What causes tinnitus?Tinnitus is not itself a disease but a symptom resulting from a range of underlying multiple causes. Although it is often assumed that tinnitus occurs as a result of disease of the ears, this is often not the case. Despite the years of scientific research, the precise cause of tinnitus is still not fully understood. However, it is usually associated with some hearing deficits, commonly age-related hearing loss (known as 'presbyacusis'), noise-induced hearing loss (especially those exposed to loud music, or noisy working environment).Other than hearing loss, common ear causes include ear infections, foreign objects or wax in the ear,nose allergies that prevent (or induce) fluid drain and cause wax build-up. It can also be due to Meniere's disease (a type of vertigo illness), acoustic neuroma (a type of tumor of the hearing nerve). Your ENT doctor should be able to exclude the common ear causes by examining your ears and determining your hearing level through a test called 'pure tone audiometry (PTA)'.However, a person without ear problems can still suffer from tinnitus. There are many commonly-used medications that can cause tinnitus, such as aspirin, some antibiotics (eg. gentamicin, chloramphenicol, erythromycin, vancomycin etc.), diuretics furosemide, quinine, some chemotherapy drugs and many others. Head injuries can also increase the likelihood of tinnitus.Therefore, a person can still have tinnitus despite having normal level of hearing and no other obvious medical causes. In fact, in many cases, no exact underlying physical cause can be identified.Who gets tinnitus?Experiences of tinnitus are very common in all age groups, especially following exposure to loud noise; however, it is unusual for it to be a major problem. There is a widely held misconception that tinnitus is confined to the elderly, but various studies have shown that it can occur at any age, even quite young children. Mild tinnitus is common - about 10% of the population have it all the time and, in up to 1% of adults, this may affect the quality of their life. Chronic tinnitus can be quite stressful psychologically, as it distracts the affected individual from mental tasks and interferes with sleep, particularly when there is no external sound. So what is the treatment for tinnitus ?Possible causes should be reversed, eg. to remove ear wax in a clogged ear canal, treat any ear infection, withdraw/substitute any offending drugs. In a person with hearing loss, a hearing aid may also help.However, if no possible causes are elicited, treatment may be difficult. Over the years, many treatments have been tried and tested to treat tinnitus but till today, convincing evidence is still lacking. Although many 'miracle cures' have been claimed, they remain questionable. To add to the dilemma, tinnitus can improve or deteriorate spontaneously even without treatment. Various treatments that have been tried include: Ginkgo biloba, lignocaine, nerve tonics, mutilvitamins, zinc supplements, sedatives, avoidance of caffeine, nicotine, salt. Some even claimed consuming more alcohol cure them of tinnitus ! Hearing aids with or without tinnitus maskers may work for some. Nowadays, special music therapy have also been tried on tinnitus patients in order to help them adapt better to the constant ringing soundUnderstanding the myths of tinnitus "Will my tinnitus drive me insane?" There have been no reported cases of tinnitus causing insanity "Will it get louder?" Generally not, though it can wax and wane."Will it continue forever?" Although there are cases where tinnitus has spontaneously disappeared, it is the exception rather than the rule. It is best to assume that you have it for the longer term and learn to manage it. "It can't be cured." There are many researchers that are working on more fully understanding tinnitus, however do not live in hope of a miracle cure. Learn to manage it and get on with your life. "I will have no more peace and quiet." Very rarely do we have absolute quiet. Most times there are ambient and environmental noises around us. Being in an absolutely quiet environment is unnatural for humans. You are still able to enjoy peace and tranquility. "It will interfere with my concentration." The ability to concentrate will improve over time as you habituate to the tinnitus. "It will affect my sleep." Particularly in the early stages medication may be required to obtain a full night sleep, but in time you will return to normal sleep patterns. If you think you have tinnitus...Try to relax. Don't worry, be happyAlthough there are no specific cures for tinnitus, anything that calms you down helps tinnitus recede over a period of time. Basically, learn to relax and do not worry ! (Therefore, in the name of relaxation, calming body-based therapies, counselling and psychotherapy are sometimes recommended)•Learn to reduce your stress level (at home, work etc). Practise relaxation and take time out for yourself can also be a great help. Stress can increase tinnitus !•If the noises seem louder at quiet times, particularly during the night, it may help to have soothing music or some other environmental or natural sound quietly on in the background. It helps with the relaxation as well.•Know the importance of not focusingon your tinnitus. The more a person focuses on their tinnitus, the louder it will appear and the more distressed they will become. Learn to shift your focus from the tinnitus to something more pleasurable eg. walking, gardening, reading, listening to relaxing music or any activity that you enjoy that absorbs your mind. Many people say that they notice tinnitus less when they are doing something (i.e distraction). Keeping your mind occupied helps. •Receive adequate rest each day; if necessary, seek medical help to sleep well at night.•Avoid loud noiseas it will exacerbate tinnitus. Ear muffs or ear-plugs should be worn when activities such as mowing the lawn or using a chainsaw are undertaken. Venues such as nightclubs or entertainment venues that have excessively loud noise should be avoided or ear protection used.
What is tinnitus ?: The word “tinnitus” is derived form the Latin word “Tinnire”, which means “to ring”. Hence, “tinnitus” is the name given to the condition of noises ringing 'in the ears' and/or 'in the head' with no external source. Tinnitus noises are described variously as ringing, whistling, buzzing and humming.The noise/s may be heard in one ear, both ears or in the middle of the head or it may be difficult to pinpoint its exact location. The noise may be low, medium or high-pitched. There may be a single noise or two or more components. The noise may be continuous or it may come and go. Tinnitus is very common and you're not alone !
This patient education is provided in good faith to help patients and their families learn more about their medical conditions, the options available to them and the possible consequences of their decisions. This information is not intended to be used for diagnosis, or treatment of any specific individual. Please consult with your ENT doctor regarding your particular circumstances.
DR. VINCENT TANConsultant Ear, Nose and Throat, Head and Neck Surgeon,MD (UKM), MS ORL-HNS (UKM), DOHNS RCS Edinburgh (UK), MRCS Edinburgh (UK), Postgrad. Cert.in Allergy (UK), A.M. (Mal), Fellowship in Rhinology (Singapore)Fellowship in Head and Neck Oncology & Surgery (Amsterdam)