Content

Introduction

Tinnitus, also called tinnitus, they are commonly referred to by those affected as annoying noises in the ears or head.

In almost all cases, they do not come from any sound source, neither inside nor outside the body, and are perceived only by the people who suffer from them, which is why they are defined subjective.

Rarely, they can originate from the ear and, in these cases, both the sufferer and the visiting doctor can hear them. In this case they are therefore defined objective.

In the case of the most common form, i.e. the one in which the noise is perceived only by the affected person, the acoustic perception is defined ghost sound. It is not a real disease but rather a more or less annoying disorder or, in some cases, the signal of some other disease.

The type of noise and intensity varies from time to time and from person to person. The sounds can be of various tones, from low to high, and can be perceived as whistling, buzzing, rustling, hissing, pulsations similar to the heartbeat. The duration and intensity of the discomfort are very variable, from a slight noise to very intense sounds that can heavily affect the quality of life; they can appear only once, occur several times at variable time intervals or, rarely, last all the life.

It is a rather common and widespread disorder, many people have experienced it at least once, even if only for a short time. In Italy about 15% of the population claims to have suffered from it at least once.

Tinnitus should not be confused with noises physiological that every normal individual perceives in a perfectly silent environment.

They are also distinguished from the so-called auditory hallucination, situation in which a person believes he hears sounds, words, phrases, music that, in reality, do not exist but are generated by his psyche.

Symptoms

Tinnitus is commonly described as ringing in the ears, although perceived noises can be of various types:

  • hissing
  • rhombuses
  • whistles
  • screeching
  • jingled
  • hum
  • rustles
  • crackles
  • puffs
  • pulsation (in this case we speak of pulsating tinnitus)

The sensation can be similar to an electric background hum, to the running of water, to a chirping, to the whistle of a pressure cooker, to the sound of crickets or cicadas, more rarely to music or singing.

The noise can be heard in one or both ears or, more generally, inside the head.

It can disappear and then reappear (be intermittent) or be constant; it can be similar to a single noise or to several overlapping sounds and its volume can vary in intensity, from barely audible to extremely loud.

In some people, it manifests itself with such intensity that it seriously hinders hearing and concentration, also negatively affecting the quality of life and social relationships.

In some cases, its presence becomes constant over time (chronic) and can cause consequences of a psychological nature that can degenerate into significant psychological disorders. Among the complications associated with tinnitus there can be, in fact, depression, anxiety and sleep disturbances.

Causes

Tinnitus can develop gradually over time or occur suddenly. They can affect people of any age, although they are rarer in children while they are more common in older people. Children may be at risk of tinnitus if exposed to very loud noises that can damage their hearing.

It is not clear exactly what the causes are, but they are more common in people who have suffered hearing damage or loss.

It is thought they may be linked to a problem in the transmission of the acoustic signal from the ear to the brain and in its decoding.

Many cases are associated with hearing loss caused by damage to the inner ear, although about one in three people have no obvious ear or hearing problems.

Sometimes tinnitus is linked to other diseases such as, for example, those of the circulatory system.

Understanding how sound transmission works helps to understand the mechanism that intervenes in the development of tinnitus: the sounds pass from the "external ear to" the inner ear, which contains the cochlea and the auditory nerve.

The cochlea is a coiled tube containing a large number of cells, equipped with cilia, which are very sensitive to vibrations.
The auditory nerve transmits sound signals to the brain.

If part of the cochlea is damaged, the delivery of information to the brain stops. The brain can then actively search for signals from parts of the cochlea that are still functioning. These signals could become over-represented in the brain causing the classic sounds of tinnitus. .

Damage to the cochlea occurs naturally with age in older people. In younger people it can be caused by repeated exposure to excessive noise (disco, workplace).

