Tinnitus is ringing sound or noise in the ear. The characteristic feature is that the origin of this sound is within the patient. Usually, it is unilateral but may also affect both ears. 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. Tinnitus is more annoying in quiet surroundings, particularly at night, when the masking effect of ambient noise from the environment is lost.
TYPES OF TINNITUS
Two types of tinnitus are described:
□ Subjective, which can only be heard by the patient. .
□ Objective, which can even be heard by the examiner with the use of a stethoscope.
CAUSES OF TINNITUS
Subjective tinnitus may have its origin in the external ear, middle ear, inner ear, Vlllth nerve or the central nervous system. Systemic disorders like anaemia, arteriosclerosis, hypertension and certain drugs may act through the inner ear or central auditory pathways. In the presence of conductive deafness, the patient may hear abnormal noises in the head during eating, speaking or even respiration.
Objective tinnitus is seen less frequent. Vascular lesions, e.g. glomus tumour or carotid artery aneurysm cause swishing tinnitus synchronous with pulse. It can be temporarily abolished by pressure on the common carotid artery. Venous haemorrhage can sometimes be stopped by pressure on the neck veins.
Tinnitus synchronous with respiration may occur due to abnormally patent eustachian tube. Palatal myoclonus produces clicking sound due to clonic contraction of the muscle of soft palate and can be easily diagnosed. Clonic contraction of muscles of middle ear (stapedius and tensor tympani) may cause tinnitus which is often difficult to diagnose.
Sometimes, tinnitus is psychogenic and its cause can be found in the ear or central nervous system.
Tinnitus should be differentiated from auditory hallucinations in which a person hears voices or other organised sounds like that of music. It is seen in psychiatric disorders.
TREATMENT
Tinnitus is a symptom not a disease. Where possible, its cause should be discovered and treated. Sometimes, even the treatment of cause may not alleviate tinnitus. When no cause is found, management of tinnitus includes:
□ Reassurance and psychotherapy. Many times the patient has to learn to live with tinnitus.
□ 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. Tinnitus is more annoying at bed time when the surroundings are quite. Use of a fan, loudly clicking clock or a similar device may mask the tinnitus and help the patient to go to sleep. Use of a hearing aid, in persons with hearing loss, not only improves hearing but also provides a masking effect..
Tinnitus maskers can be used in patients who have no hearing loss. They are worn like a hearing aid. Use of tinnitus masker for a short time may provide, in some individuals, a symptom-free period for several hours due to the phenomenon of residual inhibition.