WE LOOK FOR THE MOST ADEQUATE TREATMENT FOR RINGING AND BUZZING IN THE EARS
Noise society: How does it affect our noise?
What is tinnitus?
Tinnitus is the perception of sounds or noise without an external source being present to produce these sounds. Tinnitus can be perceived in multiple ways: as a ringing or buzzing noise, as a cricket sound, as murmur of the sea, as timbre, etc. The perception of this sound or noise can either be continuous or intermittent. It can also be unilateral, bilateral, or it can be perceived throughout the entire head.
Although we will all have experienced some noise in our ears or heads from time to time, many of us experience them permanently. This may, to a certain degree, cause disturbance or interference in the quality of life of those affected.
Tinnitus is not always associated with hearing loss, nor is its occurrence an indication of imminent deafness. Some 30% of people affected by significant deafness are not affected by tinnitus while approximately 18% of the population suffer from some kind of tinnitus.
What are the causes?
Tinnitus can have various causes. We distinguish between three principal causes as triggers of tinnitus:
- Lesions of the auditory canal causing hearing loss: ageing of the ear, various outer, middle and inner ear diseases, acoustic trauma, ear infections, Menière's vertigo, etc.
- Bad postures which primarily affect the temporomandibular and cervical muscles: grinding teeth during sleep, as well as other bad craniofacial habits, cervical arthrosis, contractures, variations in the normal position of the back, etc.
- Stress (at work, within the family, etc.) With regard to stress, it is important to emphasise that there is evidence of increased brain activity in the auditory and the limbic area of tinnitus patients, which is the part of the brain that is responsible for emotions.
How is tinnitus perceived by patients?
Luckily, the majority of patients affected by tinnitus gradually get accustomed to it. However, approximately 10% of patients suffer major repercussions such as loss of concentration, difficulty falling asleep and/or intense emotional distress, which may even lead to depression.
In these cases, patients enter a circle which is difficult to control. The more a patient becomes obsessed with their tinnitus, the greater the stimulation of the brain areas involved and the worse their situation. In these cases, patients will widely search for any treatment that offers them some hope. However, this search will usually be met with few favourable replies, which will add to the patients' discouragement.
In approximately 40% of cases, patients will also experience heightened sensitivity and a lower tolerance of external sounds. This phenomenon is called hyperacusis.
How is tinnitus diagnosed?
The first step in the diagnosis of tinnitus is to consult a specialised otorhinolaryngologist in order to determine the cause (if possible) and to establish an appropriate treatment.
At our Tinnitus Unit, we offer patients an exhaustive screening in order to attempt to identify the cause of their tinnitus. In each case, we will perform all necessary tests.
- Screening for tender spots in the craniofacial and neck area
- Tinnitometry in order to identify the exact type of the patient's tinnitus
- Discomfort threshold
- Complementary tests (analytical tests, CT, MRI, angio MRI, cervical X-rays, echo Doppler test)
- Tinnitus severity questionnaire
How is tinnitus treated?
The treatment of tinnitus depends on its cause. If the tinnitus continues to persist despite treatment, we will use one or more of the following available treatments:
- Medication. The most common method involves the use of cerebral vasodilators. This treatment continues to be used as, in some cases, a decrease in the intensity of the tinnitus can be achieved. In other cases, it may even disappear completely. If this approach proves ineffective, we will use other alternatives aimed at controlling the excitatory activity in the brain. In these cases, we will use melatonin, sulpiride, hydroxyzine, Lyrica, etc. Depending on the individual requirements, we may also add anxiolytics such as alprazolam or amitriptyline. If the treatment is unsuccessful, we will resort to the following options:
- TRT ("Tinnitus Retraining Therapy"). This is currently the most frequently used treatment method. Its objective is to get the patient accustomed to their tinnitus, with the result that the tinnitus will no longer be consciously perceived. It involves therapeutic counselling (detailed explanation of the problem) and "sound therapy" (in order to weaken the perception of the sound). For sound therapy, it may be recommended to use so-called "sound generators", which, in the case of patients with significant associated hearing loss, are coupled with conventional hearing aids. Rehabilitation. If a muscle contracture or a bad posture is identified as the cause, the patient is referred on to rehabilitation.
- Tinnitus masker. This is a device which is worn like a hearing aid and emits quiet sounds directly into the ear or obscures the tinnitus. It inverts the sound waves of the tinnitus and thus makes it disappear for a variable amount of time (minutes, hours or even days).
- Hearing aid. If the patient suffers from hearing loss, their tinnitus often disappears or improves upon fitting a hearing aid. This can be achieved because the patient now hears noises from their environment instead of their own tinnitus.
Treatment at the Tinnitus Unit
During a first visit, the specialist performs various tests with the patient. These include:
- Tinnitometry, which permits an evaluation of the frequency and intensity of tinnitus episodes.
- Audiometry, with the objective of measuring alterations in hearing in relation to acoustic stimuli.
- Otomicroscopy, in order to examine the ears by means of an optical microscope.
Depending on the results of the tests performed, the subsequent step will be:
- If the screening of the ear produces abnormal results, among other things an evaluation of whether the discomfort is caused by ear wax blockage or by a tumour is performed and the cause of the discomfort is corrected.
- If the screening of the ear produces normal results, the specialist will request a CT, MRI or echo Doppler scan, if required. Once a diagnosis has been made, the tinnitus will be treated by means of medication, a tinnitus masker, a hearing aid or retraining therapy.