Key Points About Treating Tinnitus:

• 1. Depression can play a role for some and antidepressants can help, but they can have serious side effects.
• 2. Sleep Deprivation may be a factor so sedatives may help. Primarily used for a sleep aid, but they will make you tired, and you shouldn’t take them for long.
• 3. You can try to cover up the noise. This is done with machines called masking devices or as part of tinnitus retraining therapy.
• 4. Some people feel better if they listen to music or other sounds they enjoy however this can be a distraction.
• 5. Hearing aids can make your hearing better, though they won’t help your tinnitus. But if you can hear better, the tinnitus might annoy you less.
• 6. There are alternative holistic remedies that can help a great deal with Tinnitus. Learn More Here:

Prevention

The phrase “prevention is the best medicine” could have been coined specifically for tinnitus. That is because tinnitus can be difficult to treat. It is better to avoid tinnitus than to correct it. The best way to prevent tinnitus are to avoid those things that assault the ears namely prolonged exposure to loud noise, short exposures to extremely loud noise, and drugs that can hurt the ears. Maintaining good health, in general, helps prevent tinnitus. Regular checkups can catch hormonal and metabolic problems in the early stages before they result in tinnitus.

Medical (pharmacological) tinnitus treatments

When poor physical health is to blame for tinnitus, correct the underlying medical issue(s) are sometimes all it takes to get rid of the ringing in the ears. Balancing thyroid hormone, correcting anemia, and controlling cholesterol might be all that is required to reverse tinnitus. Perhaps a good earwax removal is all that is needed. A full medical checkup is a good place to start because a great number of potential causes will be checked and addressed if needed.

While it is not clear exactly why they work, certain antidepressant medications can correct or reduce tinnitus. While some have argued that tinnitus and depression are linked, it is not so simple to think that depression alone leads to tinnitus. Sure having tinnitus can be depressing, but only certain types of antidepressants work on tinnitus, specifically tricyclic antidepressants. If depression was the sole cause, one would expect that better depression medicines like selective serotonin reuptake inhibitors (SSRIs) would also be the better tinnitus medicines. The area is certainly murky, scientifically, but antidepressant medications may be a tool to treat tinnitus in certain patients.

Benzodiazepines (most famously, Valium and Ativan) have been tried in tinnitus with mixed results. These medicines quiet electrical activity in the brain and can be helpful in quieting some of the signals that cause tinnitus. Unfortunately benzodiazepines cause drowsiness and slow thinking at higher doses. Also, this class of drugs can be habit-forming, which is why they are used with caution and weighed against their usefulness.
Surgical tinnitus treatments

While it may sound extreme, surgery has a place in tinnitus treatment for some people. If there is a physical problem that is causing tinnitus and it can be reached and corrected surgically, surgery becomes the treatment of choice. Take for example, the case of acoustic neuroma. An acoustic neuroma is a benign growth around the nerve that carries electrical signals from the inner ear to the brain. This growth can have a negative impact on hearing as well as create unusual sounds. A neurosurgeon may be able to remove the benign tumor and correct the problem. Similar tissue growths at various places in and around the ear can cause tinnitus and can be cured surgically.

Tissue growth is not the only surgically correctable cause of tinnitus. Derangements of the blood vessels could also be a surgical target. Sometimes these arteriovenous malformations, as they are called, are present at birth but more often they develop later in life. Traditionally these blood vessel abnormalities would be directly cut out by a surgeon. Newer strategies for treating abnormal blood vessels include burning them or injecting them with sclerosing agents which causes the vessel to shrink and to die. If the blood vessel that is causing the problem is an important one (like the jugular vein) destroying it is not a viable option. In this case other treatment options should be considered.

When tinnitus is a symptom on Meniere’s disease, surgical therapy might be able to correct the dizziness and ear fullness while at the same time eradicating tinnitus. In Meniere’s disease there is an excess of endolymph (fluid) in the vestibular system (the inner ear organ that helps us walk upright and maintain balance). Surgeons can place a tube (shunt) in the vestibular system to drain excess fluid. More aggressively, they can cut away part of the vestibular system itself. Meniere’s surgery is not 100% effective at treating the primary disease or tinnitus, but it may be an option for some people.

Stimulation and suppression

While they have not yet been perfected, there are various types of electrical and mechanical devices that have been used to treat tinnitus. Since once of the root causes (or pathways, really) of tinnitus is abnormal electrical activity in the nerves going from the cochlea to the auditory cortex, scientists and doctors have tried to use electrical stimulation to override those signals. In fact, the earliest reports of electrical stimulation of the ears for the treatment of tinnitus date back over a hundred years. While directly stimulating the auditory system has been reported to help 4 out of 5 patients, the tinnitus returns soon after the stimulation has stopped. It is not practical to use current methods of stimulation constantly—there would be no time for living life. However, one area of research is in people with cochlear implants. While these devices are primarily used to give the sense of hearing to the deaf, they do so by directly stimulating the cochlea. While it would be considered a rather bold clinical move, cochlear implants may be used to treat tinnitus in the future.

A longer lasting form of stimulation therapy is transcranial magnetic stimulation. Instead of stimulating the cochlea, a device is applied to the outside of the skull and stimulates brain tissue using strong magnetic oscillations. The technology has been used to improve drug delivery and reduce auditory hallucinations, but may also be effective in treating tinnitus. Early research indicates that transcranial magnetic stimulation may reduce the symptom of tinnitus for up to six months at a time.

Sound-producing devices have been one of the main treatments of tinnitus for decades. These tinnitus treatments include hearing aids, masking devices, and tinnitus feedback retraining. Since hearing and tinnitus are intimately related, it makes sense that treating deafness also helps treat tinnitus. Improving hearing with a hearing aid does not always correct tinnitus, but it can be quite helpful to a number of patients with both hearing loss and tinnitus (about half).

A tinnitus masking device is quite similar to a hearing aid in form but not necessarily in function. While a hearing aid amplifies sounds that enter the ear, a tinnitus masking device creates noise of its own.

Psychological treatment and support

Biofeedback is a process in which a patient is trained to identify a bodily process or symptom that is not routinely considered to be under their control and attempt to control it. Heart rate is a good example. Patients are taught by a psychologist or other clinician skilled in biofeedback therapy to think about the rate of their heart, focus on it, isolate it in the mind, and attempt to change its rate. Since heart rate is easily measured by monitoring the pulse, the patient’s efforts are immediately recognized, which fuels an even further reduction in heart rate.

When biofeedback is used to treat tinnitus, it is a little less clearly defined. The sound is most likely only audible to the patient, so there is no objective means of quantifying the patient’s success. Nevertheless, by isolating and exerting mental control over the sound, many patients have learned to control the symptom. Four out of five people notice an improvement of symptoms and one in five reports a complete resolution of the tinnitus.

