What is chemotherapy?
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What is tinnitus? What are the causes?
What is tinnitus? What are the
causes?
Tinnitus is a symptom affecting almost 10% of the population that
can occur for a variety of reasons. The term tinnitus originates from the Latin
word “tinnire”, meaning “ringing, jingling”. Tinnitus is the perception of
sound that does not have an external source, so other people cannot hear it. People experiencing tinnitus describe these sounds in various
ways, such as a ringing, buzzing, whistling, clicking, rubbing or burbling
sound. Tinnitus is usually unilateral and transient but can also be bilateral
and prolonged. In the absence of vascular or neurologic symptoms, tinnitus can
be caused by noise, ototoxic drug exposure, etc. However, in some cases,
tinnitus may be caused by problems with the central nervous system and can be a
symptom of an underlying disease.
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Subjective
Tinnitus
Subjective tinnitus is heard only by the patient and is the most
common form of tinnitus. Subjective tinnitus can occur for a variety of
reasons, including peripheral and central hearing problems, metabolic
disorders, anxiety, depression, otologic causes and ototoxic drugs.
Otologic
Causes
●
Noise-induced hearing loss: Tinnitus is a common symptom in
individuals exposed to loud sounds and noise.
●
Sudden deafness: Viral infections, impaired blood circulation in
the inner ear, and damage to the hair cells of the cochlea can cause
sudden deafness. Sudden deafness can damage the ear and give rise to
tinnitus.
●
Presbycusis: Hearing loss that develops with aging is known as
presbycusis. The corti organ, which acts as a receptor in hearing, degenerates
with age, leading to tinnitus and hearing loss.
●
Impacted wax or foreign body in the ear: The presence of a foreign
body or untreated blockage of the ear canal from ear wax are among the causes
of tinnitus.
●
Otosclerosis: Otosclerosis causes sensitivity in the inner ear,
leading to tinnitus. Surgery can reduce the severity of tinnitus.
●
Meniere’s disease: Meniere's disease can cause hearing loss in the
inner ear, inability to hear low-frequency sounds, a feeling of congestion in
the ear, tinnitus and vertigo symptoms.
Metabolic
Disorders
●
Hyperthyroidism and hypothyroidism can cause tachycardia and
irregularities in cardiac output, leading to tinnitus. Especially in
hyperthyroidism, severe tinnitus may be observed.
●
Hyperlipidemia may cause narrowing of blood vessel diameters,
leading to tinnitus due to insufficient blood supply.
●
Zinc deficiency may cause tinnitus. Treating zinc deficiency can
help relieve tinnitus symptoms, especially in the elderly.
●
Diabetes can cause tinnitus by affecting the central and
peripheral nervous system.
●
Vitamin deficiencies: Vitamin B12 deficiency can cause neurologic
pathology, which can affect the auditory pathways and cause dysfunction and
tinnitus.
Neurological
Disorders
●
Head injuries: Tinnitus can occur following head trauma, such as a
skull fracture. It usually develops a week or ten days after the trauma.
●
Meningitis can cause severe tinnitus due to the development of
infection and impairment of the central nervous system.
●
Multiple sclerosis can cause severe tinnitus by affecting the
central nervous system.
●
Cerebellopontine angle tumors can cause unilateral hearing loss
and tinnitus. Sensorineural hearing loss associated with vertigo is frequently
observed.
Pharmacological
Causes
●
Sedatives, diuretics, narcotics, beta blockers, antihistamines,
calcium channel blockers, antidepressants, antibiotics, ACE inhibitors and
nonsteroidal anti-inflammatory drugs can cause tinnitus.
Psychological
Causes
●
Tinnitus can occur in people receiving psychiatric treatment for
depression, distress and anxiety.
Objective Tinnitus
Objective tinnitus is a perceived sensation of sound that
occurs in the absence of external acoustic stimulation, but it can also be
heard by the examiner, e.g. by placing a microphone or stethoscope over the
patient's external auditory canal. Objective tinnitus results from transmission
of rhythmic and pulsatile sounds generated near the ear from vascular noises,
muscular contractions or joint sounds. It is a rare condition that can be
caused by brain and neck tumors or structural disorders in the vessels, nerves,
muscles or inner ear. Pulsatile tinnitus that develops unilaterally should be
taken seriously and referred to a specialist physician. The causes of objective
tinnitus include:
●
Vascular anomalies: Arterial tinnitus is usually a
sharp beating sound that is in sync with the pulse. Venous tinnitus, on the
other hand, is a low-frequency, low-intensity buzzing sound, similar to the
noise of a machine with rhythmic accents.
