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Tinnitus: The Noise From Inside the Head
Tinnitus: The Noise From Inside the Head Repeated exposure to loud noises such as from iPods, radios, televisions, hair dryer, concerts, and sporting events will have a cumulative damaging effect on the hearing nerve.

Tinnitus is the medical term for the perception of noise in the ears or head in the absence of external sound. The word originates from Latin and means “to tinkle or to ring like a bell.” It can be objective (the sound can also be heard by a clinician) or subjective (heard only by the patient). In most cases, tinnitus is subjective. Patients with tinnitus often refer to the noise as “ringing in the ears.” However, many different types of noises have been described including hissing, crackling, roaring, chirping, clicking, humming, beating, whistling, whooshing, pulsing, or buzzing. The noise can be intermittent or constant, the pitch can range from low roar to high squeal, and the perceived volume can range from barely audible to shattering.

Tinnitus is a very common condition and affects over 50 million Americans. Although for most of these patients, the condition is a mere annoyance, approximately two million patients are so seriously debilitated by the condition that they cannot function and live a normal life.
Causes
Tinnitus itself is not a disease but a symptom that is caused by a number of different medical conditions. In many cases, tinnitus is associated with damage to the hearing nerve in the inner ear as a result of exposure to excessive noise. Aging, head trauma, medications, diabetes, infections, and hypertension also play a role. Noise-induced hearing damage is by far the most common culprit. Although significant progress has been made in reducing work-related noise exposure, recreational noise exposure continues to play a significant role in hearing damage. Repeated exposure to loud noises such as from iPods, radios, televisions, hair dryer, concerts, and sporting events will have a cumulative damaging effect on the hearing nerve. Other causes of tinnitus may include stiffening of the bones in middle ear (otosclerosis), wax build-up, allergy, fluid in the middle ear, and ear infection. In a small number of cases, patients describe hearing rhythmic pulsing or humming sound similar to that of a heartbeat. This pulsatile tinnitus is caused by the exaggerated noise of blood flow resulting from certain disorders of the blood vessels such as narrowing of carotid artery, hypertension, vascular malformation, and certain type of tumor (glomus tumor).

Available Treatments
In small percentage of cases where the specific cause of tinnitus is identified, effective treatment may be possible. For example, removal of earwax, drainage of middle ear fluid, treatment of allergy and infection, removal of a blood vessel tumor, and removal of plaque from the carotid artery may lead to relief of tinnitus. However, in a majority of cases where tinnitus is associated with damage to the hearing nerve, the nerve damage cannot be reversed. Thus, treatment is directed at management of the symptom (noise) and not at fixing the cause (hearing nerve damage). Because patients experience tinnitus differently, they also respond to treatment differently. What works for one patient may not work for other patients. Thus, many different treatment options are available, and there is no single standard treatment that is better than all the rest. Most of these treatments focus on ways to reduce the severity of noise and techniques to help patients cope with the noise through improved psychological well being.
When to Seek Medical Help
Although the noise of tinnitus may be annoying, it is rarely associated with a serious medical condition. Approximately 90 percent of all tinnitus patients have some level of hearing loss. If the hearing loss is significant, these patients should see their physician for treatment. Just as the sound quality of tinnitus can be very different, patients experience and react to tinnitus with varying degree of annoyance. It is a very personal and individual experience. Patients who are excessively bothered by this noise to the point that it interferes with their daily routine (such as sleep and concentration) should seek medical help. Finally, patients with pulsatile tinnitus should seek medical attention because it can be associated with serious medical conditions that might need treatment.

Ways to Reduce Severity
Severity of the noise associated with the tinnitus can be reduced in several ways. One of the simplest ways is to avoid things that make the tinnitus worse. Most patients find that alcohol, tobacco, coffee, tea, and chocolate can worsen their tinnitus. Certain medications such as anti-malarials, anti-inflammatories, and aspirin can also exacerbate tinnitus. Typically, patients find tinnitus more bothersome in certain quiet situations such as when they are trying to go to sleep. In those situations, the use of a competing sound at a constant low level, such as a fan, machine-generated environmental sounds (rainfall, ocean wave) or low-volume radio static, may mask the tinnitus and make it less noticeable. For those patients who have tinnitus associated with moderate to severe hearing loss, the use of hearing aid(s) can amplify outside sounds to cause the tinnitus noise less obvious. Finally, patients with minimal hearing loss can be fitted with a tinnitus masker, which emits a competitive but pleasant sound that can either partially or completely cover over the sounds of tinnitus.

Coping with Tinnitus
Patients with a healthy sense of well-being are more able to cope and ignore the tinnitus noise. However, for patients who are highly distressed by the tinnitus, it may be difficult for them to get adequate rest, sleep, and relaxation, all of which are important for maintenance of psychological well-being. Some of these patients may even develop depression and become more vulnerable to the tinnitus in a never-ending vicious cycle. In order to break this cycle, prescription medications may be necessary to treat depression, help with relaxation, and promote a good night of sleep.

In summary, tinnitus is a symptom that affects many Americans and can be caused by a variety of medical conditions. Its effect on a person can range from slight annoyance to debilitating. Treatment depends on the cause of tinnitus and can be effective.

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"Tinnitus: The Noise From Inside the Head"
   authored by:
OTOLARYNGOLOGY
Ho-Sheng Lin, MD is an Assistant Professor at the Department of Otolaryngology - Head and Neck Surgery at Wayne State University School of Medicine and a staff physician at the John D. Dingell VA Medical Center. He received his medical degree from Y...



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