Psychological treatment may be useful apart from its role in biofeedback. In these cases, the mental health professional provides the patient with a way to cope with the troubling sound and methods to manage situations where tinnitus interferes with life. There is also great power in the reassurance that comes from knowing that tinnitus is not a symptom of a deadly or otherwise severe disease. Reassurance can also come from group therapy and group support. The premier tinnitus support organization in the United States is the American Tinnitus Association. The ATA is involved in support, advocacy, research, and in the organization of treatment resources.

Alternative tinnitus therapy

Because medical, psychological, and surgical therapy does not help every patient, some of the treatments prescribed by the medical establishment are associated with their own side effects and complications, and because people with illnesses that are not life threatening like to treat themselves, alternative tinnitus therapy thrives.

Tinnitus sufferers turn to homeopathy more than most other illnesses. While practitioners of homeopathy are often at odds with practitioners of traditional Western medicine, it is curious to note that some of the treatments overlap. For example, zinc deficiency is one of the many causes of tinnitus. If your doctor finds you to have zinc deficiency or even if zinc deficiency is suspected, you would likely be given zinc supplements as treatment. While the philosophy behind the treatment is completely different, Zincum Metallicum is one of the homeopathic treatments used for tinnitus. If you choose to use homeopathic remedies for tinnitus, it is important to seek the services of a professional since many of the treatments (at high concentrations) are harmful and even deadly. In other words, use with caution and under the direction of a professional.

Acupuncture has been used with success in patients with tinnitus. Acupuncture is the system of Traditional Chinese Medicine in which practitioners improve the flow of Qi (pronounced chi) along channels or meridians in the body. Needles are used in various acupuncture points most famously, but there are a number of ways that acupuncturists go about treatment. Anecdotal evidence supports the use of acupuncture in the treatment of tinnitus. In other words, it has been very helpful for some and reported in the scientific literature as helpful to small groups of patients. When large studies were performed to examine the effective of acupuncture on tinnitus, acupuncture treatment was no better than a sham procedure (placebo). However, the placebo effect should not be dismissed; those that achieved a benefit from acupuncture—even a placebo effect—still got relief from their symptoms.

A number of herbal and “natural” preparations are available that have been used to treat tinnitus. The most commonly used agents are Ginkgo biloba, niacin, and high-dose antioxidants. The way that these drugs work is not known (assuming that they do, in fact, work). Ginkgo biloba may help tinnitus sufferers by increasing blood flow in the brain and near the ears. In addition to being a vitamin, high dose niacin is a cholesterol medicine and may reduce the contribution of high cholesterol on the symptom of tinnitus.

Also, high-dose antioxidants are believed to protect against age-related tissue destruction, in this case, the breakdown of hair cells and related auditory system structures.

Finally, hypnosis has been helpful for some in the treatment of tinnitus. Just like other alternative therapies (and many traditional medical therapies) it is not always clear which treatments work in which patients. While some self-hypnosis programs are available, if this is your first exposure to hypnosis you are better off having a professional show you how to perform the steps necessary to do it properly.

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Homeopathy for tinnitus

The three basic principles of homeopathy are that 1) any substance can cause particular symptoms or disease in an otherwise healthy person, 2) anyone with a particular disease displays certain characteristic symptoms, and 3) a small amount of the substance that can cause symptoms in a healthy person can reduce symptoms in a person with the corresponding disease. Simply put, it is said that homeopathy is the alternative medical system in which “like treats like.” It is important to note that occasionally the substances that are used for homeopathic treatment can, at high concentrations, be quite dangerous. However in the correct application of homeopathy, the active ingredient is diluted considerably. Often you will see a “c” or “x” beside a particular substance. From the Roman numerals 100 and 10 respectively, these indicate the dilution that is required of the neat (pure) substance (e.g. an “x” is one part active substance diluted in nine parts solvent, such as water).

Cimicifuga 6c may be prescribed by a doctor of homeopathy to combat tinnitus in a person that is particularly sensitive to loud noises. On the other hand, if tinnitus is associated with decreased hearing (as it often is) then Graphites 6c might be tried. Lycopodium 6c is the homeopathic treatment of choice in cases where the tinnitus is roaring/humming and hearing is decreased. This treatments may be taken up to four times a day and reduced when the symptom is improved.
Carbo vegetabilis 6c is a general purpose agent that is used when tinnitus is accompanied by dizziness and vertigo, such as in Meniere’s disease. Essentially Carbo vegetabilis is used in cases where the vestibular system is broadly affected. Natrum salicylicum 30c is also a Meniere’s disease treatment and when tinnitus is a low, dull hum.

For more specific cases of tinnitus, more specific therapies are used. When the symptom can be isolated to dosing/overdosing of quinine, Chininum sulfuricum 30c is the most direct homeopathic treatment. When aspirin is believed to be the cause of the tinnitus, Salicylicum acidum 30c (essentially aspirin itself) is used. While it can be taken up to three times a day it should only be used for three consecutive days before trying another treatment. Likewise, when zinc is believed to be related to the phantom noise, Zincum metallicum 30c is used.

Herbal remedies for tinnitus

The most well-known and perhaps the most commonly used herbal remedy for tinnitus is ginkgo biloba. Ginkgo biloba is ancient and has been used for various medicinal purposes for centuries. The extract that is obtained from the tree is not a single ingredient but rather a collection of various substances. These substances include bioflavinoids and terpene lactones; substances that behave as antioxidants but may have other biological effects. Ginkgo biloba has been used most successfully (though with limited success) in issues related to memory loss and dementia. For tinnitus, most believe the herbal remedy to be most effective in cases that arise from increased levels of blood cholesterol.
Niacin (also known as Vitamin B3 or nicotinic acid) has had some success treating tinnitus according to informal accounts. When you look across anecdotal reports, niacin reduces the severity of tinnitus symptoms in one out of every two patients. While this percentage is quite high, when the vitamin is tested in large clinical studies, it does not seem to be more effective than placebo. Curiously, high dose niacin is also a traditional medical treatment for certain cholesterol problems.

Feverfew is an herbal medicine that has been use to treat a variety of conditions, including tinnitus. In its native form, feverfew is a short bush with daisy-like flowers. The leaves are either eaten fresh or dried leaves/flowers/stems are used in capsules or in liquid extracts. There are very few scientific studies that have looked at feverfew in the treatment of tinnitus, but it is an herb with very few side effects.

