Tinnitus

Overview of Tinnitus

In general, The characteristic feature is that the origin of this sound is within the patient. Usually, it is unilateral but may also affect both ears.

Furthermore, It may vary in pitch and loudness and has been variously described by the patient as roaring, hissing, swishing, rustling or clicking type of noise.

This disease is more annoying in quiet surroundings, particularly at night, when the masking effect of ambient noise from the environment is lost. It may be intermittent or continuous in nature.[2]

Causes of Tinnitus

• Subjective tinnitus may have its origin in the external ear, middle ear, inner ear, VIII th nerve or the central nervous system.
• Systemic disorders like anemia, arteriosclerosis, hypertension and certain drugs may act through the either inner ear or central auditory pathways.
• In the presence of conductive hearing loss, the patient may hear abnormal noises in the head during eating, speaking or even respiration. [2][1]
• Objective tinnitus is seen less frequently. Vascular lesions, e.g., glomus tumor or carotid artery aneurysm cause swishing tinnitus synchronous with pulse. It can be temporarily abolished by pressure on the common carotid artery.
• Venous hum can sometimes be stopped by pressure on the neck veins.
• It synchronous with respiration may occur due to abnormally patent eustachian tube.
• Palatal myoclonus produces clicking sound due to clonic contraction of the muscles of soft palate also can be easily diagnosed.
• Clonic contraction of muscles of middle ear (stapedius and tensor tympani) may cause it which is often difficult to diagnose.
• Sometimes,it  is psychogenic and no cause can be found in the ear or central nervous system.
• It should be differentiated from auditory hallucinations in which a person hears voices or other organized sounds like that of music. Lastly, It is seen in psychiatric disorders.[1][2]

Types

Classification:

Subjective tinnitus

• Subjective tinnitus can only be heard by the patient. It  has also been called "tinnitus aurium", "non-auditory" or "non-vibratory" tinnitus.
• Subjective tinnitus is the most frequent type of It.
• It may have many possible causes, but most commonly it results from hearing loss.
• When It is caused by disorders of the inner ear or auditory nerve it can be called otic.
• These ontological or neurological conditions include those triggered by infections, drugs, or trauma.
• A frequent cause is traumatic noise exposure that damages hair cells in the inner ear.
• When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, It  can be called non-otic.
• In some 30% of Its cases, it is influenced by the somatosensory system, for instance, people can increase or decrease their tinnitus by moving their face, head, or neck.
• This type is called somatic or cranio-cervical, since it is only head or neck movements that have an effect.
• There is a growing body of evidence suggesting that some tinnitus is a consequence of neuro-plastic alterations in the central auditory pathway.
• These alterations are assumed to result from a disturbed sensory input, caused by hearing loss.
• Hearing loss could indeed cause a homeostatic response of neurons in the central auditory system, and therefore cause It.

Objective tinnitus

• The specific type of It called objective tinnitus is characterized by hearing the sounds of one’s own muscle contractions or pulse, which is typically a result of sounds that have been created by the movement of muscles near to one’s ear, or sounds related to blood flow in the neck or face, which can even be heard by the examiner with the use of a stethoscope.[1][2]

Pulsatile tinnitus

• If the examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.

Risk factors

Pathogenesis

Pathophysiology

Clinical Features

Sign & Symptoms of Tinnitus

• It is most often described as a ringing in the ears, even though no external sound is present.
• However, tinnitus can also cause other types of phantom noises in your ears, including:
• Buzzing
• Roaring
• Clicking
• Hissing
• Humming
• Most people who have tinnitus have subjective tinnitus.
• The noises of tinnitus may vary in pitch from a low roar to a high squeal, and you may hear it in one or both ears.
• In some cases, the sound can be so loud it interferes with your ability to concentrate or hear external sound.
• It may be present all the time, or it may come and go.
• In rare cases, tinnitus can occur as a rhythmic pulsing or whooshing sound, often in time with your heartbeat. This is called pulsatile tinnitus.
• If you have pulsatile tinnitus, your doctor may be able to hear It when they does an examination (objective tinnitus).
• Psychological effects-Besides being an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people. Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying. 45% of people with tinnitus have an anxiety disorder at some time in their life.[2]

