Tinnitus Treatment
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What is Tinnitus?
Tinnitus is a ringing or hissing sound/ noise in the ear. The source of this sound is within the patient. It is mostly unilateral, but may be bilateral on some occasions.
Classification of tinnitus
- Subjective tinnitus: Can be heard only by the patient and not by the examiner.
- Objective tinnitus: Can be heard by the patient and the examiner.
Cause of Subjective tinnitus
The most common causes of subjective tinnitus are:-
- Presbycusis ( age related hearing loss)
- Noise induced hearing loss Idiopathic sudden sensorineural hearing loss
- Impacted wax Acute otitis media
Vestibular schwannoma - Use of ototoxic drugs
- Anxiety/ depression
Most of these causes can be ruled out by eliciting a good history, a thorough clinical examination and basic investigations like pure tone audiometry and impedance audiometry.
Cause of Objective tinnitus
This may be caused by :-
- Vascular malformations like glomus jugulare, carotid aneurysms, arteriovenous malformations, etc.
- Patulous eustachian tube
- Palatal myoclonus
- Temporomandibular joint dysfunction
Symptoms of Tinnitus
Tinnitus is not a disease but may be a symptom of some underlying pathology. The patient may complain of a high pitched whistling sound in the ear which may get more severe in the night or in very quiet surroundings.
Treatment in Tinnitus
The treatment of tinnitus is based upon treating the underlying cause. Sometimes, no definite cause of tinnitus is identifiable. In such cases, the treatment of tinnitus includes:
- Reassurance and counselling: To reassure the patient and to allay any anxiety related to tinnitus
- Masking of tinnitus: Tinnitus may be masked by sources of ambient noise like usr of a fan, ticking clock, a radio playing in the background.
- Hearing aids : Can be used in patients of tinnitus with hearing loss. They not only improve hearing, but also provide a masking effect for tinnitus.
- Tinnitus maskers: Used in patients with tinnitus but no hearing loss. They are worn like hearing aids and even when used for a short time, may provide relief from tinnitus for a longer duration.
Tinnitus Retraining Therapy
Described by Jastreboff from University of Maryland. It consists of two major components:
- Counselling: To educate the patient about tinnitus, its mechanism of generation and the various reactions of the brain to its perception.
- Sound therapy: The patient is taught to avoid surroundings which are absolutely silent as tinnitus gets aggravated in such surroundings. He is asked to keep sound generators like television, radio etc in his ambience.
Tinnitus Retraining Therapy works in approximately 80 percent of patients.
