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03/12/2013

Tinnitus

Filed under: Health — anlactunay @ 8:52 AM

Tinnitus
After a loud concert, sports event or using a very noisy machine like a chainsaw, people often hear ringing in their ears – even after the outside noise has stopped. This ringing usually goes away after a short while, though. It is called tinnitus, and everyone experiences it from time to time. But 1 or 2 out of every 10 people will hear this kind of noise constantly for a while. Or they have episodes that just come and go, for no obvious reason. The tinnitus could go on for months or even years, but it is usually only mild and a bit annoying.

Non-stop noises can really interfere with daily life. It can be difficult to cope with tinnitus if it affects your ability to concentrate and sleep. Although there is no simple treatment for tinnitus, there are several things you can try that could help you manage better so that your tinnitus is less distressing, even if you are badly affected. In this fact sheet, we will describe the different options, as well as what researchers have discovered about tinnitus treatments and strategies for coping. You may be surprised by some of these findings – there are many widespread beliefs and myths about tinnitus.

What is tinnitus and why is it so distressing sometimes?

The word tinnitus comes from the Latin for “ringing”. The noises that people with tinnitus hear may indeed sound like ringing, but could also be more like whistling, buzzing, humming, hissing, clicking or knocking. They may be heard in one or both ears. To some people, it feels like the sound is coming from “the middle of their head”. It could be constant, or it could come and go. It is sometimes very quiet and sometimes very loud.

The sound that a person who has tinnitus hears cannot be heard by anyone else, because it is not coming from outside their head. But they are not imagining it – they really hear the sounds in their head. Some people have what are called auditory hallucinations – they “hear” voices or other things. That is not the same as tinnitus.

Tinnitus is very common. About half of us will have a temporary episode of tinnitus at some time in our lives, and up to 2 out of every 10 people will have a chronic ongoing episode of tinnitus at some point (10 – 20%). About 1 in 200 people (0.5%) will have tinnitus that is so bothersome that it really interferes with their lives. Tinnitus is more common in older people than it is in younger adults, but children can have it too.

Many people get used to the sound they are hearing after a while, but some find it very distressing. Because the parts of the brain that are affected by tinnitus also play an important part for our emotions, the sounds in the ear can sometimes be hard to tolerate. In some people, tinnitus and depression are closely linked, but it is not entirely clear whether tinnitus plays a role in the development of depression or makes it worse.

What causes tinnitus and can it harm my hearing?

The cause for tinnitus can usually not be determined. The medical term for tinnitus with unknown cause is “idiopathic tinnitus”. Tinnitus is not a form of hearing loss, and having tinnitus does not mean that your hearing will get worse. If it does get worse, it is not because of tinnitus.

However, tinnitus symptoms can start at a time when people have age-related hearing loss or damage. The kind of damage that can lead to tinnitus could be caused by a sudden extremely loud noise, like an explosion, or long-term exposure to loud noise, for example, working with loud machinery without using hearing protection, or listening to loud music a lot.

Could tinnitus be a sign of another condition?

Sometimes tinnitus is a sign of another condition, such as Menière’s disease. Menière’s disease affects the ears, and tinnitus is only one of the symptoms. People who have Menière’s disease also have dizziness (vertigo) and hearing loss. If you feel like the room is spinning and you cannot hear well when you have bouts of tinnitus, then you could have Menière’s disease. We will publish more information about this condition and how it can be treated in the future.

Tinnitus could also be a symptom of acoustic neuroma. Acoustic neuroma is a benign growth in the inner ear. “Benign” means it is not cancerous. However, a growth like this could still be harmful. Tinnitus can also sometimes be an adverse effect of the medications quinine or acetylsalicylic acid (ASA, called ASS in Germany).

If the noise in your ear pulses to the rhythm of your heartbeat this is called pulsatile tinnitus. That type of tinnitus may be caused by very high blood pressure. You might find that if you reduce your blood pressure, the tinnitus symptoms improve or even go away. Pulsing sounds in the ear might also be a sign that the tinnitus is coming from a problem with a blood vessel. For example, pulsatile tinnitus is sometimes caused by a vascular loop deep inside their ear: a little abnormal loop of blood vessel. Minor surgery might then be considered.

How is tinnitus diagnosed?

If you consult your doctor about tinnitus, he or she will first try to rule out the problems we have just described. The doctor will also check to see if there is a problem with your blood vessels, your jaw joint or the muscles around the roof of your mouth. If this is where the sound is coming from, your doctor should be able to hear it when he or she examines you. It may also be a good idea to have a dentist examine the area around the jaw to rule out any problems there.

For most people, though, it will not be possible to find out what is causing the tinnitus. Researchers are still trying to find out why it happens. Some research showed that if healthy people spend several minutes in a completely sound-proof room, 9 out of 10 will start to hear ringing in their ears. It is not known why this happens.

Are there any medications, devices or complementary therapies that can help?

If you have serious hearing loss as well as tinnitus, you might need a hearing aid. These aim to help you hear conversations better and filter out bothersome background noises. If a hearing aid works for you, you might also find that your tinnitus bothers you less. However, hearing aids have not been proven to work if used as a treatment for tinnitus only, when the person has no hearing loss.