Bojungikgitang and banhabaekchulchonmatang are herbals used in Traditional Korean Medicine to treat tinnitus. While much about the mechanism of action and use of these herbs are not known to Western medicine (or cultures), they have been approved by the Korean Food and Drug Administration for use in adults. In fact, at least one study shows that the herbs are safe and effective for tinnitus.

Acupuncture

Some studies have shown acupuncture to be successful in treating tinnitus. While most people know of acupuncture as the treatment involving needles, it is actually a major medical system within Traditional Chinese Medicine involving various interventions. Practitioners seek to balance the flow of Qi (pronounced chi) along meridians in the body. A licensed acupuncturist may apply techniques of acupuncture in the treatment of tinnitus including auricular acupuncture. Auricular acupuncture is microsystem of acupuncture that focuses on the meridians and Qi roughly around the ears. It may be of particular use in tinnitus.

Hypnosis

Hypnosis has been maligned by popular representations in television and in movies but for select indications, it is a very useful tool. While most people think that being “under hypnosis” is like being put to sleep, it is actually a state of focused concentration. In this state one’s body is very relaxed but the brain is alert to various facets of the mind. With the help of a skilled hypnotherapist it may be possible to minimize or eliminate the perception of tinnitus in the ear.

Hypnosis for tinnitus treatment is actually a fairly sophisticated application of the technique. While self-hypnosis programs are available to treat various maladies, the entire endeavor is much more likely to succeed if guided by a professional. Moreover, the professional should have experience in treating tinnitus, specifically.

Relaxation, massage, and aromatherapy

One component of tinnitus that many sufferers will attest to is that it interferes with sleep. This is one of the more maddening features of the symptom. Relaxation, massage, and aromatherapy can be used alone or in combination to ease tinnitus, particularly by restoring normal sleep patterns. These techniques are first learned and applied in a controlled environment so that the patient can learn to compartmentalize the tinnitus sound and push it away from prominence. In other words, relaxation techniques are used to reduce the sound and increase focus on other internal processes and external senses. Once trained, the patient can then apply these techniques (relaxation and aromatherapy) to the home and in everyday use.

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Know the cause

Patients are much more likely to cure tinnitus if they know their specific cause. This usually poses a clinical challenge for physicians for two reasons. First there are a huge number of causes of tinnitus, each with a possible role to play in your disease. Second, the search for the cause or causes can take a long time and a lot of energy. Nevertheless, if you can narrow the search down to at least a few possible or probable causes, it can be used to guide treatment.

Objective versus subjective tinnitus

One diagnostic distinction is between objective tinnitus and subjective tinnitus. In objective tinnitus, that is, tinnitus that is caused by a physical, sound-wave-making source, the problem may be treatable with surgery or related non-surgical procedure. For example, if the source of objective tinnitus is an aberrant blood vessel, it could be clipped or cut away thus curing tinnitus in that case. Likewise, a case of subjective tinnitus could be tracked back to a certain medication that is ototoxic (harmful to the organs responsible for hearing). If this cause is isolated, stopping the offending drug may be a tinnitus cure.

Important issues that inform a tinnitus cure

Does the tinnitus occur on both sides or can you localize it to one ear? If the problem is in both ears, the cause is probably metabolic or related to a drug that you are taking/did take. The tinnitus cure in this case is to correct the metabolic or hormonal abnormality—the tinnitus usually resolves when the medical problem is corrected. For instance, if a patient is suffering from a vitamin B12 deficiency, restoring the vitamin can correct or cure the resulting tinnitus. A problem in one ear usually means different things, such as wax buildup in one ear canal or one cochlea is affected by Meniere’s disease.

Is there hearing loss, no change in hearing, or even hyperacusis (overly sensitive to sound)? Again, no hearing loss suggests a metabolic cause; however hearing loss could mean the cause of tinnitus is something like otosclerosis (abnormal growth of middle ear bones). In each of these cases, the tinnitus cure is different. In the case of otosclerosis, for example, the cure for tinnitus would be surgery on the stapes, either laser resurfacing or replacement of the entire bone.

Go to the experts

While they are great in their field, general practitioners and internists are usually not the best source for help with tinnitus. If you are having a significant problem and are sincerely interested in a tinnitus cure, you will likely want to visit one or more specialists. An audiologist can perform tests that may provide an accurate tinnitus diagnosis, but also help distinguish between various causes and help direct treatment. If you would like to start your search for a tinnitus cure with an M.D., your best bet is to visit a otolaryngologist (ENT; Ear, Nose, and Throat Specialist). Some ENTs specialize in tinnitus and diseases related to hearing and balance. What is rather unique about ENTs is that they are somewhat like a hybrid physician/surgeon. They practice clinical medicine in about the same amount as they perform surgery.

Suppression, masking, and retraining

If a specific cause is elusive, which it most often is, there are general tinnitus treatments that may offer a cure. A number of devices that provide some form of white noise to cover up, suppress, or force the brain to ignore the tinnitus sound. Given the number of variations in devices and approaches, it may take a few attempts or trials in order to find your tinnitus cure. Finding a specialist with an excellent track record with these devices can limit the amount of time and money that you devote to your search. Stick with it, however, because one of these masking or retraining devices might be the thing that does the trick for you.

Biofeedback

While it is not 100 % effective, biofeedback does help about 80 % of those that seriously try it, making it very close to a tinnitus cure. In biofeedback, patients are taught how to isolate the phantom sound and “will” themselves to reduce its intensity. While it may sound fantastic or unbelievable, biofeedback is an extremely effective tool for controlling physiological processes generally thought to be uncontrollable. The process generally requires expert training in order to be effective.

Drugs may not be the cure

Few drugs are actually helpful in the treatment of tinnitus. Certain drugs do work very well in certain people (making it a tinnitus cure for them, apparently) but it is virtually impossible to match the effective drug with the particular person from the beginning. If tinnitus occurs with depression, antidepressants are a little more effective than they would be in people who are not depressed (though not 100 % effective). Likewise, patients with anxiety disorder and tinnitus may find relief from anti-anxiety drugs. The herbal remedy ginkgo biloba is about as effective as other tinnitus medicines available, but none can really be called an absolute tinnitus cure.

The only foolproof tinnitus cure

There is one way to ensure patients do not have tinnitus—one surefire tinnitus cure. The cure is prevention. Great pains should be made to prevent tinnitus from developing in the first place. This means avoiding loud noises, either sustained or in sharp bursts. Avoiding tinnitus means keeping the body healthy and limiting drugs that can destroy the organs of hearing. Preventing tinnitus means staying quite vigilant and on top of treatments for diseases that can indirectly cause tinnitus, like multiple sclerosis and fibromyalgia. When these diseases are well-controlled, tinnitus can usually be avoided. Because finding the cause is daunting and the treatments are rather hot or miss, the only true tinnitus cure that works every time is to avoid the condition altogether. Avoiding tinnitus begins by learning about it and taking the precautions necessary to stay healthy.

