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Tinnitus (TIN-ih-tus) is the perception of noise being heard in the ear or ears. It is estimated that up to 20% or more of Americans experience tinnitus. It is often described as a high-pitched ringing noise, but can also sound like roaring, clicking, hissing, humming, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears. The vast majority of tinnitus is not an actual sound - it is the perception of a sound - the brain's interpretation of an abnormal nerve signal. Although bothersome, tinnitus is often associated with other conditions, especially hearing loss, or a circulatory system disorder so it is important to have it evaluated. Tinnitus can worsen with age but, for many people, tinnitus can improve with treatment.
Your doctor will examine your ears, head and neck to look for possible causes of tinnitus and will conduct tests.
Hearing (audiological) exam. An audiologist will conduct this test using earphones through which will be played specific sounds into one ear at a time. You'll indicate when you can hear the sound, and your results are compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus. Your doctor will review this with you.
Movement. Your doctor may ask you to move your eyes, clench your jaw, or move your neck, arms and legs. If your tinnitus changes or worsens, it may help identify an underlying disorder that needs treatment.
Imaging tests. Depending on the suspected cause of your tinnitus, you may need imaging tests such as CT or MRI scans.
Tinnitus is often related to underlying hearing loss. It can also be seen in association with many other problems including Ménière's disease, tumors of the hearing and balance nerve, hypertension, stress, and certain medications. It can occasionally be related to abnormal blood flow/blood vessel abnormalities.
The difference between tinnitus being a minor or major issue in a patient's life is less often related to how loud tinnitus is, but how the patient feels their tinnitus affects the quality of their life. In some patients tinnitus can cause depression or insomnia.
In patients who already have hearing loss, the use of hearing aids will often suppress the tinnitus while the hearing aids are in use, and in some patients even after they are removed.
If tinnitus is due to a health condition, your doctor may be able to take steps that could reduce the noise. For example earwax removal, treating a blood vessel condition that may require medication, surgery or another treatment to address the problem, changing a medication that to be the cause of tinnitus, your doctor may recommend stopping or reducing the drug, or switching to a different medication.
In some cases white noise may help suppress the sound so that it's less bothersome. Your doctor may suggest using an electronic device to suppress the noise. White noise machines produce simulated environmental sounds such as falling rain or ocean waves, and can be an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans, humidifiers, dehumidifiers and air conditioners in the bedroom also may help cover the internal noise at night. Hearing aids can be especially helpful if you have hearing problems as well as tinnitus. Masking devices worn in the ear and similar to hearing aids, produce a continuous, low-level white noise that suppresses tinnitus symptoms. Tinnitus retraining can include a wearable device that delivers individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Over time, this technique may accustom you to the tinnitus, thereby helping you not to focus on it. Counseling is often a component of tinnitus retraining.
There is no FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo. In some cases medications may help reduce the severity of symptoms or complications. For example tricyclic antidepressants have been used with some success. However, these medications are generally used for only severe tinnitus, as they can cause troublesome side effects, including dry mouth, blurred vision, constipation and heart problems.
There's little evidence that alternative medicine treatments work for tinnitus. However, some alternative therapies have been tried for tinnitus such as acupuncture, hypnosis, ginkgo biloba, zinc supplements and B vitamins.
Neuromodulation using transcranial magnetic stimulation (TMS) is a painless, noninvasive therapy that has been successful in reducing tinnitus symptoms for some people. Currently, TMS is utilized more commonly in Europe and in some trials in the U.S. It is still to be determined which patients might benefit from such treatments.
Cognitive behavioral therapy (CBT) uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Patients usually keep a diary and perform "homework" to help build their coping skills. Therapy is generally short-term — for example, weekly sessions for two to six months. Some studies have found that after CBT, the sound was no less loud, but it was significantly less bothersome, and patients' quality of life improved.
Tinnitus retraining therapy (TRT) is based on the assumption that tinnitus results from abnormal neuronal activity. The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy. A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. Depending on the severity of the symptoms, treatment may last one to two years.
Tinnitus is stressful, and stress can worsen tinnitus. Biofeedback is a relaxation technique that helps control stress by changing bodily responses. Electrodes attached to the skin feed information about physiological processes such as pulse, skin temperature, and muscle tension into a computer, which displays the output on a monitor. Patients learn how to alter these processes and reduce the body's stress response by changing their thoughts and feelings. Mindfulness-based stress reduction techniques may also help.
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