What is tinnitus?
Tinnitus or ringing in the ears affects almost 20% of the population, but is more common in the elderly. Besides ringing it’s also been described as a roaring, rushing , hissing or chirping crickets type of noise. In about 75% of the cases the sound doesn’t interfere with the person’s lifestyle. However in the other 25% the noise can cause problems with everyday activities. Tinnitus can be divided into two separate categories: objective and subjective.
Causes of tinnitus
Objective tinnitus is less common and in this type other persons besides the one affected can hear the noise. The noise may be caused by muscle contractions, temporomandibular joint disorders, eustachian tube abnormalities, flow disturbances in the carotid artery or jugular vein in the neck or within the skull, etc. Subjective tinnitus is the more common type and etiologies are less well understood. In this type only the person affected hears the ringing or other noises. At times it can be associated with a conductive or sensorineural hearing loss.
Otosclerosis, Meniere’s syndrome and cochlear and auditory nerve lesions can sometimes have associated tinnitus. A fairly lengthy list of conditions which may cause or exacerbate tinnitus includes: food allergies, marijuana use, Lyme Disease, acoustic neuromas, glomus tumors, exposure to loud noises, severe ear infections, atherosclerosis, ototoxic medications (especially high doses of aspirin and non steroidal antiiflammatories), stress, intracranial hypertension, trauma, dental procedures, etc. In some series close to 50% of cases have no cause found.
Diagnosis and Treatment
In most cases the patient provides a history or description of the abnormal noise. Evaluation of all cases of tinnitus should be conducted by an ear, nose and throat physician. In addition to obtaining a detailed history and performing a physical exam, other tests may include MRI, audiometry, duplex ultrasound of the neck. If a specific cause is found then treatment will be based on the particular problem. In those cases in which no etiology is discovered, treatment can be more difficult.
There can be a strong emotional response to the tinnitus and some patients can develop sleep deprivation, anxiety and depression. There are several centers around the U.S. that specialize in this type of disorder and training programs for these patients have been developed base on neurophysiological models.