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Habituation is integral to sensation

If habituation did not take place, things that we hear, feel, see, taste, and smell would slowly drive us crazy. While most of us think about habituation as ignoring something (which it is) the process actually takes place in the nerve cells of the brain. It is not that we stop sensing things all together; it is that the brain selects which stimuli to recognize and which to ignore. If habituation did not occur, we could not sense anything at all because every stimulus would be recognized simultaneously and be drowned amongst the others. Threatening stimuli, on the other hand, do not become habituated. For the most part, any non-threatening stimulus that is constant and/or repetitive will be ignored in time. While tinnitus fits this same definition, tinnitus is often difficult to ignore. The basis of Tinnitus Retraining Therapy is to train the auditory (hearing) system to become habituated to the tinnitus sound.

Sound therapy

Imagine if a person suffering from tinnitus had a machine that produced a sound that was very similar to the tone, pitch, and frequency of the phantom sound. If the tinnitus sufferer could listen to the sound produced by that machine, constantly, in a short while one would expect the sound to be ignored by the brain. Ideally, since the sounds are presumably processed by the same hair cells and neurons (nerve cells) the tinnitus would go away as well.

Since it is very difficult to match an individual’s tinnitus sound exactly, Tinnitus Retraining Therapy takes a slightly different approach. In general, the sound therapy component of Tinnitus Retraining Therapy employs a white noise generator. White noise has no decipherable pattern. Because the brain cannot attach significance to the white noise the tinnitus sound is lost in it, so to speak. However, unlike tinnitus itself, it is quite easy for patients to become habituated to white noise. Therefore, in theory, the tinnitus is “ignored” along with the white noise.

These sound generators can resemble hearing aids or even be combined with hearing aids. They can both provide white noise as well as amplify certain frequencies of sound. Tinnitus Retraining Therapy sound generators can resemble earphones or a stereo with speakers. The decision of which device to use depends on the patient’s regard for privacy and cost—it is not clear if one mode of sound generation is better than another. People that have increased sensitivity to sound (hyperacusis) may prefer to have a bedside device rather than a device that goes in or over the ears. The key point is that the white noise is loud enough to be audible but so loud that it causes pain or discomfort.
Directive counseling and psychotherapy

Most practitioners of Tinnitus Retraining Therapy would insist that directive counseling is an essential component of the therapeutic process. In directive therapy, the patient is taught about the how the ear hears, how sound waves are converted to mechanical and then electrical energy, and how tinnitus and deafness are often related. Through teaching, the patient develops a mastery of the symptom of tinnitus.

Recall that we are habituated to non-threatening stimuli but not threatening stimuli. Thus the strategy in directive counseling is to instruct the patient not to fear or feel threatened by the tinnitus. While this may be easy to do on a rational level, it often takes directive counseling to thoroughly pacify the mind when thinking about the tinnitus.

One hurdle to directive counseling is that tinnitus gets more pronounced the more that one thinks about it, but how does one learn about tinnitus without thinking about it? Thus some therapists have included refocusing therapy into Tinnitus Retraining Therapy. Refocusing therapy can be described roughly as taking your mind off of tinnitus. Patients are encouraged to think about enjoyable things instead of tinnitus. This is easier said than done, which is why professional therapy is usually necessary.

Some patients find that stress exacerbates the symptom of tinnitus. Therefore some therapists also add relaxation therapy to the program. This approach not only reduces general stress and stress arising from the tinnitus itself, but also improves sleep and the ability to fall asleep.

Duration of Tinnitus Retraining Therapy

Tinnitus Retraining Therapy is not always easy. The process is very involved and takes a long time to achieve maximum effect. Most patients require treatment for one to two years. Most patients enjoy relief after one year but often require an addition six months to a year to solidify the habituation and make it permanent in the brain. What is more, the white noise generator is usually used for six hours each day, which many patients find cumbersome. However if tinnitus is severe, most patients will stick to the Tinnitus Retraining Therapy because it promises to relieve the symptom permanently.

The importance of comprehensive, professional therapy

If you are considering dedicating two years to an involved treatment regimen, it is important to find a provider that has a strong, proven track record in Tinnitus Retraining Therapy. Otolaryngology and audiology clinics are a good place to start. The American Tinnitus Association may also have resources of experts in Tinnitus Retraining Therapy in your area.

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If a tree fell in the woods…

If a tree fell in the woods and no one was there to hear it, would it make a sound? This ancient, perplexing question actually has a straightforward answer: no. Sounds are only sounds because of the biological structures that process them. Until a “sound” reaches the ear it is only a pressure wave or disturbance. The wave strikes the eardrum, which moves three small bones in the middle ear, which in turn move fluid within the cochlea. Depending on the frequency of the pressure wave, hair cells within the cochlea are disturbed emitting electrical signals to the brain. The brain processes these electrical signals as sounds. The brain assigns them a quality and a meaning. Without a functioning auditory system, there would be no sound, only pressure waves.

When hearing is lost

Why the philosophical and scientific discussion? It helps to frame a discussion of hearing loss. As alluded to above, the auditory system is complex. As a complex system, there are a number of ways in which it can go awry. When the auditory system does go awry, it can lead to decreased hearing or deafness (It can also cause tinnitus, as we will see). Something as simple and treatable as impacted earwax in an ear canal can cause deafness. A punctured (perforated) eardrum prevents pressure waves from being converted to mechanical energy. Abnormal bone growth or infection can keep the tiny bones in the middle ear from moving smoothly. If they cannot move, the bones cannot transmit the movements of the eardrum. Loud noises and certain drugs can damage and destroy the cochlea, more specifically the hair cells contained within. A number of neurological problems can disrupt the nerves involved in hearing—all leading to some degree of deafness.

The brain needs input

The brain works best when it gets constant input. When one has lost hearing, the input from the nerves that carry information about sound are no longer providing the brain with as much input as it would like. When the brain is deprived of electrical input from nerves, like auditory nerves, strange things happen.

To help illustrate the point, consider someone that has suffered the loss of an arm. When the nerves to the arm are severed, the nerves wither and die, all the way up to the brain. Obviously these nerves no longer provide input to the brain about heat, pain, or touch. Some amputees suffer a curious disorder called phantom limb syndrome in which the person feels pain, burning, or other sensations in the lost limb. This is not a pain in the stump that remains—this is pain in the portion of the limb that is no longer there.

