After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of the tinnitus, i.e., what has caused it, and your options for treatment.
In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a permanent disability that the patient will have to "live with." Some otolaryngologists have recommended niacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing
2006-10-27 00:49:52
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answer #1
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answered by shirley e 7
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Tinnitus (ti-NIGHT-us or TIN-i-tus[1]) is the perception of sound in the absence of a corresponding external sound. It can be perceived in one or both ears or in the head. Tinnitus is the Latin word for "ringing"[2], and usually it is described as a ringing noise, but some describe it as a buzzing, humming, or whistling sound, tunes, or songs. [3]. It has also been described as a "whooshing" sounds, as of wind or waves [4].
Tinnitus is not itself a disease, but an unwelcome symptom resulting from a range of underlying causes, including ear infections, foreign objects or wax in the ear, and injury from loud noises, as may have been experienced by war veterans (bombardments, shelling, etc.).
The sound perceived may range from a quiet background noise to a signal loud enough to drown out all outside sounds. The term 'tinnitus' usually refers to more severe cases. A 1953 study (Heller and Bergman) of 80 tinnitus-free university students placed in a soundproofed room found that 93% reported hearing a buzzing, pulsing or whistling sound. However, it must not be assumed that this condition is normal -- cohort studies have demonstrated that damage to hearing from unnatural levels of noise exposure is very widespread in industrialized countries.[5] (see noise health effects)
Because tinnitus is often defined as a subjective phenomenon, it is difficult to measure using objective tests, such as by comparison to noise of known frequency and intensity, as in an audiometric test. The condition is often rated clinically on a simple scale from "slight" to "catastrophic" according to the practical difficulties it imposes, such as interference with sleep, quiet activities, or normal daily activities.[6] For research purposes, the more elaborate Tinnitus Handicap Inventory [7] is often used.
Objective tinnitus
In a minority of cases, a clinician can perceive an actual sound (e.g., a bruit) emanating from the patient's ears. This is called objective tinnitus. Objective tinnitus can arise from muscle spasms that cause clicks or crackling around the middle ear.[8] Some people experience a sound that beats in time with the pulse (pulsatile tinnitus)[9]. Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear (such as from atherosclerosis or venous hum[10]), but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.[11] Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm[12] or dissection[13] .
[edit] Causes of subjective tinnitus
Tinnitus can have many different causes, but most commonly results from otologic disorders - the same conditions that cause hearing loss. The most common cause is noise-induced hearing loss, resulting from exposure to excessive or loud noises. Ototoxic drugs can cause tinnitus either secondary to hearing loss or without hearing loss, and may increase the damage done by exposure to loud noise, even at doses that are not in themselves ototoxic.[14]
Causes of tinnitus include:[15]
Otologic problems and hearing loss:
conductive hearing loss
external ear infection
cerumen (earwax) impaction
middle ear effusion
sensorineural hearing loss
excessive or loud noise
presbycusis (age-associated hearing loss)
Meniere's disease
acoustic neuroma
ototoxic medications
analgesics:
aspirin
nonsteroidal anti-inflammatory drugs
antibiotics:
aminoglycosides
chloramphenicol
erythromycin
tetracycline
vancomycin
chemotherapy drugs:
bleomycin
cisplatin
mechlorethamine
methotrexate
vincristine
loop diuretics:
bumetanide
ethacrynic acid
furosemide
others:
chloroquine
quinine
mercury
lead
neurologic disorders:
multiple sclerosis
head injury
skull fracture
closed head injury
whiplash injury
temporomandibular joint disorder
metabolic disorders:
thyroid disorder
hyperlipidemia
vitamin B12 deficiency
psychogenic disorders:
depression
anxiety
other disorders:
fibromyalgia
[edit] Mechanisms of subjective tinnitus
The inner ear contains thousands of minute hairs which vibrate in response to sound waves. Receptor cells (hair cells) in turn send signals to the brain, which are interpreted as sound. Although receptor cells can be regenerated from the adjacent supporting Deiters cells after injury in birds, reptiles, and amphibians, in mammals it is believed that they can be produced only during embryogenesis. Although mammalian Deiters cells reproduce and position themselves appropriately for regeneration, they have not been observed to transdifferentiate into receptor cells except in tissue culture experiments.[16][17] Therefore, if these hairs become damaged, through prolonged exposure to excessive decibel levels, for instance, then deafness to certain frequencies occurs. In tinnitus, they may falsely relay information at a certain frequency that an externally audible sound is present, when it is not.
The mechanisms of subjective tinnitus are often obscure. While it is not surprising that direct trauma to the inner ear can cause tinnitus, other apparent causes (e.g., TMJ and dental disorders) are difficult to explain. Recent research has proposed that there are two distinct categories of subjective tinnitus: otic tinnitus, caused by disorders of the inner ear or the acoustic nerve; and somatic tinnitus, caused by disorders outside the ear and nerve, but still within the head or neck. It is further hypothesized that somatic tinnitus may be due to "central crosstalk" within the brain, as certain head and neck nerves enter the brain near regions known to be involved in hearing.
[edit] Prevention
Because tinnitus and hearing loss can be permanent conditions, precautionary measures are advisable. If a ringing in the ears is audible after exposure to a loud environment, such as a rock concert or work place, it means that damage is being done. Prolonged exposure to noise levels as low as 70 dB can result in damage to hearing (see noise health effects). If it is not possible to limit exposure, earplugs or ear defenders should be worn. For musicians and DJs, special musicians' earplugs can lower the volume of the music without distorting the sound and can prevent tinnitus from developing in later years.
