Noise exposure. Exposure to loud noises can damage the outer hair cells, which are part of the inner ear. These hair cells do not grow back once they are damaged. Even short exposure to very loud sounds, such as gunfire, can be damaging to the ears and cause permanent hearing loss. Long periods of exposure to moderately loud sounds, such as factory noise or music played through earphones, can result in just as much damage to the inner ear, with permanent hearing loss and tinnitus. Listening to moderately loud sounds for hours at a young age carries a high risk of developing hearing loss and tinnitus later in life.
When TRT was developed in the 1980s by neuroscientist Dr. Pawel Jastreboff (now at Emory University in Atlanta), it was designed to be administered according to a strict protocol. Today, the term TRT is being used to describe modified versions of this therapy, and the variations make accurate assessment of its effectiveness difficult. Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus. In a Cochrane review of the one randomized trial that followed Jastreboff's protocol and met the organization's standards, TRT was much more effective in reducing tinnitus severity and disability than a technique called masking (see below).
On the internet, on TV and radio commercials and in papers and magazines you can easily find many who offers a method that can cure, or at least reduce, tinnitus. This could for example be in the form of “medication” (pills and injections), herbal treatments, different types of therapy and hypnosis. But other “cures” also exist. The list of “cures” is long, and is getting longer.
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.
The latest news about tinnitus treatment comes from a UK study showing that Mindfulness Based Cognitive Therapy (MBCT) significantly helps reduce the severity of the disorder. The researchers reported that, among the 75 patients being studied, both relaxation therapy and MBCT worked to alleviate symptoms as well as reducing psychological distress, anxiety and depression related to the disorder. MBCT led to greater reductions in tinnitus severity and the improvements lasted longer.
Inspection of the eardrum may sometimes demonstrate subtle movements due to contraction of the tensor tympani (Cohen and Perez, 2003). Tensor tympani myoclonus causes a thumping. Another muscle, the stapedius, can also make higher pitched sounds. See this page for more. Opening or closing of the eustachian tube causes a clicking. The best way to hear "objective tinnitus" from the middle ear is simply to have an examiner with normal hearing put their ear up next to the patient. Stethoscopes favor low frequency sounds and may not be very helpful.
If the cause of your tinnitus is excessive earwax, your doctor will clean out your ears by suction with a small curved instrument called a curette, or gently flush it out with warm water. If you have an ear infection, you may be given prescription ear drops containing hydrocortisone to help relieve the itching and an antibiotic to fight the infection.
Muscular tinnitus can be caused by several degenerative diseases that affect the head and neck including amyotrophic lateral sclerosis or multiple sclerosis. Myoclonus can also cause muscular tinnitus, especially palatal myoclonus, which is characterized by abnormal contractions of the muscles of the roof of the mouth. Spasms of the stapedial muscle (which attaches to the stapes bone or stirrup), which is the smallest muscle in the body, and tensor tympani muscle, both of which are located in the middle ear, have also been associated with objective tinnitus. Myoclonus or muscle spasms may be caused by an underlying disorder such as a tumor, tissue death caused by lack of oxygen (infarction), or degenerative disease, but it is most commonly a benign and self-limiting problem.
Schecklmann et al (2014) suggested that tinnitus is associated with alterations in motor cortex excitability, by pooling several studies, and reported that there are differences in intracortical inhibition, intra-cortical facilitation, and cortical silent period. We doubt that this means that motor cortex excitability causes tinnitus, but rather we suspect that these findings reflect features of brain organization that may predispose certain persons to develop tinnitus over someone else.
Removing Excess Earwax. There is a small chance that your tinnitus is being caused by an excess build up of ear wax that is blocking the ear canal. This is especially common in older patients who have a lot of ear hair that ear wax has been building up on over the years. By removing both the excess hair and ear wax, especially if it’s in contact with your ear drum, your tinnitus can improve.
Vertigo is the sensation of spinning or rocking, even when someone is at rest. Vertigo may be caused by a problem in the brain or spinal cord or a problem within in the inner ear. Head injuries, certain medications, and female gender are associated with a higher risk of vertigo. Medical history, a physical exam, and sometimes an MRI or CT scan are required to diagnose vertigo. The treatment of vertigo may include:
Most people should have a formal hearing test done by either the doctor or a hearing specialist (audiologist). People with tinnitus in only one ear and hearing loss should have gadolinium-enhanced magnetic resonance imaging (MRI). People with tinnitus in only one ear and normal hearing should have an MRI if tinnitus lasts more than 6 months. People with pulsatile tinnitus often require magnetic resonance angiography (MRA) and sometimes angiography.
Another way of splitting up tinnitus is into objective and subjective. Objective tinnitus can be heard by the examiner. Subjective cannot. Practically, as there is only a tiny proportion of the population with objective tinnitus, this method of categorizing tinnitus is rarely of any help. It seems to us that it should be possible to separate out tinnitus into inner ear vs everything else using some of the large array of audiologic testing available today. For example, it would seem to us that tinnitus should intrinsically "mask" sounds of the same pitch, and that this could be quantified using procedures that are "tuned" to the tinnitus.
Think about your breathing. Notice that it has a natural rhythm. Try to breathe in a steady, even rhythm. It helps to breathe in through your nose, hold your breath for a moment and then breathe out through your mouth. Wait a moment before breathing in again. Every time you breathe out, try to release a little bit of your tension. Do this for a few minutes, until you feel ready to move on to the next step.
Repeated loud noise exposure can be a cause of tinnitus as well as hearing loss. Loud music may cause short term symptoms, but repeated occupational exposure (for example, musicians, factory and construction workers) requires less intense sound levels to cause potential hearing damage leading to tinnitus. Minimizing sound exposure, therefore, decreases the risk of developing tinnitus. Sound protection equipment, like acoustic ear-muffs, may be appropriate at work and at home when exposed to loud noises.
Patients with head or neck injury may have particularly loud and disturbing tinnitus (Folmer and Griest, 2003). Tinnitus due to neck injury is the most common type of "somatic tinnitus". Somatic tinnitus means that the tinnitus is coming from something other than the inner ear. Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. This is thought to be due to somatic modulation of tinnitus. We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.