Hearing loss and tinnitus

While it is not a perfect analogy, tinnitus that is associated with hearing loss is roughly similar to phantom limb syndrome in a lost limb. When the input from the cochlea to the brain is diminished, tinnitus may be caused by abnormal electrical activity that is generated in its place. The abnormal electrical activity in tinnitus and hearing loss is thought to be twofold. One, nerves coming from the cochlea are actually hyperactive, though not necessarily corresponding to sound input coming from the world. Instead of “hearing” distinct sounds, these nerves create the sensation of strange sounds like ringing, humming, or buzzing. Two, the area of the brain that is responsible for hearing, the auditory cortex, gets bigger (in a manner of speaking). More cortex devoted to lost nerves makes for some strange noises (consistent with tinnitus).

Hyperacusis

These neurological changes actually create a paradox, of sorts. A large portion of patients suffering from tinnitus also suffer because of hyperacusis. Hyperacusis is a condition in which sounds over a certain frequency are overly loud and even painful.When you consider the changes that occur in hearing loss and tinnitus, it is not difficult to imagine how hyperacusis is related as well. If hearing loss leads to aberrant neuronal input to the brain, even soft sounds are sent the auditory cortex in a massive assault, which the brain registers as a loud (or painfully loud) sound.

Tinnitus Retraining Therapy

The solution to hearing loss, hyperacusis, and tinnitus might rest in Tinnitus Retraining Therapy and related treatments. Tinnitus Retraining Therapy seeks to retrain the auditory system to process sounds normally and undo the abnormal connections in the brain. Some Tinnitus Retraining Therapy devices use a hearing aid along with a noise generator to help improve a patient’s ability to hear but also to minimize tinnitus. The white noise generated in Tinnitus Retraining Therapy tends to cause the brain to “habituate” or get used to the tinnitus sound. When hyperacusis is one of the symptoms, the noise therapy is sometimes hindered by the volume that can be used. However if an audible, but not painful sound can be used to retrain the auditory system, it can correct both tinnitus and hyperacusis.

Cochlear implants

Taking the idea of stimulation one step further is research into cochlear implants. Cochlear implants are devices that convert sound waves entering the ear into electrical impulses that are sent to the brain. Cochlear implants have been pioneered for use in patients with congenital or acquired deafness, but the principle of how they work seems to lend itself to the treatment of tinnitus as well.

One treatment that has been tried for decades is electrical stimulation of the ear. By providing electrical stimulation of the cochlea, the auditory cortex is almost directly stimulated. This gives the brain the input it craves, but could also overwhelm the neuronal pathways that underlie the tinnitus sound. Both are helpful.

As it stands right now, a cochlear implant is not a primary treatment for tinnitus. The devices are quite expensive and are not indicated as sole treatment of tinnitus. However, in patients that are candidates for cochlear implants because of hearing loss and also have tinnitus, the implanted devices may provide a cure for both conditions.

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Characteristics

The way in which patients with tinnitus experience the unusual sound in their ears differs greatly from person to person. Commonly people will describe the sound as a ringing, so much so that tinnitus is used interchangeably with the phrase “ringing in the ears.” However, the medical symptom can sound just like any nondescript sound: buzzing, whirring, whistling, whooshing, pulsing, or clicking. It can be low pitched, high pitched, or anywhere in between. It can be soft, like ambient background noise or so loud that it becomes difficult to hear actual sounds. The sound that occurs in tinnitus is never a voice or words (which would mean the issue is a hallucination). Finally tinnitus may occur infrequently or be present constantly.

Causes of tinnitus

As mentioned, tinnitus is a symptom, not a distinct medical condition. When people experience this strange sound in the ear(s), it means that there is some other medical issue occurring. There are many different disease and disorders that can cause tinnitus; fortunately none of them are overly severe or imminently life threatening.
Unlike most diseases which stay within a single bodily system, tinnitus can be caused by a problem in one of many different systems. The root cause of tinnitus can be metabolic, neurologic (involving the nervous system, vascular (involving the blood vessels), otologic (involving the ear and hearing system). It can be caused by something as simple as a buildup of earwax to something as complex as fibromyalgia. Certain forms of hearing loss are associated with tinnitus. Also, a number of drugs have been identified as potential causes of the symptom.

Tinnitus and hearing

Most cases of tinnitus occur in some part of the auditory system. The auditory system includes the ear canal, eardrum, the bones that connect the eardrum to the cochlea, and the nerves that connect the cochlea with the brain (and the auditory cortex). Without drowning in anatomy, it is useful to be aware of each of these structures since it helps frame some of the many causes of tinnitus. The ear canal is home to cerumen (earwax). Too much earwax can lead to strange sounds in the ears and is a common cause of tinnitus. The eardrums and ear bones are next to a variety of blood vessels and other structures that can become inflamed or otherwise abnormal. This too causes phantom noise in the ears. The cochlea is the organ that converts sound waves to nervous tissue impulses so that the brain can detect sound. Along with the vestibular system, these delicate, fantastic structures allow us to hear and maintain balance. However if they do not function properly, several problems can occur.

Hearing loss often goes hand in hand with tinnitus, particularly sensorineural hearing loss. The two main causes of sensorineural hearing loss—namely noise-induced hearing loss and presbyacusis (the loss of hearing that occurs as we age)—are both associated with tinnitus. In sensorineural hearing loss there is some abnormality of the cochlea that leads to decreased hearing, but also to the generation of sounds that are not really there. Not only is the hearing decreased but it is also dysfunctional.

Meniere’s disease is a disease of the vestibular system (the system that helps us maintain balance). Severe cases of Meniere’s disease cause dizziness, nausea, vomiting, a feeling of fullness in the ears and, not surprisingly, tinnitus.

In Meniere’s disease, the ringing can vary to a constant low intensity hum to a sound of deafening proportions during a bout of intense dizziness.The final part of the auditory system, originating at sound wave to brain, is the eighth cranial nerve. It carries electric signals starting in the cochlea to the brain itself. In some people this nerve gets encased and impinged by a benign growth called an acoustic neuroma. This rare growth can interfere with the normal electric signals making the brain perceive noise that is not there. When these growths do occur, they almost always occur on one side of the head, thus tinnitus is only heard on one side as well.

Drugs that cause tinnitus

Several drugs are known to be ototoxic (literally translated as “ear killing”) which means they can cause partial or total deafness. While this is infrequent, especially when the medications are used judiciously, the deafness can be accompanied by tinnitus. In other cases, tinnitus is the only symptom of ototoxic drugs.

