Tinnitus (Ringing in the Ear)

Tinnitus is hearing a sound without any outside source for it. About 10 to 15 per cent of adults have it.

Risk factors

Hearing loss is the main factor blamed for tinnitus. Even so, no direct link can be drawn, because people with completely normal hearing tests also get tinnitus severe enough to disturb them.

Other possible risk factors are obesity, smoking, regular alcohol use, earlier head injury, a history of arthritis and high blood pressure.

Some medicines cause tinnitus: salicylates, quinine, aminoglycoside antibiotics and certain cancer drugs.

Tinnitus often appears together with other conditions, anxiety and depression above all.

How the doctor investigates it

For most cases there is no objective test that shows whether tinnitus is present or how severe it is. The diagnosis therefore rests on the patient’s history and on assessing how much the tinnitus affects them.

Every patient needs a full ear, nose, throat, head and neck examination. Blood tests and imaging are used when they are needed.

Every patient who comes with tinnitus has a hearing assessment after the examination. Pure tone audiometry is done. Patients who describe a blocked feeling in the ear can also have tympanometry. Computed tomography, magnetic resonance imaging or MR angiography are requested when the suspected cause or area calls for them.

Treatment

The aim is to reduce how strongly the patient perceives the tinnitus, or to make it disturb them as little as possible.

Explaining the condition to the patient during assessment and treatment matters. Cognitive and behavioural treatments are available for tinnitus.

Medicines are the method used most often. If the tinnitus is severe enough to affect daily life, a tinnitus masker, which is a device similar to a hearing aid, can help. If a tumour causes the tinnitus, the surgeon treats it.

Other methods

• Sound masking. A device covers the tinnitus with another sound. It does not treat it. When the tinnitus is mild, it can help the patient fall asleep.
• Stimulation of the hearing nerve. A broadband acoustic signal, delivered through headphones, aims to desensitise the patient to the tinnitus.
• Cognitive behavioural therapy. It aims to reduce or correct the negative response to the tinnitus, to lower anxiety and depression, and to improve daily life.
• Repetitive transcranial magnetic stimulation (rTMS). One of the newest treatments. Tinnitus units in respected medical faculties have used it since 2011, and its versions have widened in the last two years. Depending on the cause of the tinnitus, success reaches 65 to 70 per cent.

What you can do

• Stay away from loud music.
• Have your blood pressure checked regularly.
• Avoid salty food.
• Cut down coffee, fizzy drinks and cigarettes, which stimulate the nervous system.
• Exercise daily, to keep the blood flowing steadily.
• Rest enough during the day and avoid getting over-tired.