What Is Tinnitus?
The word tinnitus comes from the Latin tinnire and means “tinkling, ringing”, and from the Greek akouein (to hear) and phaneros (visible, that can be seen). Therefore, tinnitus is the perception of a sound in the absence of an external auditory stimulus.
Although the actual prevalence is difficult to pin down, it is estimated that 15-20% of the world’s population suffers from this condition. It’s more common after the age of 50.
Classification of tinnitus
Based on the information provided by the person, doctors classify the type of tinnitus that the patient is suffering from. There are several classifications. This helps guide diagnosis and then treatment.
According to the cause
Depending on its origin, tinnitus can be the following:
- Primary: there is no apparent identifiable cause
- Secondary: caused by a specific condition
According to who perceives the sound
This other classification considers two groups:
- Subjective: only the person hears the sound. It is the most frequent (95% of sufferers).
- Objective: the sound can also be perceived by other people when approaching, since it can be associated with a crepitus of the temporo-mandibular joint or the murmur produced by a vascular pathology.
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According to its duration
Acute tinnitus lasts less than 6 months and is considered chronic when it exceeds that time threshold.
Causes of tinnitus
Tinnitus is a symptom and not a disease. It can be present in different types of pathologies.
Many ear disorders are accompanied by tinnitus as part of their manifestations. Among them, we can mention the following:
- In the external ear: wax impacted in the ear canal or external otitis.
- In the middle ear: otosclerosis, otitis media, cholesteatoma.
- In the inner ear: vestibular schwannoma, Meniere’s disease, use of drugs (aminoglycosides, vancomycin, furosemide, aspirin). Also, nasopharyngeal carcinoma and hypothyroidism, although to a lesser extent.
How can the doctor determine the cause of tinnitus?
As with any other symptom, diagnosis begins with a detailed medical history. Through a series of questions, the doctor will ask the patient to describe the characteristics of the discomfort.
Then a general evaluation will be carried out to rule out vascular, geriatric, endocrine (diabetes mellitus, hypothyroidism), neurological, vitamin B, or zinc deficiency diseases. In order to identify the cause, a physical examination of the ears, head, and neck will also be performed.
The examination will begin with the inspection of the external auditory canal and eardrum, using an otoscope. A fairly simple test follows, using a metal fork-shaped instrument called a tuning fork. It emits vibrations at a specific frequency.
Depending on the test to be performed, the tuning fork will vibrate and rest on the upper region of the head or on the bony part behind the pinna. A person without hearing problems will perceive loudness centrally in both ears.
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The Weber test allows us to compare the hearing in both ears and thus confirm that there is a hearing problem. In this technique, after vibrating the tuning fork, it will be placed at the level of the vertex (upper region) of the head.
In a normal test, the sound is distributed evenly to both ears i.e it is not lateralized. If the sound is lateralized towards one ear (felt more towards that side), it can be due to two problems:
- That the person has conductive hearing loss in that ear. For example, by obstruction of the external auditory canal by a plug of cerumen.
- You may have sensorineural hearing loss, due to an auditory nerve injury in the contralateral ear.
The Rinne test allows us to compare the hearing in each ear separately and to clinically locate the area of the injury. It consists of placing the vibrating tuning fork at the level of the mastoid bone and then placing it in front of the pinna.
At that time, the patient will be asked where the sound was heard loudest. In a normal test (Rinne positive), air conduction will be greater than bone conduction. If bone hearing is greater than air, it indicates that there is a problem.
In general, all people with tinnitus are recommended to have audiometry. This is because many tinnitus patients also have some degree of hearing loss.
Head and neck imaging studies, such as a CT scan or MRI, are carried out only if there is an accurate diagnosis. These indications include the following:
- Unilateral tinnitus that could suggest a focal lesion.
- Pulsatile tinnitus, suggesting a vascular abnormality.
- Asymmetric hearing loss.
- Other signs of neurological alteration.
Is there a treatment for tinnitus?
The management of tinnitus will depend on the underlying cause. If the tinnitus is primary, which means that if, after all the tests, the cause is not identified, then the person will not require treatment.
In the case of chronic tinnitus that is very bothersome for the patient, some of the following strategies may be adopted:
- Assistive hearing aids: Hearing aids are helpful in cases of hearing loss.
- Hearing therapy: This is prescribed by audiologists. The principle is based on exposing the person to an external sound. By concentrating on listening to this sound, the perception of tinnitus is reduced.
- Tinnitus retraining therapy (TRT).
- Psychotherapy: We know that tinnitus can cause some degree of emotional affectation, such as anxiety or depression. Conductive behavior therapy encourages the patient to examine thought processes that may result in distress and negativity.
- Pharmacological: Depending on the case, the doctor may recommend NMDA receptor antagonists, antiepileptic drugs, antidepressants, antihistamines, benzodiazepines, and corticosteroids.
What knowledge should we bring home?
Tinnitus is a very common symptom. After a detailed medical history, a physical examination, and complementary examinations, a disease can be classified as primary or secondary. The objective of the treatment will depend on what causes it.
Knowing and understanding the causes of tinnitus, as well as knowing that there are multiple treatments currently and under investigation, mitigates the patient’s anxiety and fear. You should always consult an otolaryngologist when in doubt.