Clinical Examination

Diagnosis

• The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system.
• Typically, an audiogram done, and occasionally medical imaging or electronystagmography.
• Treatable conditions may include middle ear infection, acoustic neuroma, concussion, and otosclerosis.
• Evaluation of it can include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus like pitch and loudness, and psychological assessment of comorbid conditions like depression, anxiety, additionally stress that associate with severity of the It.
• One definition of tinnitus, as compared to normal ear noise experience, is lasting five minutes at least twice a week.
• However, people with It often experience the noise more frequently than this.
• Tinnitus can be present constantly or intermittently.
• Some people with constant tinnitus might not be aware of it all the time, but only for example during the night when there is less environmental noise to mask it.
• Chronic tinnitus can define as  duration of six months or more. [2]

Differential Diagnosis 

• Meniere’s disease
• Acoustic neuroma
• Glomus jugular tumor
• Cerumen (ear wax) impaction
• Otitis media
• Ear or hearing trauma
• Head injuries [2]

Complications 

Investigations

Treatment 

It is a symptom and not a disease. Where possible, its cause should be discovered and treated. Sometimes, even the treatment of cause may not alleviate It.

When no cause is found, Its management includes:

• Reassurance and psychotherapy. Many times, the patient has to learn to live with it.
• Techniques of relaxation and biofeedback.
• Sedation and tranquillizers. They may be needed in initial stages till patient has adjusted to the symptom.
• Masking of tinnitus. It is more annoying at bedtime when the surroundings are quite.

Instrument 

• It is a combination of a hearing aid and a masker in one device. Looks like a hearing aid.
• Both hearing aid and masking device have independent volume controls.

Tinnitus retraining therapy (TRT)

It occurs at two levels-

1. Habituation of reaction. It is uncoupling of brain and body from negative reactions to It.
2. Habituation of tinnitus. It is blocking the tinnitus-related neuronal activity to reach level of consciousness. With this therapy patients suffering from tinnitus lose awareness of tinnitus and also do not get annoy even when they do have tinnitus. Therapy consists of two major components:

(I) Counselling

It is important to educate the patient about this disease, its mechanism of generations, perception of tinnitus at subcortical and cortical levels and the plasticity of brain which can habituate any sensory stimuli.

(ii) Sound therapy

Patient expose to environmental sounds, music radio, television, or use of hearing aids In general, he should avoid silent environment. To produce external sound for habituation, sound generators use which produce continuous low-level, broad-band noise for at least 8 h a day.

Sound, here is used not for masking but is adjusted to remain at a low level, for habituation.

TRT needs a long period of 18–24 months but gives a significant improvement in more than 80% of patients. [2]

Prevention of Tinnitus

Prolonged exposure to loud sound or noise levels can lead to tinnitus. Custom made ear plugs or other measures can help with prevention. Employers may use hearing loss prevention programs to help educate and prevent dangerous levels of exposure to noise. Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing.

Motorbike riders also advise to wear ear plugs when riding to avoid the risk, caused by overexposure to loud noises such as wind noise.

Several medicines have ototoxic effects, and can have a cumulative effect that can increase the damage done by noise. If ototoxic medications must administer, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.[2]

Homeopathic Treatment of Tinnitus

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Tinnitus

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Medicines:

Chininum sulphuricum

• Ringing in the eras; also with deafness. Meniere’s disease.
• Humming in the ears ,Roaring in the ears, during the night.
• The person may also have a tendency toward chills and vertigo, during which the tinnitus is often worse.

