Tinnitus Symptoms & Risk factors

Tinnitus is a noise that a person hears without actually being there. It can be whistling, buzzing or clicking noises, for example. They can be heard in one or both ears, but can also seem to be present inside the head, in the front or back. Tinnitus can be occasional, intermittent or continuous. It results from a dysfunction of the auditory nervous system. It is a symptom that can have many causes.

Temporary tinnitus can occur after exposure to very loud music, for example. It usually resolves without intervention. This sheet is dedicated to chronic tinnitus, i.e. tinnitus that persists and can become extremely annoying for those who suffer from it. However, in the vast majority of cases, tinnitus does not have a significant impact on quality of life.

Prevalence

In general, it is estimated that 10% to 18% of the population suffers from tinnitus. The proportion is 30% among adults. From 1% to 2% of the population is seriously affected.

In Quebec, approximately 600,000 people are believed to be affected by this problem, 60,000 of whom are seriously. The large-scale use of personal music players and MP3 players among young people raises concerns about an increase in prevalence in the medium term.

 Types

There are 2 main categories of tinnitus.

Objective tinnitus . Some of them can be heard by the doctor or the specialist consulted, as they are caused by disorders which, for example, make the flow of blood more audible. They can also sometimes be manifested by repeated “clicks”, sometimes related to abnormal movements of the muscles of the ear, which those around you can hear. They are rare, but generally the cause is identifiable and we can then intervene and treat the patient.

Subjective tinnitus . In their cases, the sound is only audible by the affected person. These are the most frequent tinnitus: they represent 95% of cases . Their causes and physiological symptoms being very poorly understood for the moment, they are much more difficult to treat than objective tinnitus. On the other hand, the patient’s tolerance to these internal noises can be improved .

The intensity of tinnitus varies from one individual to another. Some people are not very affected and do not consult. Others hear noises all the time, which can affect their quality of life.

Note. If you hear voices or music, this is another disorder called “auditory hallucination”.

 Causes

Hearing tinnitus is not a disease in itself. Rather, it is a symptom very often associated with hearing loss . According to one of the hypotheses put forward by specialists, it is a “phantom signal” generated by the brain in response to damage to cells in the inner ear (see the Risk factors section , for more details). Another hypothesis evokes the dysfunction of the central auditory system. Genetic factors could be involved in some cases.

Most often, the factors linked to the appearance of tinnitus are:

  • In older people , hearing loss due to aging.
  • In adults , excessive exposure to noise.

Among the many other possible causes are the following:

  • Long-term use of certain medicines that can damage cells in the inner ear (see Risk factors section ).
  • An injury to the head (such as a head trauma) or neck (whiplash, etc.).
  • The spasm of a small muscle in the inner ear (stapes muscle).
  • Obstruction of the ear canal by a plug of earwax .
  • Certain disorders or diseases  :
    – Ménière’s disease and sometimes Paget’s disease ;
    – otosclerosis (or otosclerosis), a disease which reduces the mobility of a small bone in the middle ear (the stapes) and can cause progressive deafness (see diagram);
    – ear or sinus infections (recurrent ear infections, for example);
    – a tumor located in the head, in the neck or on the auditory nerve;
    – a bad alignment of the temporomandibular joint (which allows the movements of the jaw);
    – diseases affecting the blood vessels ; they can cause so-called tinnituspulsatile (about 3% of cases). These diseases, such as atherosclerosis, hypertension, or an abnormality of the capillaries , carotid artery or jugular artery, can make the blood flow more audible. These tinnitus are of the objective type;
    – Non-pulsatile objective tinnitus can be caused by an abnormality of the eustachian tube, by neurological disorders or by abnormal contractions of the muscles of the throat or the middle ear.
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 Course and possible complications

Some tinnitus appears very gradually: before becoming permanent, it is felt intermittently and only in quiet places. Others appear suddenly, following a particular event, such as a sound trauma.

Tinnitus is not dangerous, but when it is intense and continuous it can become very disturbing. In addition to causing insomnia, irritability and trouble concentrating, they are sometimes associated with depression.