It is also important to check medications for potential ototoxicity. Ototoxicity can be cumulative between medications, or can greatly increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.[18]
[edit] Tinnitus treatment
There are many treatments that are effective for tinnitus resulting from a particular cause, but none that are effective in every case. Conversely, tinnitus may resolve without any treatment. Effective treatments include:
Objective tinnitus:
Gamma knife radiosurgery (glomus jugulare)[19]
Shielding of cochlea by teflon implant[20]
Botulinum toxin (palatal tremor)[21]
Propranolol and clonazepam (arterial anatomic variation)[22]
Subjective tinnitus:
Drugs and nutrients
Avoidance of caffeine, nicotine, salt[23] [24]
Avoidance of or consumption of alcohol[25]; [26]
Zinc supplementation (where serum zinc deficiency is present)[27][28][29]
Acamprosate [30]
Etidronate or sodium fluoride (otosclerosis)[31]
Lignocaine or anticonvulsants (usually in patients responsive to white noise masking)[32]
Carbemazepine[33]
Melatonin (especially for those with sleep disturbance)[34]
Sertraline [35]
Chiropractic Adjustments to the spine and/or tmj.
Electrical stimulation
Transcranial magnetic stimulation or transcranial direct current stimulation [36][37]
Transcutaneous electrical nerve stimulation[38]
Direct stimulation of auditory cortex by implanted electrodes[39]
Surgery
Repair of perilymph fistula [40]
External sound
Tinnitus masking (white noise)
Tinnitus retraining therapy[41][42]
Auditive stimulation therapy (music therapy)[43]
Compensation for lost frequencies by use of a hearing aid. [1]
Ultrasonic bone-conduction external acoustic stimulation[44][45]
Avoidance of outside noise (exogenous tinnitus)[46]
Psychological
Cognitive behavior therapy[47]
A Tinnitus FAQ lists many other potential therapies.
Although there are no specific cures for tinnitus, anything that brings the person out of the "fight or flight" stress response helps symptoms recede over a period of time. Calming body-based therapies, counselling and psychotherapy help restore well-being, which in turn allows tinnitus to settle. Chronic tinnitus can be quite stressful psychologically, as it distracts the affected individual from mental tasks and interferes with sleep, particularly when there is no external sound. Additional steps in reducing the impact of tinnitus on adverse health consequences include: a review of medications that may have tinnitus as a side affect; a physicial exam to reveal possible underlying health conditions that may aggrevate tinnitus; receiving adequate rest each day; and seeking a physician's advice concerning a sleep aid to allow for a better sleep pattern.
A newer approach to tinnitus treatment, developed by The Ear Research Foundation, involves clinical psychology. The role of the psychologist, as a vital member of the treatment team, is to assist patients in “retraining their brain”, so they can deal with their tinnitus and minimize the difficulties it creates in their lives. While working with the psychologist, patients are taught new ways of living with tinnitus, managing stress, and improving the quality of their life.
Common Sense Remedies Avoid alcohol, smoking, and caffeine; they can make tinnitus worse.
Cut down on salt in your diet. Salt can cause fluid to build up in your ears, worsening tinnitus.
Tone down sound around you. Avoid loud noises, which can aggravate a case of tinnitus you already have. Wear earplugs whenever noise abounds. You can use foam, rubber or moldable wax plugs. You can also use headphones you wear like earmuffs.
Some people don't notice their tinnitus in the daytime, but as soon as the lights go out, they're up to their inner ears in bells and buzzers. In this case turn on an FM radio; tune it so that it will point to the static between stations. If you keep the radio near the bed just loud enough to be audible, the static near your head will mask the sounds in your head and let you fall asleep. You can also use music to soothe you to sleep. Or record a 'white noise' tape, such as of running water, and play it whenever you need relief.
Some people can't hear their tinnitus when they take showers. You can carry shower sounds around with you. How? Make a long-playing tape of a running shower. When the tinnitus gets bad, listen to the tape through headphones.
Stress was found to make tinnitus worse. So, relaxation and stress management techniques also are useful. Deep, slow breathing is one safe way to ease tension. However, this may not be enough. See a counselor if you're having difficulty dealing with stress in your life and your tinnitus is becoming worse because of it.
Avoid too much aspirin. If you take aspirin daily (for arthritis, for example), try a different anti-inflammatory drug if you are suffering from tinnitus. Aspirin can cause or worsen tinnitus. Some of the other anti-inflammatory drugs can also cause or worsen tinnitus, but not in everyone.
Distraction is an effective technique to combat tinnitus. Focus on some outside activities: Help other people. Join some volunteer groups. Enrich rather than restrict your life.
Increase circulation to the ear area by massaging or applying a hot compress on the neck before going to bed. Dip a small towel into hot water, wring out, place on neck and place a dry towel over it.
Stimulate overall circulation with alternating hot and cold foot baths every evening.
Place a small cotton pouch filled with 3 tbsp. each of hot roasted millet seeds and salt on one ear. Leave on for ten minutes.
Regularly chew dried fruit. It increases circulation to the ear area.
An occlusal splint can help stop teeth grinding, which is known to cause tinnitus.
2006-10-27 00:52:03
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answer #9
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answered by Alen 4
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