Natrum Salicylicum

• Severe headache, ringing in the ears, deafness, and impairment of vision for distant objects.
• Produces marked effect upon the internal ear; with vertigo, deafness, noises in the ears with loss of bone conduction.
• Vertigo when objects seem to move to the right; worse on rising from lying.
• Prostration after influenza.

Belladonna

• Wind rushes out of her ears.
• Furthermore, A disagreeable pressure in the meatus, as if one were boring in it with the finger.
• Pulsation in the ears, with increased sharpness of hearing.
• Very sensitive to loud tones, he starts every time.
• Hardness of hearing.
• Attack of deafness, from congestion of blood, chiefly in the evening.

Salicylicum Acidum

• Vertigo, tendency to fall to the left side, surrounding objects seem to fall to the right; headache. Additionally, Meniere’s disease.
• Simple deafness with tinnitus. Roaring also ringing in the ears.
• Deafness with vertigo.
• Lastly, Effects of suppressed foot sweats.

Graphites

• Hissing ; ringing; rushing; roaring; cracking; or clucking sounds in the ears.
• Violent nocturnal roaring, ears feel stuffed at times.
• Sounds as of rolling thunder before the ears.
• Cracking in the ear : when eating in the evening; on moving the jaw, but only in the morning while lying in bed; when sneezing.
• At every step feels as if a valve in right ear opened and closed. Loss of hearing, with dryness of the ears.
• Acute pressure in the inner ear, like otalgia. Thin, watery, offensive discharge from both ears.
• Gluey, sticky discharge at the external meatus.

Lycopodium

• Over sensitiveness of hearing. Roaring, humming and whizzing in the ears; hardness of hearing.
• Otorrhea purulent, ichorous; after scarlatina; with impaired hearing.
• People needing Lycopodium often have a tendency toward ear infections with discharge, as well as chronic digestive problems or urinary tract complaints.

Calcarea carbonica

• Hardness of hearing, also after suppression of intermittent by quinine.
• Singing and roaring or crackling in the ears.
• Cracking in the ears when chewing. Strange and peculiar noise in the ears when swallowing.
• Pulsating in the ears. Purulent, offensive discharge from the ears.
• People who need this remedy are usually chilly, easily fatigued, crave sweets, and feel overwhelmed and anxious when unwell.

Carbo vegetabilis

• Ringing in ears : buzzing. Something heavy seems to lie before the ears; they seemed stopped, hearing not diminished.
• Deafness after acute skin infection ,abuse of mercury, ears too dry, Offensive otorrhea.
• The person may feel cold and faint, but usually has a craving for fresh and moving air.
• Carbo vegetabilis is also helpful when an illness has prolonged or recovery is slow.

China (Cinchona officinalis)

• This remedy often indicate after fluids have lost through vomiting, diarrhea, heavy sweating, and surgery or other conditions involving blood loss.
• Fine ringing in ears, debility.
• Hardness of hearing; humming in ears. Besides this, Stitches in the ears.

Cimicifuga

• People likely to respond to cimicifuga often have pain and muscle tension in the neck and back.
• They are usually energetic, nervous, and talkative, but become depressed or fearful when not feeling well.
• Headaches and problems during menstrual periods often seen in people who need this remedy. Sensitive to least noise.
• Singing in the left, later in both ears.

China

• RINGING in ears. External ear sensitive to touch.
• Hearing sensitive to noise, Intolerance of noise.
• Shooting, buzzing, inkling, humming also roaring of ears.
• Redness and heat of the external ear, especially of the lobes.
• Worse – from the slightest tough. On the other hand, Better – warmth.

Causticum

• Ringing, roaring, pulsating, with deafness.
• words also steps re-echo: chronic middle ear catarrh: accumulation of ear wax.
• Worse – dry cold winds, in clear fine weather, cold air, from motion of carriage. Whereas, Better – Damp wet weather, warmth, Heat of bed. [3][4]

Diet & Regimen of Tinnitus

What to Eat

Vitamin B12 – Vitamin B12 can help alleviate your symptoms that are a result of noise damage. You can find vitamin B12 in mackerel, salmon, chicken, beef, and eggs.