In Germany and some other European countries, if a person suddenly develops tinnitus, especially with hearing loss, they might be offered immediate infusion treatment. This involves inserting a thin tube into a vein and letting a solution that contains liquid and medication ‘drip’ into their bloodstream (intravenous infusion). Anti-inflammatory drugs like cortisone are also used often. Research is still being done on these treatments, and it is not yet certain whether they really can help.

One of the drugs sometimes used for infusion therapy is hydroxyethyl starch (HES). HES can lead to a severe allergic reaction. The Drug Commission of the German Medical Association (Arzneimittelkommission der deutschen Ärzteschaft) has issued several warnings that HES often causes an outbreak of strong itching all over the body.

A lot of other different treatments and devices have been tried out to help relieve tinnitus. Some are expensive and many are heavily advertised. Unfortunately, though, research has not shown that they can help a great deal – and many even have adverse effects. Antidepressants, for example, have not been shown to relieve tinnitus.

Many people believe that tinnitus can be caused by stress. Although stress is often associated with symptoms like high blood pressure, which can play a role in the development of tinnitus in some people, relaxation techniques have not been shown to have a direct effect on tinnitus symptoms.

What treatments are still being tested?

Ginkgo biloba is an herbal medicine that is used to treat tinnitus. Various ginkgo products are available, and the research on them has produced conflicting results. So it is still not clear whether they can noticeably reduce tinnitus symptoms.

Some of the treatments that are used for tinnitus, but have not been proven to help, include:

Tinnitus “maskers” generating broadband or “white” noise: These are worn like hearing aids and they make a sound (usually quiet hissing) that is meant to cover up the tinnitus.
Acupuncture: A treatment developed in traditional Chinese medicine where needles are inserted into the skin at certain points to try to affect the flow of energy in the body. Trials of acupuncture for tinnitus have produced conflicting results.
Hypnosis: This involves getting people into a deep state of relaxation where they are at a different level of consciousness. The therapist then uses suggestions to try to change how the person perceives their tinnitus.
Relaxation techniques and yoga.
Electromagnetic stimulation or ear magnets: These are either small electrical devices that send an electromagnetic pulse through the bones near the ear, or more simple magnets.
Hyperbaric oxygen therapy: A pressurized chamber where pure oxygen is breathed. The aim is to increase the flow of oxygen to the ears and brain. Sometimes this is tried when a person has hearing loss as well as tinnitus.

If you have chronic tinnitus, the main option that could help you is to learn techniques to manage the distress that tinnitus causes. It is also important for all of us, whether we have tinnitus or not, to protect ourselves from very loud noise. This lowers the risk of developing permanent tinnitus. You can read more about hearing and the influence noise has here.

What techniques can help me cope with my tinnitus?

One of the reasons why many people who have tinnitus cope quite well, while others do not, is that there are differences in the way we respond to chronic health problems. Learning the kinds of techniques that make it easier for others to live with chronic health problems could help people who have tinnitus, too.

Cognitive behavioral therapy (CBT) aims to teach these kinds of techniques, and it has been shown to improve the quality of life of people with tinnitus – even though the tinnitus itself does not go away. You can read more about that research here.

At least 10 sessions of CBT are needed for it to have a benefit. In Germany, CBT is covered by statutory health insurance funds if the tinnitus is causing “considerable psychological distress” or if it is associated with another condition, such as depression.

If you want to try CBT, you need to find a psychotherapist who has had special training in CBT. Your therapist will work with you to identify the thoughts and behaviors that are making your life with tinnitus harder. In a second step, these are to be changed to be more positive. Then you and your therapist will set goals for you to try and reach.

Some people develop thought patterns, for example, that in psychology are called “catastrophizing”, “over-generalizing” or “all-or-nothing” thoughts. Catastrophizing is when you have thoughts like “Tinnitus has ruined my life and I will never be happy again”. Over-generalizing is when you think something like, “My tinnitus was very loud last night when I went out with my friends – so going out with my friends will always make my tinnitus unbearable”. And “all-or-nothing” thinking is when you believe that it is not worth trying out anything that will not definitely lead to a complete cure. These thought patterns all make tinnitus worse. But you can change the way you think, even if it does take a lot of effort and commitment.

The “behavioral part” of CBT tries to find out when you are behaving in a way that might be making things worse for you. For example, you may have started avoiding going to parties, concerts or other events because you are afraid that they will make your tinnitus worse. Or you could have started drinking too much alcohol, which could lead to other problems, too.

Just as researchers are not sure why idiopathic tinnitus starts, it is not known when it will go away either. During the time that you have these symptoms, you can learn to manage better despite the annoying sounds. Because it may be harder for you to relax than it used to be, it could help to explore different ways of managing stress. If you are having trouble sleeping, you might find our information on insomnia helpful. And if you would like to know when we will have new information on new developments in treatments for tinnitus, you can subscribe to our free newsletter here.
Author: German Institute for Quality and Efficiency in Health Care (IQWiG)
http://www.informedhealthonline.org/fact-sheet-tinnitus.418.en.html

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