Fortunately, some drugs can cause ototoxicity at or near the same dose that is required for a clinical affect. For example, chemotherapeutic agents that are meant to kill cancer cells may also kill the cells in the cochlea as a side effect. More commonly used drugs, like aspirin, are toxic to the cochlea at very high doses. In general, though, more routinely used medications rarely, if ever cause ototoxicity at standard therapeutic doses. Regardless, some people should be particularly careful with ototoxic medicines including the very young and the very old, people with liver and/or kidney disease, women who are pregnant, and loss that are already showing signs of sensorineural hearing loss.

Other causes

Tinnitus may occur in a variety of neurological diseases. In fact, about 1 in 15 cases of tinnitus have a neurological cause. Multiple sclerosis is a common culprit but so are acquired causes such as skull fracture, closed head injury, and whiplash. Temporomandibular joint disorder (TMJ) can lead to both dizziness and tinnitus. Blood vessels that travel near the eardrum may actually cause a whooshing sound as blood flows through them. While the sound is soft and subtle, it can be heard as tinnitus because it is so close to the eardrum.

Metabolic causes of tinnitus include anemia, hyperlipidemia, thyroid disorder, and vitamin deficiency. Anemia is the condition in which there too few red blood cells circulating in the blood. Hyperlipidemia, better known as high cholesterol, has been linked to tinnitus, but how it causes this symptom is unknown. Either too much or too little thyroid hormone can lead to ringing in the ears. Vitamin B12 and zinc deficiency can cause the symptom as well. People with fibromyalgia sometimes experience tinnitus as one of the many symptoms of that illness.

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Tinnitus and hearing loss

One of the more common causes of tinnitus is hearing loss, specifically sensorineural hearing loss. Sensorineural hearing loss is a form of deafness caused by a problem in the inner ear, namely the cochlea or the nerves that take electrical signals from the cochlea to the brain. For the most part, however, sensorineural hearing loss is due to a problem in the cochlea. The cochlea is a highly specialized sensory organ, which looks like a spiral conch shell (hence the name). The cochlea is filled with fluid that moves when disturbed by the eardrum and small bones of the middle ear. Sound waves traveling through the fluid of the cochlea move tiny hair cells inside the organ. When a hair cell moves, it sends a signal to the brain that is perceived as sound.

Hair cells are very delicate things. Sure each person is born with thousands of them in each cochlea (one cochlea in each inner ear), but hair cells are easily damaged by the ravages of life and time. Loud noises are particularly hard on hair cells, which is why people that are exposed to loud noise for prolonged periods of time lose the ability to hear later in life. As hair cells are damaged, hearing decreases and the brain is no longer satisfied with the lack of electrical input that results. Instead false neuronal sensations are perceived by the patient as sound.

Since sensorineural hearing loss goes hand in hand with tinnitus, it seems prudent to avoid the causes of both things, namely loud noises. Certain music concerts, motorized transportation, industrial and construction sites, and various other venues can bombard the ears with prolonged, damaging noise. It is important to wear ear protection, such as earplugs or earmuffs, when exposed to these environments. Hearing specialists predict that as young people that have grown up wearing headphones begin to reach middle age that we will see unprecedented levels of sensorineural hearing loss and tinnitus. If you are concerned about hearing, it is important keep the volume of music to a reasonable level.

Preventing medical causes of tinnitus

One of the best ways to prevent tinnitus is to keep your body as healthy as possible. While that is solid advice in general, it helps to prevent the medical causes of tinnitus. Various metabolic and hormonal problems can cause a ringing in the ears, from vitamin B12 deficiency to thyroid problems. While many of these health issues can be avoided by eating right and maintaining good physical health, regular visits to the physician are also important. Take thyroid disorders, for instance. Situations in which thyroid hormone levels in the blood are too high (hyperthyroidism) or too low (hypothyroidism) can manifest as tinnitus. These diseases may manifest in other ways as well, but slowly and in ways that may not be noticeable. Blood tests of thyroid hormone levels are routine but can only be performed by your doctor. High cholesterol and anemia are other examples of conditions that you may not feel but that can cause tinnitus and are usually only detected by history, physical examination, and blood tests.

Avoiding or managing drugs that can cause tinnitus

There are a number of prescription medications that can cause tinnitus. Some of those drugs are ones you might expect to be highly destructive, like medications to treat cancer. Other drugs that cause tinnitus are otherwise considered fairly safe. Some offending drugs can be avoided, but others are so commonly used that they might need to be “managed,” instead.

Chemotherapy, by design, destroys human tissue. Cancer tumors, after all, are collections of human cells that multiply rapidly and out of control. However, by introducing chemotherapy into the body, healthy human cells are also damaged in the process. One type of cell that is particularly sensitive to certain chemotherapeutics is the hair cell in the cochlea of the ear. As cancer-killed drugs course through the body, some of it ends up in the ear and may harm hair cells. This can lead to hearing loss and tinnitus. Not all chemotherapeutics are harmful to the ears; when making clinical decisions, oncologists weigh the side effects of medications against their ability to fight cancer. It is important to discuss these issues with your oncologist, especially if you are particularly prone to hearing problems.

Patients with cancer generally have to make some concessions when receiving treatment for such a difficult disease, but patients expect that antibiotics and pain medicines (especially over the counter pain medicines!) are safe. This is why it is often shocking for people to discover that these commonly used and prescribed drugs can lead to ototoxicity (ear damage) and tinnitus. There are documented cases in which the antibiotics erythromycin, chloramphenicol, tetracycline, and vancomycin have caused tinnitus in patients. Fortunately erythromycin is rarely used anymore, if at all. Chloramphenicol and tetracycline are still used, though sparingly. For these three medicines, the risk of ear problems may be eliminated by simply avoiding them. However, with the rise of antibiotic resistance in bacteria, vancomycin is widely and increasingly used. For vancomycin, avoiding tinnitus comes by keeping the doses to a minimum and spreading out doses as much as possible. These same strategies (low doses, spread out over time) can be applied to other classes of potentially ototoxic drugs.

Millions of patients rely on both NSAIDs and diuretics (loop diuretics) daily basis. People with chronic pain, especially from arthritis, take NSAIDs in fairly high doses just to make it through the day. Loop diuretics are the mainstay of therapy in patients with congestive heart failure and are needed to keep excess fluid from accumulating in the body. In these cases it may not be possible or realistic to avoid these drugs, but it is possible to optimize treatment and keep doses as low as possible. Ask your doctor about alternative treatments for chronic pain. For congestive heart failure, sticking to the prescribed diet and following other medical instructions can keep the daily dose of Lasix fairly low. What is more, properly managing congestive heart failure can reduce exacerbations of the disease and avoid hospitalization. Hospital stays pose true tinnitus risk since very high doses of intravenous loop diuretics are given to reign in the heart failure during hospitalization.