Possible causes of tinnitus are:

  • presbycusis, progressive age-related hearing loss (typically over 65)
  • damage to the inner ear caused by repeated exposure to loud noises such as heavy equipment, chainsaws and firearms, long-term use of portable music devices, such as MP3 players, at very loud volumes.Short-term exposure, such as attending a concert or the sound of a shot, usually creates a temporary problem that disappears within a short time.
  • accumulation of ear wax which causes the formation of a plug
  • middle ear infection
  • ear infection, ear inflammation causing fluid to build up in the middle ear
  • perforated eardrum
  • Ménière's syndrome, a disease that causes an increase in the pressure of the fluids contained in the auricular labyrinth of the inner ear causing hearing loss and dizziness
  • otosclerosis, an inherited disease in which abnormal bone growth in the middle ear causes hearing loss
  • conditions of strong emotional stress and states of anxiety

Rarer causes

Less commonly, tinnitus can develop, as a side effect of:

  • trauma to the head
  • exposure to a sudden noise or very loud, such as an explosion or gunfire
  • anemia, a reduction in red blood cells
  • reaction to some medications such as, for example, chemotherapy, antibiotics, diuretics, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin (in very high doses)
  • acoustic neuroma, benign brain tumor affecting the hearing nerve
  • high pressure (hypertension) and narrowing of the arteries (atherosclerosis)
  • malfunction of the thyroid gland (hyperthyroidism or hypothyroidism)
  • diabetes
  • Paget's disease, metabolic bone disease that disrupts the normal cycle of bone renewal and repair

When tinnitus is a sign of another disease, treating it can help alleviate it.

Diagnosis

If you have hearing problems or hear sounds or buzzing inside the ear or in the head, it is advisable to contact your family doctor or directly to an otolaryngologist.

It is useful to describe the acoustic disturbances (symptoms) to the doctor as precisely as possible, in order to facilitate the ascertainment of the cause (diagnosis) and to identify the most suitable therapeutic approach.

The doctor will ask you to describe the type of sounds perceived, their intensity and duration, and whether they involve one or both ears.

Generally, the doctor carries out a visit of both the external and internal ear to rule out any other factors that could determine the onset of tinnitus such as, for example, the presence of an infection or an accumulation of ear wax.

He could also perform a simple (audiometric) test to assess "possible hearing loss", or, order an audiological examination and blood tests to identify possible diseases associated with tinnitus such as, for example, anemia, diabetes or a malfunction of the thyroid gland.

There is also a specific audiometric test, called tinnitus which, as far as possible, allows you to determine the frequency and intensity of the perceived sound. It should be borne in mind, however, that the volume and intensity of tinnitus may not correspond to those heard. by the person who undergoes the test because everyone has their own level of tolerance to the noise produced.

Very rarely, computerized axial tomography (CT) or magnetic resonance imaging (MRI) may be prescribed to examine the inside of the ear and the structures of the brain in order to identify, or rule out, any damage.

Therapy

There is no specific and definitive therapy for tinnitus, but there are a number of interventions that can resolve or, at least, gradually alleviate the disorder.

If, for example, the tinnitus is caused by a buildup of ear wax, simple ear drops, available at the pharmacy, or, alternatively, ear irrigation can be used to remove it.

If, on the other hand, they are caused by a reaction to a drug, it is necessary to consult the treating doctor to replace the drug in question with another medicine or to stop the treatment.

In the case of tinnitus caused by a hearing loss, it may be useful to use a hearing aid or, in some cases, to undergo surgery.

The specialist will be able to recommend the most suitable treatment.

In fact, it has been noted that improving hearing decreases attention to tinnitus and, consequently, reduces the disturbance.

Conversely, a reduction in hearing, which forces greater attention to hear, sharpens the perception of tinnitus.

However, since it is not possible to identify a specific cause and therefore a definitive therapy, strategies are often used to learn to live with it.
Only in severe cases can antidepressant drugs be given to relieve discomfort. If the disorder is not severe, it is possible to learn to hardly notice it again without having to use any specific treatment.

If your tinnitus has just started and you are not properly informed, you may be afraid that the noise will get louder, last forever, cannot be cured or be a sign of a more serious illness.

The main treatments (therapies) available are:

  • sound therapy, since tinnitus is often more noticeable in quiet environments, the purpose of the sound therapy is to fill any silence with neutral sounds to distract from the presence of tinnitus. Sometimes simple measures are enough such as leaving a window open to hear noises from outside, leaving the radio, television or fan on at low volume. There are also specially designed sound generators that look similar to a radio. They produce sounds. natural, such as the rustle of leaves moved by the wind or the sound of the sea waves (undertow).There are also pillows with built-in speakers to help distract attention from tinnitus when you go to sleep, and small audio-generating devices that fit into the ear like a hearing aid. Some hearing aids are equipped with sound generators for people with tinnitus. Since in people suffering from tinnitus silence is unbearable as it makes the noise worse, sound therapy should always be practiced, regardless of the other treatments followed.
  • expert advice (counseling), the dialogue with an expert, the checks (follow up), the dissemination of correct information on the disorder, allow you to correct thoughts and misconceptions that make you interpret tinnitus as a worrying sound; the advice of an expert allows you to better understand the disorder to the person suffering from it so that they can manage it more effectively. Usually, it is carried out by hearing therapists, audiologists (specialists in hearing disorders) or doctors
  • cognitive-behavioral therapy (TCC), psychological therapy used to treat a "wide range of disorders such as, for example, anxiety, depression, sleep disturbances, etc." It is based on the idea that thoughts influence the way one behaves. It aims to reorganize the way of thinking in order to see and face situations in a new way. In particular, during therapy, the person is educated to use mental techniques that allow him to deal more effectively with the problem. This technique is also effective in countering the problems caused by tinnitus because, basically, it teaches you to live with it. For example, if the knowledge of tinnitus is limited or incorrect, you may have misconceptions that cause anxiety and depression.Changing the way you think can help reduce anxiety and allow you to have a different perception of noises which, over time, may become less noticeable
  • tinnitus retraining (restructuring) therapy (tinnitus retraining therapy - TRT), is a particular type of treatment that combines sound therapy with expert advice and aims to help "re-educate" the hearing of people suffering from tinnitus by inducing the inner ear to classify the noise perceived as a sound without importance and without particular value. The central point of TRT is to restore tinnitus to be a meaningless sound that the individual can learn, with a suitable period of time, to neglect. The treatment path does not is of short duration, it can take from 12 to 24 months during which, normally, there is an attenuation of the disorder, even if not its disappearance. In the following phases, the tinnitus should become a natural element of the daily background sound . If this does not happen, further investigations and a change in treatment may be required. Tinnitus retraining therapy should only be performed by personnel trained in this technique

Prevention

Noise is one of the main risk factors for hearing, the damage it causes is associated with its duration and intensity. Damage to the ear often has tinnitus as a secondary effect. To prevent its occurrence, therefore, the first rule is to avoid exposing yourself to very loud noises and to protect your hearing.

Some simple precautions can help avoid the onset of tinnitus:

  • avoid exposure to high intensity noise (loud music and TV volume, external noises such as pneumatic hammers, gunshots, etc.)
  • wear ear protection (headphones or ear plugs) in all situations in which you are forced to expose yourself to loud noises
  • comply with safety regulations in the workplace (provided for by Legislative Decree 81/08 "Consolidated law on safety"): wear suitable headphones or earplugs when the noise exceeds a certain threshold (evaluated in decibels)
  • keep blood pressure under control
  • keep your ears clean to avoid the formation of earwax plugs

Living with

Not all people with tinnitus see it as a disturbance to their daily activities. In fact, noise tolerance varies from individual to individual. Some interpret tinnitus as a threat or a danger, others do not consider it a risk to their mental and physical health.

Often tinnitus cannot be cured. If it is not severe, you can get used to it and learn to live with it until you hardly notice it anymore.

Some tricks can help:

  • avoid absolute silence
  • cover the buzz caused by tinnitus with another sound: low volume music, the turning on of the television or radio, the noise of a fan or washing machine. In this way the attention is shifted from the tinnitus to other background noises
  • avoid exposure to loud noise which can make the situation worse
  • reduce consumption of foods and beverages rich in caffeine and cocoa and avoid alcohol and smoking

Some people find self-help techniques useful for managing tinnitus. In many cases they may be enough to overcome the problem. They include:

  • relaxation, stress can worsen the perception of tinnitus, some relaxation techniques, such as deep breathing, meditation or yoga, can help
  • music, listening to your favorite songs and soothing sounds (such as the sound of water) can help you relax and facilitate sleep
  • regular sleep, if tinnitus affects the quality of sleep, it is useful to follow some rules such as, for example, respecting regular times at bedtime, avoiding the use of alcoholic or caffeinated drinks just before going to bed
  • hobbies and activitiesHaving a hobby or engaging in any enjoyable activity can help distract from tinnitus
  • support groups: Sharing your experiences with other people who have the same problem can help you deal with it better

If tinnitus causes depression or excessive anxiety, it may be helpful to see a mental health specialist.

Bibliography

NHS Choices. Tinnitus (English)

Mayo Clinic. Tinnitus (English)

In-depth link

Italian Association Tinnitus - Tinnitus (AIT)

Italian Association for Deafness Research (AIRS)

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