One would have never imagined ringing sound or noise in the ear, this in medical terms is referred to as Tinnitus. If we look back in history Beethoven, Van Gogh, Charles Darwin, Neil Young are few known to have had tinnitus.

10-15% of the population worldwide is affected..It limits daily living in 1-2% of the people. It’s prevalence increases with age. 80% of the people don’t seek help.6-8% of those affected are severe &40% of patients experience depression. Sounds heard can vary between barely perceptible noise to a deafening roar. Very little is understood about its cause or cure.

In tinnitus, the origin of sound is within the patient. Usually it is unilateral(one ear) but may also affect both ears. Patient’s describes the sound as roaring, hissing, swishing or clicking noise. It is more annoying in quiet surroundings ,particularly at night, when the masking effect of ambient noise from the environment is lost.

What are the types of tinnitus?

Tinnitus can be

  • Objective tinnitus can be heard by the patient and the examiner with the help of a stethoscope.
  • Subjective tinnitus is heard by the patient alone.

Auditory hallucinations can occur in the presence of some neurological or psychiatric conditions where there is perception of meaningful sounds like music or speech.

   What are the causes of tinnitus?

Subjective tinnitus can be due to ontological (Ear) causes like infections,wax,noise induced, presbycusis, otosclerosis, menieres disease, neuromas,labrynthitis etc. It can also occur in neck injuries, meningitis, auto immune disorders, metabolicdisorders like hypothyroidism, obesity, hyperlipidemia,depression , anxiety, drug induced or it can be idiopathic.

Objective tinnitus can occur in arteriovenous malformations,vascular tumours, venous hum ,anemia,pregnany rtc

What are the adverse effects it can produce?

Tinnitus can produce impairment of concentration, decreased hearing, insomnia ,hyperacusis, cognitive impairment & psychological effects like anxiety , depression etc.

How the problem actually occurs?

The real cause of tinnitus is poorly understood. Lot of theories from loss of outer haircell function to increased spontaneous activity of central nerves exist.It can be generated from any part of auditory system from ear to central nervous system.

How can one  deal with this issue?

First of all thorough evaluation is necessary to rule out significant pathology.Treat the underlying cause if present.The aim of treatment should be habituation rather than “cure” of tinnitus.We should reassure the patient & make them understand the problem.Ask them to avoid aggravating factors like noise and decrease the intake of stimulants like caffeine.Relaxation exercises and avoiding silence by using background noise can be advised. Hearing Aids can be given to those with associated hearing loss. Those having severe tinnitus can be advised tinnitus masking devices & white band noise generators.Tinnitus retraining therapy could be given to weaken or remove the functional connections between the auditory pathways which include counseling & speech therapy.Some psychopharmacological agents like antidepressants, antipsychotics, mood stabiliser may help to reduce the severity of psychological issues associated with tinnitus and some of them help to reduce the symptoms of tinnitus itself.

Dr Silpa S P M.B.B.S..,D.L.O