●
Hypertension : Hypertension is a common cause of
objective tinnitus.
What are the symptoms of tinnitus?
Tinnitus is a symptom characterized by the perception
of various sounds in the ear and head, such as rustling, ringing, buzzing or
humming. These sounds can be heard
constantly or intermittently and can vary in intensity. In addition to tinnitus
symptoms, headaches, vertigo-like dizziness, hearing loss or hearing disorders,
stress and sleep problems may also occur.
Tinnitus symptoms and their severity may vary from person to
person. Tinnitus can be a harbinger of serious diseases. Therefore, if you have
chronic tinnitus symptoms or if these symptoms have reached a level that
negatively affects your daily life, it is recommended to consult an
otolaryngologist.
How is tinnitus diagnosed?
A detailed history should be taken from patients who complain of
tinnitus. The patient should describe in detail how and when they experience
ringing or other noises in one or both ears. If tinnitus is caused by exposure
to noise or ototoxic drugs, detailed examination may not be necessary provided
that there are no vascular or neurological symptoms accompanied by symmetrical
hearing loss indicating other disorders. In general, tinnitus is diagnosed as
follows:
●
First, your doctor will ask you about the mode of onset. Tinnitus
with progressive hearing loss usually occurs with aging, while sudden onset may
be due to acoustic causes or head trauma.
●
A nasal examination is performed to confirm any allergies.
●
Cervical spine evaluation is performed to confirm arthritis and/or
trauma.
●
Any murmur detected during stethoscope examination is evaluated as
to whether it is in sync with the pulse.
●
It is confirmed whether there is any change in tinnitus during
head movement.
●
An audiometric examination is performed to detect hearing loss
accompanying tinnitus.
In cases of suspected overexposure to ototoxic drugs, heavy metals,
pollutants and carbon monoxide, complete blood count, erythrocyte sedimentation
rate, autoimmune disease evaluation, blood glucose and TSH measurement and
radiological examinations (direct radiographs, brain tomography, MRI,
angiography) can also be performed.
How is
tinnitus treated?
Once tinnitus has been diagnosed, treatment methods are determined
according to the underlying condition. Since tinnitus usually manifests as a
symptom, treatment of the underlying disease often provides relief from
tinnitus. Tinnitus treatment methods can be classified as follows:
●
Medical treatment: Medical treatment methods for tinnitus include
local anesthetics, antidepressants, benzodiazepines, antihistamines,
anticholinergic, antiadrenergic and anticonvulsant drug groups, vitamin
supplements, ginkgo biloba extracts.
●
Masking therapy: Hearing aids, tinnitus devices and maskers are
actively used in tinnitus treatment. These devices produce constant,
non-disturbing sounds allowing the person to shift their attention away from
the tinnitus.
●
Electrotherapy: Biofeedback, electrical stimulation,
transcutaneous electrical nerve stimulation (TENS) and acupuncture can be
effective in treating tinnitus.
●
Psychological treatment: Tinnitus habituation therapy (THT),
hypnosis, psychotherapy and meditation methods can provide tinnitus relief and
improve quality of life through psychological support.
●
Surgical treatment: Surgical methods are preferred in cases of
inner ear damage, tumor presence, fluid accumulation and Meniere's disease.
●
New approaches: New treatment approaches, such as laser therapy
and magnetic stimulation, can also alleviate tinnitus.
●
Intratympanic treatment methods, such as dexamethasone
administration, have proven to be successful in treating tinnitus associated
with Meniere's disease, sudden hearing loss, and autoimmune inner ear disease,
especially when characterized by inner ear damage.
Tinnitus is a symptom that, depending on its severity, can have a
big impact on a person's social life, work efficiency and psychological state.
If you are struggling with tinnitus, you should contact a specialist physician
as soon as possible to discuss and find the treatment method that works best for you.
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