Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.
The diagnosis of tinnitus is usually based on the person's description. A number of questionnaires exist that may help to assess how much tinnitus is interfering with a person's life. The diagnosis is commonly supported by an audiogram and a neurological examination. If certain problems are found, medical imaging, such as with MRI, may be performed. Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat. Rarely, the sound may be heard by someone else using a stethoscope, in which case it is known as objective tinnitus. Spontaneous otoacoustic emissions, which are sounds produced normally by the inner ear, may also occasionally result in tinnitus.
There are many different conditions and disorders that affect nerve channels leading to the ears, which can cause someone to hear abnormal ringing or other sounds in their ears. These conditions usually cause other symptoms at the same time (such as dizziness, hearing loss, headaches, facial paralysis, nausea and loss of balance), which doctors use as clues to uncover the underlying cause of tinnitus.
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Tinnitus can be extremely frustrating and can leave you feeling overwhelmed and unsure about your next steps. Remember that you are not alone - tinnitus, while not well-understood, is common. Make an appointment with a hearing care professional near you, preferably one who specializes in tinnitus treatment. Be prepared to discuss your symptoms in detail so you can get relief and regain your quality of life.
Generally, following the initial evaluation, individuals suspected of rhythmic tinnitus will undergo some form of specialized medical imaging. Individuals may undergo high resolution computed tomography (HRCT) or magnetic resonance angiography (MRA) to evaluate blood vessel abnormalities such as a vascular malformation that may be the cause of tinnitus. An HRCT scan can also be used to evaluate the temporal bone for sinus wall abnormalities and superior semicircular canal dehiscence. HRCT uses a narrow x-ray beam and advanced computer analysis to create highly detailed images of structures within the body such as blood vessels. An MRA is done with the same equipment use for magnetic resonance imaging (MRI). An MRI uses a magnetic field and radio waves to produce cross-sectional images of particular structures or tissues within the body. An MRA provides detailed information about blood vessels. In some cases, before the scan, an intravenous line is inserted into a vein to release a special dye (contrast). This contrast highlights the blood vessels, thereby enhancing the results of the scan.
Supporting the idea that central reorganization is overestimated as "the" cause of tinnitus, a recent study by Wineland et al showed no changes in central connectivity of auditory cortex or other key cortical regions (Wineland et al, 2012). Considering other parts of the brain, Ueyama et al (2013) reported that there was increased fMRI activity in the bilateral rectus gyri, as well as cingulate gyri correlating with distress. Loudness was correlated with values in the thalamus, bilateral hippocampus and left caudate. In other words, the changes in the brain associated with tinnitus seem to be associated with emotional reaction (e.g. cingulate), and input systems (e.g. thalamus). There are a few areas whose role is not so obvious (e.g. caudate). This makes a more sense than the Wineland result, but of course, they were measuring different things. MRI studies related to audition or dizziness must be interpreted with great caution as the magnetic field of the MRI stimulates the inner ear, and because MRI scanners are noisy.
From amongst the many treatments for tinnitus, you’re certain to find a solution that helps you live a more comfortable life, free of the frustration of tinnitus. Although a definitive cure is not currently available, these tools can help you manage your tinnitus and minimize its influence on your life. If you work closely with an experienced tinnitus specialist, they can help you determine which course of action is best for you.
Demographic variables (age, sex, type of tinnitus) and baseline THI scores of placebo (n = 16) and treatment (n = 11) groups did not significantly differ from one another at the start of the study. At 3 months, participants in the treatment group reported significantly lower scores on the THI when compared to the placebo group (p < .05). The treatment group also showed an 11-point drop in THI scores when comparing baseline and 3 months (p < .05; please see Figure 2). THI scores for the placebo group comparing both time points were non-significant. Past studies have indicated that the minimum change in the THI score to be considered clinically significant is a drop of 6 to 7 points.9 As such, the results of our clinical study suggest that tinnitus and its related symptoms can produce a clinically significant reduction in tinnitus within the first 3 months using the personalized music-based therapy.
Tinnitus – a sound in the head with no external source – is not a disease; it is a symptom that can be triggered by a variety of different health conditions. So what causes tinnitus? Common sources include hearing loss, ear wax buildup, ototoxic medications, and ear bone changes. No matter what the cause, the condition interrupts the transmission of sound from the ear to the brain. Some part of the hearing system is involved as well, whether the outer, middle, or inner ear.
Research regarding using cognitive behavioral therapy for tinnitus shows that tolerance to tinnitus can be facilitated by “reducing levels of autonomic nervous system arousal, changing the emotional meaning of the tinnitus, and reducing other stresses.” (6) It’s been found that there’s some overlap in anxiety and tinnitus due to an association between subcortical brain networks involved in hearing sounds, attention, distress and memory functions.
Limit use of earplugs. Earplugs are important to use to protect your hearing when you’re likely to be exposed to loud noises. (Remember, exposure to loud sounds, and noise-induced hearing loss, are common causes of tinnitus, and may make tinnitus worse if you already have the condition.) But otherwise, people with tinnitus are advised not to wear earplugs, including for sleep. Earplugs reduce your ability to hear external noise and can make tinnitus more noticeable.
Tinnitus that's continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Pulsatile tinnitus calls for a medical evaluation, especially if the noise is frequent or constant. MRI or CT imaging may be needed to check for a tumor or blood vessel abnormality.
Currently there is no cure for most cases of tinnitus. Depending on the type of tinnitus, symptoms will tend to come and go over time. Stress level, diet, and exposure to noise can worsen tinnitus. Many people find their tinnitus annoying but can learn to adapt without difficulty. It is likely that if you have had tinnitus, you will have it again in the future.
We encourage you to avoid anything that can make your tinnitus worse. For instance, you may want to avoid smoking, drinking alcohol, or listening to loud noises. Another precaution is protection. If you’re a construction worker, airport worker, hunter, or regularly exposed to loud noise, you should wear custom earplugs or special earmuffs. Ear protection goes a long way towards preventing your tinnitus from getting worse.
Although there’s no proven cure for tinnitus, there are treatments that help make it easier to ignore. For example, you can wear devices in your ear(s) that produce soothing therapeutic noises to shift your focus away from the tinnitus. Other devices produce constant, soft noise to mask the tinnitus. Tinnitus sufferers who also have hearing loss sometimes find relief simply by wearing properly fitted hearing aids.