advisable to avoid exposure to loud noises and to seek an otolaryngologist when experiencing sudden ear pain, discharge, and/or hearing loss.
Regarding pharmacological treatment, numerous medications have been used to manage tinnitus, including vasodilators, cerebral anti-ischemic drugs, benzodiazepines, anticonvulsants, antidepressants, corticosteroids, natural products, and vitamin supplements. Although they can be helpful, none have been scientifically proven to be 100% effective so far.
As for surgical treatment, there are otological conditions that can be surgically treated, such as otosclerosis or acoustic neuroma, but unfortunately, surgery does not guarantee the disappearance of tinnitus. Surgery as a symptomatic treatment for tinnitus has been studied using techniques such as labyrinthectomy, cochlear nerve section, and even cochlear implants, which appear to be effective but come with risks and consequences such as permanent hearing loss.
What has shown the greatest efficacy in managing this symptom are measures that help patients habituate to tinnitus, reducing its perception. Some of these measures include:
- Education and professional counseling
- Avoiding absolute silence
- For patients with associated hearing loss, fitting a hearing aid is the best way to reduce noise perception.
- Tinnitus retraining therapy (TRT), which includes therapeutic counseling and sound therapy, among other approaches.
- Adequate rest and stress reduction.
Finally, it is important to remember that each patient should be studied and treated individually, and more scientific studies are needed in this field to find the origin of this condition.
Download and complete the Tinnitus Handicap Inventory (THI) assessment test and bring it with you to your appointment.