Tinnitus – Is It Treatable?

The sound we hear in our ear/ ears in the absence of an external stimulus is called Tinnitus. 

So, in a way, it is a sound that you hear that no one else does – Subjective Tinnitus.

It is produced within or around your own ear and is an internal sound.

Rarely your Tinnitus may be heard by someone when they place their ear or an instrument close to your ear – Objective Tinnitus.

What Causes Tinnitus?

The Pathology– Tinnitus is produced by stimulation of the Hair Cells within your Cochlea (Hearing organ).

The Causes

There are many causes of Tinnitus

– External ear – Wax accumulation

– Middle ear – infection or fluid accumulation, Otosclerosis.

– Cochlea – Age-related degeneration, Noise-Induced Hearing Loss, Post-traumatic, Spontaneous sound emissions ( Oto Acoustic Emission).

Tumour- Retro Cochlear – Schwannoma. 

– Vascular – Vascular malformations, Glomus tumour, Prominent Internal Jugular Vein.

– Drug-Induced- a common cause- many drugs including diuretics, Aspirin, anti cancer drugs, Quinine etc.

– Muscular abnormality- Palatal or Tensor Tympani Muscles.

– Neurological – anxiety, depression.

– Idiopathic- in the presence of normal hearing.

Types Of Tinnitus

Tinnitus can be 

Temporary – as after exposure to loud sound, 

Objective – an observer can also hear- sounds of vascular or muscular origin

Subjective- only the patient can hear

Fluctuant- comes and goes depending upon exposure to some stimulus (like a drug).

Pulsatile- related to a vascular problem

Frequency – Based on the frequency of sound- Whistling, the sound of crickets, drumming …

Unilateral versus Bilateral- Unilateral or single-sided Tinnitus is usually taken more seriously because the ENT specialist will look for a local cause like a tumour behind your ear.

Investigations

Though largely self-limiting and benign, a basic workup needs to be done. This includes

– Audiogram- to look for associated hearing loss

– Tinnitus matching – to find out the Frequency and Amplitude of the Tinnitus.

– Impedance Audiometry- to diagnose Middle ear problems, Eustachian tube disorder etc

– MRI – to look for vascular causes or tumour

Management

Answering the question asked in the title- Yes, Tinnitus is manageable.

Treatment modalities include

  1. Avoidance- loud sounds, drugs responsible…
  2. Medication – many different types of drugs have been used to suppress Tinnitus.
  3. Sound Enrichment Environment – since Tinnitus is aggravated in silence, some soothing background sound helps to alleviate Tinnitus
  4. TRT – Tinnitus retraining therapy – done to remove the negative connotation that the mind has with the disturbing sound of Tinnitus
  5. Hearing Aid and Tinnitus masker – If the patient has an associated hearing loss.

Yes, given a proper step up logical evidence-based approach Tinnitus is either completely treatable or else the symptom is manageable in a majority of patients.

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