Information on tinnitus
What is tinnitus?
A wild night of partying, a good concert or simply working with loud machines. Everyone has probably experienced the buzzing, humming and whistling that follows at some point in their life. Sometimes these ear noises come on spontaneously and for no apparent reason, but then disappear again on their own.
Almost 15% of all adults experience a longer period of tinnitus at some point in their lives, and up to 20% of those affected are so affected by the tinnitus that they can no longer carry out their everyday tasks properly. Most cases in which tinnitus manifests itself affect patients who are 45 years old or older; only rarely are cases reported in which children also suffer from tinnitus.
Ear noises that last longer than 3 months are referred to as tinnitus
Some people, however, experience this more frequently and for much longer. If ear noises last longer than three months, it is generally referred to as tinnitus. The symptoms are usually annoying but mild, so that most sufferers have come to terms with it and have eventually blocked out the noises. In some cases, however, the tinnitus is so severe that the affected patients' quality of life is very limited, they feel disturbed in their concentration, are constantly tense and also have problems sleeping as a result.
What types of ear noises can occur?
Tinnitus, translated into English, means something like "ringing". Those affected hear noises such as rushing, humming, buzzing, clicking or even whistling. It can only be perceived in one ear, but can also occur in both ears. Some patients describe the noise as coming from the head, while others claim that it comes from outside. Tinnitus, which does not have to be permanently active but also has phases in which it is more and less pronounced, does not necessarily lead to hearing loss or be the trigger for hearing loss. People who have tinnitus can usually hear normally.
Causes of tinnitus
In most cases, tinnitus is caused by trauma. Excessive noise, being in noisy environments or a loud bang from an explosion or gunshot can destroy or traumatize the sensory cells in the inner ear that conduct sound to such an extent that they can lead to tinnitus. However, there are other factors that can lead to tinnitus:
- Chronic middle ear infections
- Traumatized eardrum
- Blockage of the ear canals by earwax
- Sclerosis of the inner ear or middle ear
- Meniere's syndrome
- Craniomandibular dysfunctions that can lead to tinnitus
Sometimes patients also describe tinnitus that is synchronized with the heartbeat, in which case it is referred to as pulse-synchronous tinnitus, which is often triggered by a disorder in the blood vessels. This can be caused by, among other things, a narrowing (stenosis), a tumor or an unwanted short-circuit connection of the arterial and venous system, a so-called AV fistula.
Even though tinnitus is also described as a rare consequence of medication in cancer and malaria therapy, in the vast majority of cases no explanation can be found for the development of tinnitus. Doctors then speak of primary or idiopathic tinnitus.
Grading of tinnitus
In order to be able to classify tinnitus, it is divided into different grades:
Grade 1: Tinnitus is well compensated and does not bother the affected person.
Grade 2: Well compensated, perceived as disturbing when under stress or when concentrating.
Grade 3: Tinnitus has a negative impact on the professional and private life of those affected, resulting in physical, emotional and cognitive disorders.
Grade 4: The effects are so severe that those affected can no longer work, and psychosocial isolation usually occurs, accompanied by anxiety, depression and resignation.
Why and how exactly tinnitus is caused by noise trauma has not yet been sufficiently clarified. It is assumed that the disturbed sensory cells in the brain are permanently active and therefore always transmit signals to the hearing center, which can be reflected in the symptoms mentioned above.
How does the doctor diagnose tinnitus?
The ENT doctor first clarifies the patient's medical history and asks about the symptoms: What do the noises sound like, when and how often do they occur and with what intensity, are there other symptoms such as ear pain or a feeling of pressure in the ears? Are both ears affected or just one? If, for example, there is one-sided tinnitus that is accompanied by other symptoms, the cause can be quickly determined and the tinnitus treated. It is also important whether and which medication the patient is taking: Acetylsalicylic acid can trigger tinnitus in very high doses.
The examination and questioning of the patient's symptoms and medical history is usually followed by a physical examination: The doctor listens to the vessels in the head and neck area, arranges a dental examination to rule out jaw joint problems as the cause and uses special hearing tests to make a reliable diagnosis. He uses tests such as ear microscopy, balance testing, nasopharyngoscopy (nasopharyngeal endoscopy) or brain stem audiometry to rule out disorders of the nerve itself.
With the help of the results, the doctor can now decide which type of tinnitus is present. He distinguishes between:
Primary and secondary tinnitus: Primary tinnitus has no precise underlying cause, while secondary tinnitus can very well be attributed to a clear cause (e.g. acoustic trauma).
Subjective and objective tinnitus: Subjective tinnitus is only heard by the affected person themselves; the disorders can range from the hearing organ to the sensory cells. Objective tinnitus can also be heard by another person or detected using impulses, for example if it is caused by blood vessels or if the disorders lie in the impulse processing of the auditory nerves.
Acute and chronic tinnitus: Acute tinnitus can occasionally occur, provided the symptoms do not last longer than three months. If the duration exceeds three months, doctors already speak of chronic tinnitus.
By protecting themselves from loud noises, the patient can greatly reduce the risk of developing tinnitus or making an existing tinnitus worse.
Tinnitus treatment
The cause of tinnitus usually also determines the prognosis and prospects of success. For example, if there is a clearly identifiable reason for the occurrence of tinnitus, the disease can be identified and treated. It becomes more difficult when the causes are unclear; in these cases, the specialist tries to alleviate the symptoms to the extent that the patient can lead a relatively normal life.
Therapy for acute tinnitus
In the case of acute tinnitus, it is important to start therapy as soon as possible after the first symptoms appear; the sooner intervention is made, the better the chances of recovery:
Cortisone therapy is used if an inflammatory cause is suspected.
Infusion therapy is used to promote blood flow to the ears. Physiotherapeutic measures if misalignments of the cervical spine are the cause of tinnitus.
Hyperbaric therapy (pressure chamber therapy)
Treatment of chronic tinnitus
Chronic tinnitus is usually treated conservatively, because some patients suffer from tinnitus for years and have to learn to deal with this illness. The main thing is to reduce stress and stabilize the human psyche. Cognitive behavioral therapy, as one of many psychological solutions, can help those affected to deal with tinnitus.
Using so-called tinnitus markers, you can try to drown out the ringing in the ears. The devices produce a frequency that is intended to cover or “mask” the symptoms of tinnitus. These devices are often accompanied by a long training program (tinnitus retraining therapy, TRT), in which the patient customizes the hearing aid to their illness in numerous sessions.
If there is hearing loss in addition to tinnitus, hearing aids can provide relief. A cochlear implant, for example, which is implanted directly into the inner ear, can restore hearing by electrically stimulating the auditory nerves, and in many cases also reduces the symptoms of tinnitus.
Which doctors and clinics are specialists in treating tinnitus?
If you experience ringing in your ears, ENT doctors are the first point of contact to differentiate tinnitus from other causes. Initial treatment measures for acute tinnitus can be initiated in an ENT clinic. In the case of chronic tinnitus with severe restrictions in everyday life due to the ringing in your ears, outpatient or inpatient psychotherapy is often helpful. Bonn University Hospital is one of the best hospitals in Germany.