Symptoms of tinnitus

The list of types of noise heard by people with tinnitus is long. The most frequently mentioned noise seems to be hissing , but patients also name the following sounds:

– pulsations
– clicking
– buzzing
– hissing
– ringing
– whirring
– rustling, etc.

Depending on the cause, tinnitus can be accompanied by hearing loss , nausea, drowsiness, dizziness, pain, or a persistent feeling of having a plug in your ears.

Many sufferers also suffer from an intolerance to loud noises or have a strong or painful perception of sounds perceived as normal or weak by healthy people. This disorder is called hyperacusis .

In general, tinnitus is less bothersome during the day because it is “masked” by other noises in the workplace or at home. However, they are more noticeable at night and can cause trouble sleeping in many people.

People at risk for tinnitus

  • Seniors. Aging often causes a deterioration in the mechanisms of hearing, which can lead to the onset of tinnitus.
  • Men. They are more affected than women by this type of symptoms.
  • People exposed to noise:

– people working in an industrial environment;
– truck drivers and all those whose profession requires them to use an automobile often;
– auto mechanics;
– construction workers;
– soldiers in conflict zones;
– the musicians;
– inhabitants of cities with a high population density;
– people who regularly go to discos, nightclubs, concert halls and raves , or who listen to music at high volume with their walkman or MP3 player;

Risk factors for tinnitus

  • Excessive exposure to noise. The inner ear is lined with a few thousand hearing cells. These cells are fragile and, once destroyed, they cannot regenerate. These are provided with vibratile eyelashes , the function of which is to transmit the sound vibration. When loud sounds are heard in the ear, these eyelashes lower before they straighten up after a while. However, regular exposure to too many decibels (dB) sooner or later leads to permanent damage to the hearing cells and their cilia.

    It can also happen that a single exhibitionto a particularly violent sound (the detonation of a rifle or a firecracker, for example) close to the ear causes irreversible damage to the hearing cells. This causes permanent hearing damage and can therefore cause tinnitus.
  • Physical activity and head movement increase pulsatile-type tinnitus.
  • The use of certain drugs. When taken long term, some medications can cause tinnitus. Here are a few:
    – high doses of acetylsalicylic acid (Aspirin®) or non-steroidal anti-inflammatory drugs such as ibuprofen (Advil®, etc.);
    – antimalarials, such as quinine ;
    – certain diuretics , such as furosemide (Lasix®, etc.);
    – various drugs used in chemotherapy;
    – certain antibiotics.
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Note . Resistance to the side effects of noise and drugs varies greatly from person to person.

The stress. Stress is not a risk factor for tinnitus, but it can increase the perception of tinnitus and therefore worsen its impact on quality of life.

Prevention of tinnitus

Basic preventive measures
Watch out for noise.
 Avoid exposing yourself unnecessarily and too often to very high or even moderately high sound volumes. If necessary, use Earplugs®, ear protectors or foam earplugs, whether at work, on an airplane, during a rock concert, using noisy tools, etc.

Watch out for certain medications. 
Avoid prolonged use of high doses of nonsteroidal anti-inflammatory drugs such as acetylsalicylic acid (Aspirin®, for example) and ibuprofen (Advil®, etc.). See above for the partial list of drugs potentially toxic to the ears (ototoxic). If in doubt, check with your pharmacist or doctor.

Measures to prevent aggravation

Avoid very noisy places.

Determine the aggravating factors. The alcohol , the caffeine or tobacco increase tinnitus in some people. Very sweet foods or drinks with low amounts of quinine (Canada Dry®, Quinquina®, Brio®, Schweppes®, etc.) can have this effect on other people. These aggravating factors vary from person to person.

Reduce and manage stress. Practicing relaxation, meditation, yoga, physical activity, etc., can reduce stress and anxiety, which are both consequences and aggravating elements of tinnitus.

Avoid absolute silence in case of hyperacusis. When suffering from this intolerance to loud noises, it is best not to seek silence at all costs or to wear earplugs, as this can make the hearing system even more sensitive, thus lowering the threshold of discomfort. .

Medical treatments for tinnitus

As tinnitus has so many different origins, there is no single treatment. Usually, tinnitus is difficult to treat, but there are some methods that provide good results.

