Tinnitus is the perception of sound without an external source. It may be a symptom of ear disease but may also occur with systemic disorders such as hypertension. It is common and occurs in 15% of all people. It is more common in the elderly and may be accompanied by hearing loss and dizziness.
It is broadly divided in subjective (only noticeable to the patient) and less common objective (noticeable to the observer as well). It can be described as a hissing, rumbling, whistling or a cricket like sound and may be present in one ear only. If it follows the heartbeat (pulsatile ) it should be investigated to exclude a vascular problem, tumour or a superior canal dehiscence (SCD). Patients often report that it is worse when it is quiet.
There are many causes of which hearing loss is still the most common. An acoustic neuroma is a tumour that may present with tinnitus in one ear. Menière’s disease also causes it and it often changes character during an attack. Vestibular paroxysmia causes it due to vascular compression of the vestibulocochlear nerve. Sometimes the hearing is normal and no cause can be found.
It is well recognized that stress can aggravate it. In some cases patients can get depressed and develop sleeping problems.
There are audiologists trained in the effective management but a treatable cause should be ruled out first. A hearing test with speech discrimination should always be performed. In some cases a contrast-enhanced magnetic resonance imaging (MRI) of the brain is indicated to exclude an acoustic neuroma.
In patients with hearing loss a hearing aid is likely to improve the tinnitus. Medication is often prescribed for those patients with anxiety and depression. Patients should be careful of so called “wonder drugs”. The same applies for mechanical devices and laser treatment. Tinnitus counseling and retraining therapy (TRT) is often of value.
Tinnitus can be managed very effectively and patients should never give up hope. Never except the advice that you should “live with it”.
The tinnitus questionnaire is standardized and internationally recognised.
Tinnitus counselling and management
Tinnitus Retraining Therapy (TRT)
The Audiologist use Tinnitus Retraining Therapy (TRT) to help patients learn how to cope with their tinnitus on a conscious and subconscious level. The therapy is focused at the perceived source of the tinnitus and aims to teach the brain to ignore it. Extensive collection of information about the patient, including patient history and daily living habits are vital. If the patient is a suitable candidate, the use of hearing aids and tinnitus devices might be recommended to divert attention of the patient away from the tinnitus. This is often combined with deep relaxation exercises and stress management. The aim is to eliminate the patient’s anxiety, so that the tinnitus is no longer perceived as a danger or a threat. The end goal is complete habituation of the noise.
Tinnitus and hyperacusis can be successfully managed by passionate trained audiologists. Through research proven methods such as TRT patients can be helped in understanding and managing their tinnitus and eventually improving their quality of life. The hearing of a patient needs to be acccessed first. The impact that the tinnitus has on a patient’s life is then established. A combination of comprehensive tinnitus counselling (how tinnitus works in your brain), sound therapy and hearing improvement techniques are subsequently applied. When indicated, stress, head and neck tension and medical issues are addressed. There is no need to have your life destroyed by tinnitus and hyperacusis.