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EDUCATION Committed to YOUR Well-being...
Vincent’s S.C.A.N.S 
Ear, Nose and Throat (ENT), Head and Neck Surgery
Specialist Clinic
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 sound   Understanding 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 happy Although   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   focusing    on   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   noise    as   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 !
If only tinnitus sounds like Mozart or Beethoven...
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.
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Last update:  10/1/13 
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Tinnitus    (Ringing sound)
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D R. V INCENT T AN Consultant 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)
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