TINNITUS

Despite the fact that tinnitus can be brought on by many factors, the three main causes are:

• injuries to the auditory canal that cause hearing loss (presbycusis or aging of the ear; diseases common to the outer, middle or inner ear; acoustic trauma; ear infections; Ménière’s disease, etc.);
• poor posture that mainly affects the temporomandibular and cervical muscle (bruxism or teeth grinding while sleeping, as well as other poor craniofacial habits, cervical arthrosis, contractures, abnormal back alignment, etc.);
• work or family-related stress. We should point out that patients with tinnitus are found to experience greater cerebral activity in the auditory cortex and limbic system, which is the part of the brain that is most involved with the emotions.

The diagnosis of tinnitus begins with a thorough examination of the patient by an ENT specialist and is aimed at identifying the cause of tinnitus. After an initial observation phase, the relevant tests for each case are performed:

• otoscopy or examination of the outer ear and the eardrum with a microscope
• examination of painful craniofacial and cervical vertebrae areas
• audiometry, or test to measure the sensitivity of the ear to different sound frequencies
• acuphenometry to accurately identify the type of tinnitus
• pain threshold
• further tests (analysis, CAT, MRI and MRA scans, Cervical Vertebrae X-ray, Eco-doppler, etc.)
• questionnaire on the severity of the tinnitus

Treatment for tinnitus will depend on the cause. If the cause persists after treatment, we will resort to other approaches, which include:

• medication. Generally, cerebral vasodilators are used to reduce the intensity of tinnitus, and even to eliminate it altogether. If the tinnitus persists, other medicines are used to control the extent of brain stimulation, such as melatonin, sulpiride, hydroxyzine and lyrica, etc. If necessary, anxiolytics such as alprazolam or amitriptyline can also be prescribed;
• TRT (Tinnitus Retraining Therapy). TRT is currently the most widely used therapy. It aims to get patients used to the tinnitus, so that they are unaware of perceiving the sound;

TRT has two stages: the first is therapeutic advice (detailed explanation of the problem) and the second is sound therapy (to reduce the perception of the sound).  Sound therapy will sometimes involve the use of sound generators, which for patients with considerable hearing loss will be fitted onto the conventional hearing aid;

• rehabilitation. In cases involving muscular contractions or poor posture, the patient will be referred for rehabilitation;
• tinnitus masker. This involves fitting a device, in the same way as a hearing aid, that emits low-level sounds directly into the masked ear, consequently masking and concealing the noise produced by tinnitus. The device reverses the soundwave stemming from tinnitus making the tinnitus disappear for varied period of time (minutes, hours or even days);
• hearing aid. If the patient has reduced hearing ability, in many cases the tinnitus can disappear or lessen with the fitting of a hearing aid (the patient hears ambient noise instead of the buzzing in the ears caused by the tinnitus).

In some cases, “white noise” therapy will be prescribed to complete the treatment. White noise consists of a constant sound signal that blocks out other sounds, immersing the patient in a relaxing environment

Click on the following links to hear some examples of white noise:

• Example of white noise 1
• Example of white noise 2
• Example of white noise 3