When possible, it is also helpful to only take one ototoxic drug at once—taking multiple offending agents increases the overall risk of tinnitus. You may also request periodic hearing (audiological) testing to catch any problems early. If the tests show hearing loss, the drug or drugs that are causing the ear problems can be stopped or reduced before further damage can occur.

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A brief hearing lesson

To be sure, the great majority of tinnitus cases are considered subjective. Despite a clinician’s best efforts, no sound can be heard emanating from the affected patient. How can this be? Well as you would imagine, the auditory system (hearing system) is quite complex. First, sound waves must be captured and funneled into the ear canal. This is why we have ears at all, really. Next the collected sound waves begin their conversion from pressure waves to mechanical energy by striking the eardrum. The vibrating eardrum moves three tiny bones in the middle ear, the malleus (hammer), incus (anvil), and stapes (stirrup). Incidentally the names are derived from what the bones look like, not what they do in the ear. What these bones do is to transmit the vibrations from the eardrum to the cochlea. The cochlea is tasked with converting mechanical energy into electrical impulses, which can then be interpreted by the brain as sound. The tiny bones of the middle ear move the fluid inside the cochlea, which it turn moves tiny hair cells. When tiny hair cells are moved, impulses are sent by the eighth cranial nerve to the brain.

Subjective tinnitus

If you could take a microscopically small broom and silently brush along someone’s hair cells, the cochlea would tell the brain that the ear was hearing sound. Likewise, it you could take an ultra-small pair of tweezers and wiggle the tiny bones in the middle ear, the brain would again perceive a sound. It is in these places that subjective tinnitus is believed to originate.

Consider the causes of subjective tinnitus; they are not things that actually cause sound. One such cause is hearing loss itself. Patients that suffer from sensorineural hearing loss often also suffer from subjective tinnitus. As the hair cells are providing less and less input to the brain, it is believed that the brain actually overcompensates for this loss of electrical information and stimulates regions of the brain that perceive sound. In essence, while actual sounds become harder to hear, the nerves create a false sound in its place. Unfortunately the result is an even greater deafness, in most cases.

Meniere’s disease is another example of a cause of subjective tinnitus. Excess fluid and pressure in the structures of the inner ear can cause fullness and ringing in the ears. There is nothing about this process that can be heard by an outside observer, but the patient perceives sound nonetheless. Likewise, benign tumors on the cranial nerve connecting the cochlea to the sensory cortex (brain) can pinch the nerve itself. This causes false electrical signals that are perceived as actual sounds (to the patient). Hormonal changes, head trauma, and certain drugs are capable of causing severe are prolonged subjective tinnitus without making a single, objective sound.

Objective tinnitus

Objective tinnitus, on the other hand, is caused by things that can be heard by the examining physician. The causes of objective tinnitus are of course different than subjective tinnitus because the source needs to be physically capable of producing sound waves. The causes of objective tinnitus are primarily those things that cause faint sounds to the observer but potentially loud sounds to the sufferer. These include muscular diseases or vascular (blood vessel) diseases, essentially.

Vascular causes of objective tinnitus

The vascular causes of objective tinnitus are slightly easier to understand. Since blood vessels are carrying blood through them at a relatively high rate of speed, it is not giant leap to imagine a blood vessel near the eardrum whooshing loud enough to make an audible sound. In fact many of us are likely to have experienced a brief bout of tinnitus after strenuous physical exercise or a powerful emotional experience that caused blood pressure to increase. However in cases of prolonged vascular objective tinnitus, the offending blood vessel is usually abnormal in some way. The blood vessel could be distended (swollen) due to long standing high blood pressure. It could have weakened arterial walls as occurs in arteriosclerosis/atherosclerosis. While new blood vessels can occur anywhere in the body, when they grow near the eardrum they can be a cause of objective tinnitus.

One rare and unfortunate reason for the growth of new blood vessels near the ear is to supply blood to a tumor. Tumors, just like any human tissue, need blood in order to survive. Since the arteries that form in and around tumors are abnormal to begin with, when they occur in the ear, head, or neck they are quite capable of creating a noise. This noise is usually constant—as constant as the beating of the heart. A small microphone placed in the patient’s ear would allow the observer to hear the tinnitus-causing sound. Again, this form of tinnitus is rare, but is an illustrative example of objective tinnitus.

Muscular causes of objective tinnitus

Abnormalities in the muscles near the ear can cause objective tinnitus. One example is the case of amyotrophic lateral sclerosis (ALS Lou Gehrig’s disease). In this degenerative disease, the nerves that normally supply muscles die. The muscles that were supplied by those dying dead nerves will then atrophy. A muscle that is undergoing atrophy experiences tiny tremors called fasciculations. If you have fasciculations close to the auditory system, it can be heard as a sound. Other muscular causes of objective tinnitus are things that cause abnormal muscle movement, such as spasms. In fact, a muscle spasm in the stapedius muscle (attached to the small stapes bone in the middle ear) is known to cause objective tinnitus.

Clarifying objective tinnitus and subjective tinnitus

It should be mentioned that in some (even many) cases of objective tinnitus, the physician or other examiner will not be able to actually hear the sound that is being heard by the patient. This does not necessarily change the diagnosis to subjective tinnitus. Rather, the label of objective tinnitus versus subjective tinnitus is generally based on the cause of the abnormal sound, not whether it can be heard by the observer. In other words, if the tinnitus is being caused by something that could theoretically be heard, like blood whooshing through a blood vessel, it could be classified as objective tinnitus. On the other hand, if the cause is something that could not possibly be heard by someone other than the patient, like in Meniere’s disease, then it is classified as subjective tinnitus.

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History

As with any clinical issue, a detailed history is the first step. Your physician will ask you when the tinnitus started, is it in one or both ears, does it occur at one time of the day more than others, what the tinnitus sounds like, and if you notice if anything makes the sound better or worse. Your doctor will also ask about related symptoms. Are you also experiencing vertigo, dizziness, nausea, vomiting, fullness in the ears, hearing loss, or a particular sensitivity to sound? Each of these things may help guide the diagnosis. Family and work histories are also important as well as information about the drugs you are taking whether they are prescription, over-the-counter, herbal or illicit. Finally and importantly, the workup and treatment depend on how important the symptom of tinnitus is to you. If the tinnitus is a mild nuisance, less aggressive therapy will be pursued. If the tinnitus is unbearable or high distressing, the doctor will pursue diagnosis and treatment a bit harder.

