Tinnitus: Overview

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Tinnitus means you hear a sound in the absence of an external sound. It is a common symptom affecting nearly 36 million Americans.

Tinnitus is not a single entity but rather a diverse group of disorders. Despite symptoms that indicate the ear is the site of the pathology, there is strong evidence that most forms of severe tinnitus are caused by functional changes in the brain/central nervous system. The changes are induced through expression of neural plasticity, some of which may have been caused initially by abnormalities in the ear or the auditory nerve. The involvement of the nonclassical ascending auditory pathway with its subcortical connections to limbic structures (the amygdala) may explain some of the symptoms of some forms of tinnitus including hyperacusis and affective disorders, such as phonophobia and depression, which often accompany severe tinnitus.

Moller, A. R. (2003). “Pathophysiology of tinnitus.” Otolaryngol Clin North Am 36(2): 249-66, v-vi.

The phantom sounds are associated with numerous conditions:

  • Loud noise causing acoustic trauma
  • Ototoxic medication
  • Head trauma
  • Middle ear fluid/infection
  • Otosclerosis
  • Ménière’s disease
  • Increasing age
  • Psychological disorders (stress, anxiety, depression)
  • Chronic pain syndromes
  • TMJ dysfunction
  • Thyroid problems
  • Genetics

Tinnitus symptoms are often exacerbated by drugs:

  • High dose aspirin
  • Tobacco
  • Caffeine
  • Alcohol
  • Oral contraceptives
  • Quinine (pills, tonic water)

Episodes of illness, fatigue, hypertension, psychological stress, and depression can also exacerbate or trigger the production or perception of tinnitus.

Spasm of 1 of 2 tiny muscles attached to the middle ear bones (myoclonus) can cause an intermittent, beating type sound.

Pulsatile tinnitus is when you hear your heartbeat. The most common cause is turbulent venous or arterial blood flow through the skull bone near your ear. This can occur from high blood pressure. Rare causes include anatomic anomalies and vascular tumors.

Evaluation for Tinnitus:

A workup for tinnitus includes a complete history and physical examination to try and pinpoint a cause. Audiologic testing is usually needed to assess for hearing loss or middle ear disease.

Rikki Green, AuD is our Doctor of Audiology trained audiologist.

We provide full service adult and pediatric audiology testing including:

  • Audiograms
  • Tympanograms
    • Measures ear drum movement to assess for middle ear negative pressure / fluid
  • Otoacoustic Emission Testing
    • This tests the function of the outer hair cells in the inner ear
    • This test is very helpful in young children when audiograms may not be possible

Prevention of noise damage is very important.

Dr. Rikki Green can discuss with you advanced noise protection options including custom molded ear plugs and musician in the ear monitors.

Tinnitus Treatment Options: Unfortunately, there is no single effective cure for the majority of tinnitus patients.

  • Background white noise from a fan or sound machine at bedtime can help mask the sensation
  • Hearing aids can inhibit the brain’s attempt to amplify sound perception
  • Tinnitus maskers are helpful in some patients
  • Stress reduction
  • Biofeedback
  • Sound/acoustic therapy
  • Tinnitus retraining therapy
  • Cognitive behavioral therapy
  • Antidepressants are helpful in some depressed patients
  • Contact Dr. Rikki Green for more information

If you have tinnitus problems, please call (503) 257-3204 or request a visit online with us.