Most of us have experienced tinnitus, noises in our ears, at some time. Usually this lasts for a brief period, quickly subsides, and is quickly forgotten. For some people, however, tinnitus is constant, worrisome, and affects their quality of life, such as concentration difficulty or sleep deprivation.
Tinnitus is mostly a purely subjective phenomenon – no one else can hear it. Exceptions are usually vascular in origin and different than the typical tinnitus. Tinnitus is multi-dimensional, described by variations in pitch, loudness, fluctuation, and intermittency. One person may report “a high-pitched whistle”, another describe “a sound like the ocean”; other variations may be “frying noise”, “like a motor”, “a buzz”, “static”, “crackling”, etc. On occasion, the type of noise the person perceives can be significant to a specific pathology, but not always.
A simple, brief or occasional ring in either ear is most likely not significant. However, persistent tinnitus should always be evaluated, whether it is unilateral or bilateral. Unilateral means one-sided and is particularly significant if this ear has a loss significantly different than the other ear asymmetrical). Bilateral means both ears. Bilateral tinnitus may be a fluctuating tinnitus (pitch or loudness) in either ear; sometimes intermittent, other times constant, and even centered/unable to localize as if the sound were in the center of the head. In addition, any form of tinnitus also accompanied by dizziness/vertigo, disequillibrium, diploplia, headaches, etc. warrants a prompt medical referral.
Correlation with any degree and type of hearing loss, common with sensory deficits
Noise exposure – noise exposures at work, recreational activities, hobbies (loud music/bands, target shooting, hunting, racing, carpentry/power tools, etc.)
Physiological/pathological, ranging from simple wax impaction or ear infection to more serious types of growths, tumors, or neurological involvement.
In addition to an evaluation by an ear, nose, and throat (ENT) physician, referral for an audiological evaluation is necessary. The audiologist will perform a comprehensive audiological assessment to assess outer, middle, and inner ear status. A comprehensive assessment will include a medicalhistory; otoscopic examination, tympanometry, acoustic stapedial reflex battery, air and bone conduction audiometry, and word recognition testing. Other tests that might be performed are Tinnitus Matching and determination of minimal level masking (determination of the narrowest band and intensity of noise that would effectively mask (cover) the tinnitus) if a masking device is being considered.
An accompanying asymmetric hearing loss, particularly a newly diagnosed asymmetry, substantial decrease from a previous audiological assessment or results of the above audiological work-up may indicate the need for further tests (Auditory Brainstem Response (ABR), CT, or MRI) to rule out more serious or potentially threatening causes.
Management is the more appropriate word when dealing with tinnitus because of its variability. It is usually never cured. It may get better; it may disappear; it may return; it may change in sound or intensity level. But don’t get discouraged - if tinnitus is caused by a physiological or pathological condition, medical intervention of that condition can often resolve or at least improve tinnitus. If the person has hearing loss in addition to tinnitus, use of hearing aids can in many cases can simultaneously improve hearing as well as make tinnitus less noticeable or distracting. If tinnitus is a side effect of a medication, change of medication may be an option. If tinnitus is a result of noise exposure, then conscientious use of hearing protection devices at work and in recreation may help or at least, halt the progression of damage from further exposures. Finally, the use of tinnitus maskers is sometimes beneficial to patients with normal hearing, but constant tinnitus.
There are articles written that tout the benefits of homeopathic remedies such as nutritional modifications, supplements, vitamins, biofeedback, stress management techniques, etc. Certainly, discuss these with your ENT physician before trying any product or procedure that might not be in your best health interests.
Ellen R. Wilson, AuD, CCC-A
Submitted Sept. 24, 2006
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