 Treatment of the underlying disease

In the event that tinnitus is linked to a well-defined disease, it is possible to obtain an improvement or even a cure by treating the disease in question: otitis or other infection, otosclerosis , Paget’s disease, Ménière’s disease, etc. However, not all of these diseases are easily curable. Removing an earwax plug or removing a tumor can also end tinnitus.

Medication modification

When medications are the cause of the problem, a change in treatment or lowering the dosage can reduce or make tinnitus go away.

 Medications

If tinnitus is caused by hearing loss or hearing damage resulting from excessive noise exposure, there is currently no specific treatment. Different medicines have been used (vasodilators, baclofen, cinnarizine, benzodiazepines like clonazepam), but most have more side effects than positive ones.

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In some special cases, drugs to control stress or depression (such as amitriptyline) may be prescribed with good results.

People have had some relief with niacin (vitamin B3) supplements, but the result is unpredictable (take under medical supervision only).

Corticosteroid injections (dexamethasone) through the eardrum can also be effective in some cases 29 .

The doctor may offer various drugs, but without any guarantee of effectiveness.

 Tinnitus masking

The white tone generator. This device broadcasts a “ white sound  ” (a noise similar to that produced by a radio device tuned between 2 stations) to the affected ear  at a low volume. This sound masks tinnitus and reduces inconvenience to the patient. This device looks like a hearing aid; an audiologist can provide one. White tone generators are recommended for patients with normal or near normal hearing.

The hearing aid. Using a hearing aid may reduce the discomfort of some patients with mild to moderate hearing loss by making their tinnitus less audible. When the prosthesis is insufficient, they can also resort to a generator of white tones.

Therapies and techniques

Acoustic habituation therapy (TAH). This approach, developed by an American specialist (Jastreboff), is often mentioned under its name: Tinnitus Retraining Therapy (TRT). It includes therapeutic meetings allowing the sufferer to live better with their tinnitus. He is explained the mechanism of tinnitus and the influence of emotional factors, he is taught relaxation techniques and distraction of attention, etc. This involves, among other things, reprogramming your brain so that it filters sounds selectively. The goal is for the person to hear only useful sounds and ignore unnecessary sounds.

HAT also includes exposure to noise to avoid silence, as well as the wearing, as the case may be, of a white tone generator or a hearing aid. This therapy lasts approximately 18 months and includes around 16 hours of personalized follow-up. This is ideally offered by a multidisciplinary team including an otolaryngologist, an audiologist and an occupational therapist. In 2010, a clinical study of 123 patients concluded that TAH was more effective than masking tinnitus 31 .

Cognitive-behavioral therapy. This psychological approach can markedly improve the quality of life of a person suffering from tinnitus 4 . It is based on techniques of relaxation, visualization and distraction of attention, and on reshaping thoughts and beliefs about tinnitus. Swedish researchers have even achieved some success in subjects participating in a cognitive behavioral therapy program offered on the Internet 5. The duration of treatment is usually 3 months. Cognitive behavioral therapy can be supplemented by noise therapy: it involves avoiding silence, wearing a white tone generator, making sure to maintain ambient noise, etc. According to a meta-analysis published in 2010, cognitive behavioral therapy does not reduce the “strength” of tinnitus, but is effective against depression and improves quality of life 30


References

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Medical Association of Canada (Ed). General public Disease – Tinnitus,  Amc.ca . [Accessed February 3, 2011]. www.cma.ca
Canadian Center for Occupational Health and Safety – Noise in the Workplace – Basics,  CCOHS  [Accessed February 3, 2011] www.cchst.ca
Ernst E (Ed). The Desktop Guide to Complementary and Alternative Medicine: an evidence-based approach , Mosby Elsevier, 2006.
InteliHealth (Ed). Health AZ – Tinnitus,  Aetna Intelihealth . [Accessed February 3, 2011]. www.intelihealth.com
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Natural Standard (Ed). Condition Center – Tinnitus,  Nature Medicine Quality Standards . [Accessed February 3, 2011]. www.naturalstandard.com