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Tinnitus

Tinnitus is a phenomenon of the nervous system connected to the ear, characterised by perception of a ringing or beating sound (often perceived as sinusoidal) with no external source. This sound may be a quiet background noise, or loud enough to drown out all outside sounds. It is sometimes refered to as "the club disease" as many people get temporary tinnitus at loud clubs or concerts. more...

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Tinnitus can be objective (the sound, e.g., a bruit, can be perceived by a clinician) or subjective (perceived only by the patient).

Causes

Causes of tinnitus include:

  • A sudden loud noise, prolonged exposure to loud music through PA systems or personal stereos, exposure to an excessively noisy work environment without ear protection, (eg industrial)
  • Hearing loss (20 per cent of cases: chronic noise damage and presbycusis)
  • Head injury (especially basal skull fracture)
  • Drugs: aspirin overdose, loop diuretics, aminoglycosides, quinine
  • Temporomandibular and cervical spine disorders
  • Suppurative otitis media (also chronic infection and serous OM)
  • Otosclerosis
  • Ear wax
  • Meniere's disease
  • Impacted wisdom teeth
  • Hypertension and atherosclerosis
  • Acoustic neuroma
  • Palatal myoclonus (objectively detectable)
  • Arteriovenous fistulae and arterial bruits (objectively detectable)
  • Severe anemia and renal failure
  • Glomus jugulare tumours (objectively detectable)
  • Lyme Disease
  • Stress and depression
  • Thyroid disorders, such as hyperthyroidism or hypothyroidism

Treatment

Some types of tinnitus can be treated while others are permanent. In general, there are no cures specific to tinnitus, but if it is caused by a physical condition that can be treated, the tinnitus may also resolve. Chronic tinnitus can be quite stressful psychologically as it distracts the affected individual from mental tasks and interferes with sleep, particularly when there is no external sound. The affected individual may have to generate artificial noise that masks the tinnitus sound. A combination of external masking and psychological counseling known as tinnitus retraining therapy is widely practiced. While it does not actually cure the tinnitus, many report that it becomes much less disturbing and easier to ignore.

Mechanisms of subjective tinnitus

The mechanisms of subjective tinnitus are often obscure. While it's not surprising that direct trauma to the inner ear can cause tinnitus, other apparent causes (e.g., TMJ and dental disorders) are difficult to explain. Recent research has proposed that there are two distinct categories of subjective tinnitus, otic tinnitus caused by disorders of the inner ear or the acoustic nerve, and somatic tinnitus caused by disorders outside the ear and nerve, but still within the head or neck. It is further hypothesised that somatic tinnitus may be due to "central crosstalk" within the brain, as certain head and neck nerves enter the brain near regions known to be involved in hearing.

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Vestibular findings in a patient presenting with tinnitus
From Ear, Nose & Throat Journal, 9/1/04 by Kenneth H. Brookler

A 75-year-old woman presented with a chief complaint of constant tinnitus of 2 months' duration. She described it as a hissing sound in the left ear and/or on the left side of her head. She reported no tinnitus in the right ear or the right side of the head. She was aware of some hearing loss in the left ear, but she was not sure when it started. She said there might have been some minor fluctuation in her hearing in the left ear. She had experienced no aural fullness, dizziness, or balance problems.

Audiology revealed that the patient had a moderate sensorineural hearing loss in the low tones and a mild loss at 3 through 6 kHz in the left ear. Her speech reception threshold was 30 dB, and her speech discrimination score was 88% at 70 dB hearing loss.

Electronystagmography showed nystagmus while the patient was lying on her right side; the nystagmus was unaffected by neck torsion. The alternate binaural bithermal caloric test showed no abnormal reduced vestibular response or directional preponderance. The simultaneous binaural bithermal test elicited a type 3 response with a left-beating nystagmus on both cool and warm stimuli. Ocular fixation suppression was present during all responses to both calorie and positional stimuli.

This case serves as an illustration of abnormal vestibular findings on electronystagmography in a patient presenting with tinnitus. In the absence of dizziness, the vestibular findings suggest a peripheral origin of the tinnitus despite her inability to specifically localize the tinnitus either to her ear or her head.

COPYRIGHT 2004 Medquest Communications, LLC
COPYRIGHT 2004 Gale Group

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