Tinnitus

What is tinnitus?

Tinnitus is hearing sounds without external stimulation in the ear. Approximately 15% of all adults suffer from this ringing in the ears. While some people experience little or no disruption in their lives from tinnitus, for others, ringing in the ears can be severely disabling and associated with mental health conditions such as depression. Tinnitus can also affect children, although they are usually much less affected by the noise in their ears.

Symptoms of Tinnitus

Tinnitus can not only make itself felt through ringing or ringing in the ears. Possible noises include:

• Pipes
• Brumming
• hiss
• Ring
• Rush
• Voices or Music: Voices and/or music produced by tinnitus must be distinguished from hallucinations. In contrast to hallucinations, the voices in tinnitus are difficult or impossible to understand and make no sense.

The ringing in the ear can be in one or both ears and can be “inside the head” or sound like the sound is coming from outside the head. A pulsating noise in the ear can occur at the same time as the heartbeat ( pulse-synchronous ) or independently of it. Tinnitus can come on suddenly, but in most cases it comes on gradually and gets worse over time. In addition to ringing in the ears, hearing loss and/or hyperacusis , sensitivity to noise and dizziness can occur.

The variability in the severity of tinnitus often makes diagnosis difficult, but certain symptoms can indicate a possible cause of the tinnitus. Pulsatile tinnitus, for example, is often caused by changes in the blood vessels.

Classification of tinnitus

Classification by trigger:

• Objective tinnitus: Objective tinnitus is caused by a sound source in or near the ear. These include, for example, vascular or muscle-related ear noises.
• Subjective tinnitus: Subjective tinnitus is not caused by an external or internal sound source. It is believed that abnormal activity in the inner ear and/or central nervous system causes this type of tinnitus.

Classification based on duration:

• Acute: lasting less than 3 months
• Chronic: lasting for more than 3 months

severity of tinnitus

• Grade 1: The tinnitus is well compensated. Despite ringing in the ears, there is no psychological strain.
• Grade 2: The ringing in the ear occurs mainly in silence. In the case of stress or increased strain, the tinnitus is perceived as disturbing.
• Grade 3: The tinnitus leads to a permanent impairment in private and professional life. In addition to the ringing in the ears, there are disturbances in the emotional and physical areas. Tinnitus can cause mental disorders.
• Degree 4: The tinnitus leads to a complete inability to take part in normal life. Tinnitus grade 4 leads to disability.

Depending on the severity, tinnitus can be divided into compensated and decompensated tinnitus . The first 2 degrees of severity constitute a compensated tinnitus. The ringing in the ear can be heard here, but it does not cause any major problems, so that no additional concomitant diseases occur. Quality of life is not significantly affected by grade 1 or grade 2 tinnitus. Decompensated tinnitus, on the other hand, affects all areas of life and leads to the development or worsening of comorbidities. The quality of life is severely impaired.

Causes of tinnitus

Ringing in the ears can have many different causes. The cause of an objective tinnitus can often be precisely described by diagnostic methods, but this is not possible in many cases with a subjective tinnitus. Since tinnitus is often associated with hearing loss, it is now assumed that, similar to phantom pain, reduced stimuli to auditory areas of the brain lead to excessive reactivity via feedback mechanisms. Over time, the perception of ear noises becomes increasingly decoupled from the inner ear, so that tinnitus perception is possible even after complete deafness. Unfortunately, this process has not yet been sufficiently researched to be able to determine a definitive cause for the development of tinnitus.

Causes of hearing loss are:

• Hearing loss in old age: Age -related hearing loss usually occurs from the age of 60 and progressively worsens.
• Exposure to Noise: Loud music, concerts, guns, and devices such as chainsaws can cause permanent damage to the inner ear over both short- and long-term exposure. Tinnitus often resolves after brief exposure to noise, but hearing loss may persist.
• Earwax: Earwax protects the ear, but if there is too much wax and it is squeezed by a cotton swab, it can block the ear canal. Due to the blockage, sound waves cannot reach the eardrum unhindered and the eardrum can be irritated by the earwax plug, which can lead to tinnitus.
• Sudden hearing loss with acute hearing loss on one side and tinnitus as a possible sign
• stiffening of the auditory ossicles

Other possible causes for the development of tinnitus are temporomandibular joint problems, head or neck trauma, ventilation disorders of the ear or Meniere’s disease, a disease of the inner ear. In rare cases, drugs or brain tumors can cause ringing in the ears.