Physical examination

While the physical exam should cover the whole body, obviously the ear and head will be the primary focus. The physician will look for easily treatable causes of tinnitus, such as earwax or infection. The doctor will also inspect the eardrum to see if it punctured or damaged. She will also inspect the skull around the ear, the throat, and nostrils looking for obvious abnormalities. The workup also includes a neurological exam in which the cranial nerves are tested. The cranial nerves are the nerves that communicate information from the head to the brain. The eighth cranial nerve is particularly important in this case because it provides electrical signals related to hearing and balance.
There are two in-office tests of hearing that are performed with a tuning fork, namely the Rinne and the Weber tests. Both tests help the physician determine if there is hearing loss and distinguish between conductive and sensorineural causes. Conductive hearing loss means sound waves are not reaching the cochlea because of some physical problem. Sensorineural hearing loss involves the specialized organs of hearing. As you might expect, conductive hearing loss is easier to treat than sensorineural. Unfortunately, the latter type is often associated with tinnitus.

Blood tests and radiological studies

The tinnitus workup includes a number of blood tests, especially if the history and physical exam lead the doctor to suspect that there is a hormonal or metabolic cause. She will send for tests of thyroid hormone, complete blood chemistry (CBC), and tests to measure blood cholesterol. Tests for vitamin deficiencies are less often ordered, but vitamin B12 levels may be assessed. If the cause is likely to be physical, like an abnormal blood vessel, the doctor may order a special CT or MRI study. These tests are “special” because they specifically focus on the blood vessels (CTA and MRA). The studies are done in such a way to make the blood vessels in and around the ear “light up” so that they can be carefully studied. These tests are not only diagnostic, but if a physical cause is identified they will be instrumental in planning surgery to treat the tinnitus.
Audiometric testing
At some point in the tinnitus workup, a referral is usually made to an audiologist for audiometric testing. This is done to better characterize the tinnitus, judge severity, and create a common language for the patient and the clinician. For example, the audiometric testing identifies the quality of the tinnitus sound. What is ringing? What is clicking? Formal and complete audiometric testing is called an audiogram—a map of your hearing system. The process may include provocative tests (tests to make the tinnitus temporarily worse) or palliative tests (tests to make the tinnitus temporarily better). This can be helpful for identifying a treatment. The audiogram and related tests are sent to your physician to direct further care.

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Tinnitus can result from any one of a number of different causes like foreign objects inside the ear, nasal allergies, ear infections, or build up of wax. Hearing loss that comes with aging can also bring on tinnitus as well as taking certain medications and other types of hearing loss due to genetics. Most commonly, tinnitus is the result of hearing loss brought on by noise.

The Characteristics or Symptoms of Tinnitus
Tinnitus can affect just one or both ears. In most cases, those affected by it describe it as a ringing sound, but can it also be characterized by:

· Whining
· Buzzing
· Roaring
· Hissing
· Whistling
· Tinging
· Wooshing

Some people say that it also sounds like ticking, clicking, songs, beeping, or even the sound that frogs, crickets, or locusts make. The sounds can range from a more subtle background noise to a noise that can even be detected over loud external noises.

The sounds that tinnitus induces can come and go or be continuous, which can cause a lot of distress. Some people report that the intensity changes with movements of the eyes, jaw, tongue, head, or shoulders.

Most of those who have tinnitus have some level of hearing loss. They may not be able to pick up external sounds that are within the frequency range of the sounds they hear caused by the tinnitus. When the term “tinnitus” is used it is normally in reference to cases of phantom noises that are more severe.

There are two types of tinnitus:

· Subjective tinnitus – This is the most common type, and is tinnitus that only the patient can hear. It is usually related to outer, middle, or inner ear problems or by issues with auditory nerves in the brain that translates nerve signals as sounds.

· Objective tinnitus – With this type of tinnitus, a doctor can actually hear the sound during an exam. This is very rare.

Causes of Tinnitus
Objective tinnitus can be caused by muscle spasms in the ear that make clicking or cracking sounds near the middle ear. Some people who have objective tinnitus hear a sound that actually beats in rhythm with their pulse. This is what is known as pulsatile tinnitus and can happen when the flow of blood near the ear changes or there is an increase in blood turbulence. This increased turbulence can be brought on by atherosclerosis. It is rare, but pulsatile tinnitus can be a symptom of a serious condition like an aneurysm in the carotid artery.

There are many different possible causes for subjective tinnitus, most of which are related to disorders of the ear:

· Hearing loss related to age – Many people experience hearing loss as they age, normally near the age of 60. This type of hearing loss is known as presbycusis and it can cause tinnitus.

· Long-term exposure to loud noises – Common sources of hearing loss are loud noises such as from heavy equipment, firearms, and chainsaws. The use of earplugs or headphones in portable music devices can also cause noise-related hearing loss if the music is played loudly and for extended periods. This type of long-term exposure can cause permanent damage to the ears. Attending an occasional loud concert is considered short-term exposure and any hearing loss and associated tinnitus will usually go away.

· Earwax blockages – Too much earwax can build up in the ear canal and become too hard to wash away. This can irritate the eardrum or cause hearing loss, which can occasionally result in tinnitus.

· Medications – Certain oral medications like aspirin can cause subjective tinnitus. There are actually more than 260 medications that list tinnitus as a possible side effect.

Diagnosing Tinnitus
Doctors will conduct several different tests to determine the cause tinnitus that include an Audiological (hearing) exam. The extent of a patient’s tinnitus can be determined by playing sample sounds through headphones in one ear at a time and asking the patient what he or she hears. The tinnitus should be the same as or less than the noises that the patient hears. The results of this test are compared with other results that are considered normal for the age of the patient. This testing method can be used for objective and subjective tinnitus, but comparing the results with “normal” results does not work with subjective tinnitus.

When this type of test is used for someone with subjective tinnitus, they can often hear the sounds even when played at very low levels. This indicates that the tinnitus would be very difficult for them to hear. But if the patient is asked to focus only on the tinnitus and not the sound that is played, they will usually report that they can hear the sound even when the test noise is played at very high levels. This shows that their tinnitus is noticeable in environments that are both quiet and loud.

Treatment
The treatment for tinnitus is based on the underlying cause. For instance, if the tinnitus is due to an earwax blockage, removing the earwax should decrease the tinnitus. If a certain medication is the cause, the doctor will recommend stopping or reducing the dosage of the drug, or changing to a different one. For a patient with objective tinnitus who is diagnosed with a vascular condition, the treatment could be anything from medication to surgery to correct the condition.

Doctors often recommend the use of “white noise” or tinnitus masking devices to help disguise the tinnitus sound. There are dozens of possible treatments other than these that can help decrease tinnitus. Some of these include:

· Drugs and nutrients like benzodiazepines, tricyclics, zinc, anticonvulsants, melatonin, Ginko Biloba, and certain vitamin combinations.

· Psychological methods like cognitive behavioral therapy

· Electrical stimulation

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