Bromelain – Tinnitus can have adverse effects on the body, which can lead to inflammation. However, bromelain, which is found in pineapple, can help reduce inflammation in the body, thus lessening the effects of tinnitus.

Potassium – potassium helps regulate the proper flow of fluids throughout the body. Potassium-rich foods that may help alleviate your symptoms include apricots, sweet potatoes, pears, papayas, bananas, yogurt, spinach, mangos, and apples.

Zinc – Sometimes ringing in the ears can be caused by low levels of zinc, which is responsible for healing and cell growth. So make sure you keep your levels up by eating plenty of nuts, dark chocolate, yogurt, chicken, beef, spinach, lamb, and shellfish.

Folate – Folate helps improve blood flow to the inner ear by increasing circulation and can help improve tinnitus, sudden hearing loss, and age-related hearing loss. Get your daily dose of folate by eating plenty of beans, spinach, romaine lettuce, broccoli, turnip greens, asparagus, and bok choy.[5]

What Not to Eat/Consume Less

• Processed/pre-packaged/fast foods
  • MSG
  • Table salt
  • Artificial sweeteners
  • Vegetable oils
  • Sulfites
  • Saturate fats
  • Refined carbohydrates
  • Trans fats
  • Caffeine
  • Processed sugar
  • Alcohol [5]

Do’s:

• Protect your hearing: Avoid exposure to loud noises. Use earplugs or earmuffs in noisy environments.
• Manage stress: Practice relaxation techniques such as yoga, meditation, or deep breathing exercises. Stress can worsen tinnitus.
• Get enough sleep: Aim for 7-8 hours of quality sleep each night. Fatigue can exacerbate tinnitus.
• Seek professional help: Consult an audiologist or otolaryngologist (ear, nose, and throat doctor) for evaluation and treatment options.
• Consider sound therapy: Sound therapy devices or apps can help mask the tinnitus sound and provide relief.
• Stay active and engaged: Pursue hobbies and activities that you enjoy. Staying active can help distract from the tinnitus and improve overall well-being.
• Maintain a healthy lifestyle: Eat a balanced diet, exercise regularly, and avoid smoking and excessive alcohol consumption.

Don’ts:

• Don’t expose yourself to loud noises: Avoid concerts, loud machinery, and other sources of loud noise.
• Don’t isolate yourself: Stay connected with friends and family. Social interaction can help reduce stress and improve coping mechanisms.
• Don’t focus on the tinnitus: Try to distract yourself from the tinnitus by engaging in activities you enjoy.
• Don’t self-medicate: Avoid using over-the-counter medications or supplements without consulting a healthcare professional.
• Don’t give up: Tinnitus can be managed effectively with the right treatment and lifestyle adjustments. [7]

Terminology

References use for Article Tinnitus

1.  Diseases_of_Ear_Nose_and_Throat_6Edition
2.  https://en.wikipedia.org/wiki/Tinnitus#cite_note-74
3. Homoeopathic Body-System Prescribing – A Practical Workbook of Sector Remedies
4. https://hpathy.com/cause-symptoms-treatment/tinnitus-cure/
5. https://www.neilsperlingmd.com/blog/2018/05/foods-for-tinnitus-what-to-eat-and-what-to-avoid-when-you-have-tinnitus
6. Aryal, P., Shrestha, B., & Bista, S. (2023). Prevalence of Tinnitus and its Characteristics Among Indian Adult Population. Annals of Otology, Rhinology & Laryngology, 132(03), 230-234.
7. Tyler, R. S., Searchfield, G. D., & Rauschecker, J. P. (Eds.). (2014). Tinnitus: Pathophysiology and Treatment (2nd ed.). Springer.

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