Possible comorbidities of tinnitus

Conditions associated with tinnitus can be divided into two categories: conditions that precede the ringing in the ears or others that are caused by the tinnitus. Hearing loss and hyperacusis (sensitivity to noise) are very common comorbidities of tinnitus. In addition, communication disorders can occur, which are often caused by hearing impairment. The more pronounced the ringing in the ears, the more likely it is that a concomitant disease will occur.

Other possible comorbidities include:

• Psychiatric or psychosomatic comorbidities: Tinnitus can trigger or worsen illnesses such as depression or anxiety disorders, but tinnitus can also impair concentration. Social withdrawal and avoidance behaviors may occur to minimize ringing in the ears.
• Physical comorbidities: Tinnitus can cause insomnia, back and neck tension, earache, headaches, dizziness and teeth grinding.

Risk factors for developing tinnitus

Although the exact cause of tinnitus is not yet fully understood, there are some factors that increase the risk of developing tinnitus. These include:
– Obesity

• Smoking
• Alcohol
• arthrosis
• high blood pressure

While hearing loss is a major risk factor for tinnitus, it’s important to note that not all people with hearing loss or hearing loss experience tinnitus. Anxiety disorders, depression and other mental illnesses can not only be triggered by tinnitus, they are also a risk factor for the development of ringing in the ears.

diagnosis of tinnitus

Since the possible causes of tinnitus are very diverse, they must be determined and ruled out individually. The basis for the diagnosis of tinnitus is the detailed patient discussion . It enables the degree of severity to be assessed and the further diagnostics useful in individual cases to be initiated. In addition, concomitant diseases can be recorded in the patient consultation. Further diagnostics can include:

• tone threshold audiogram
• Neurological examination
• Determination of tinnitus loudness and frequency characteristics
• Examination of the organs of hearing and balance

When should I go to the doctor?

You should see a doctor as soon as possible if tinnitus has come on suddenly with no apparent cause, or is accompanied by hearing loss and/or dizziness. If you develop ringing in your ears after an upper respiratory infection, such as a cold, and the tinnitus lasts for more than a week, you should see a doctor. If ringing in the ears without accompanying symptoms restricts you in everyday life, a visit to the doctor can be helpful to discuss how to deal with ringing in the ears in everyday life.

What can you do yourself against tinnitus?

Once tinnitus has developed, it can be very difficult to get rid of it. It is therefore important to prevent hearing loss by protecting your ears, as this is a major risk factor for developing tinnitus. Loud noises can damage your hearing over short and long periods of time. If you use circular saws, are a musician, or have a high level of noise exposure at work, it is therefore important to ensure that you have appropriate hearing protection. You should also avoid listening to loud music through headphones, as this is also harmful to your hearing.
By getting enough exercise and eating a healthy diet, you can keep your blood vessels healthy to minimize the risk of vascular tinnitus.

Tinnitus therapy

The treatment of tinnitus is based on the severity and the associated diseases. The basis of the therapy is tinnitus counseling. In tinnitus counseling you will receive advice on how to deal with ringing in the ears. The reinforcing factors and the personal processing of the tinnitus are worked out in order to enable an individual therapy. Furthermore, psychological or psychotherapeutic help can be called in to treat concomitant illnesses such as depression or sleep disorders.

For chronic tinnitus , the focus of therapy is to develop techniques to desensitize the brain or completely adjust to the tinnitus to bypass the ringing in the ears. Many patients also help self-help groups to talk to other sufferers about everyday life and how to deal with tinnitus.

Here’s how Med-Healths can help

Via Med-Healths you can talk about your symptoms in an individual conversation with a doctor. If you suffer from tinnitus, the doctor can narrow down the possible causes in order to recommend further therapy that is as adapted as possible. Through Med-Healths, he/she can issue you direct referrals to specialists who focus on tinnitus.