It has been estimated
that approximately 37 million Americans have tinnitus
in some form. Some are bothered by it much more than
Tinnitus is an abnormal perception of a sound which
is reported by patients that is unrelated to an external
source of stimulation. Tinnitus is a very common
disorder. It may be intermittent, constant or fluctuant,
mild or severe and may vary from a low roaring sensation
to a high pitched type of sound. It may or may not
be associated with a hearing loss. It is also classified
further into subjective tinnitus (a noise perceived
by the patient alone) or objective (a noise perceived
by the patient as well as by another listener). Subjective
tinnitus is common; however, objective tinnitus is
relatively uncommon. The location of tinnitus may
be in the ear(s) and/or in the head.
Tinnitus is a symptom much like a headache, pain,
temperature, hearing loss, or vertigo. With tinnitus,
the reported distress is usually subjective and difficult
to record and appreciate by others.
The quality of tinnitus refers to the description
by the patient of the tinnitus: it may be a ringing,
buzzing, cricket, ocean, etc., type sound. The quality
may be multiple sounds or a singular sound.
Tinnitus may be produced in one or more locations
called its site of lesion. The cause of tinnitus
may be singular or multiple. A peripheral (i.e.,
auditory nerve, or cochlea) site of lesion includes
dysfunction established within the auditory system
that extends up to but not involving the brainstem.
A central site of lesion refers to involvement of
the central auditory pathways, beginning at the brainstem
and involving other portions of the central nervous
Tinnitus is therefore, a symptom of neurotologic
disease. It may occur with a hearing loss, vertigo
or pressure symptoms in the ear or it may occur alone.
A complete cochleovestibular evaluation is necessary
in all patients with severe disabling tinnitus. The
test battery is used to attempt to establish the
site of lesion and to rule out any significant pathology,
which may require further treatment. There are many
causes just related to the ear, which would result
in tinnitus. Such things as simple ear wax in the
ear canal to other middle ear abnormalities may result
in tinnitus. Otosclerosis (fixation of the stapes
bone in the middle ear) can cause tinnitus as well
as fluid in the middle ear. There are many other
ear abnormalities which may cause tinnitus. A more
common example would be Meniere’s disease.
Sudden trauma to the inner ear such as exposure to
excessively loud sounds may result in tinnitus. Tumors
on the hearing nerve or other problems in the brainstem
or central nervous system may also cause tinnitus.
In addition, other vascular abnormalities in the
skull or base of the skull may result in tinnitus.
Measurement of Tinnitus
Since tinnitus often has a high pitch, frequency
judgements in this region normally are poor. Frequency
discrimination up to approximately 16,000 Hz (which
is the upper limit of hearing) is far less exacting
than the middle frequency region. In addition, patients
suffering from high-pitched tinnitus often have a
high frequency hearing loss, which may impair their
frequency discrimination. Therefore, test-retest
reliability in matching the frequencies of audiometer
tones to the pitch of tinnitus may be poor. An attempt
is made, however, to do pitch matching and loudness-matching.
In addition, an attempt may be made to determine
the maskability of the tinnitus (which is unrelated
to its loudness) and a determination of residual
inhibition can be made (i.e. when tinnitus is temporarily
reduced after a masking sound has been turned off.
The reduction is termed "residual inhibition").
Function of the Normal Ear
The ear is divided into three parts: an external
ear, a middle ear, and an inner ear. Each part performs
an important function in the process of hearing.
The external ear consists of the auricle (pinna)
and ear canal. These structures gather the sound
and direct it down the ear canal towards the ear
The middle ear chamber lies between the external
and the inner ear and consists of an eardrum membrane
and three small ear bones (ossicles), maleus (hammer),
incus (anvil), and stapes (stirrup). These structures
transmit the sound vibration to the inner ear. In
so doing they act as a transformer, converting the
sound vibrations in the external ear canal into fluid
waves in the inner ear.
The inner ear chamber contains the microscopic hearing
and balance nerve endings (hair cell) bather in fluid.
Fluid waves initiated by movement of the stapes bone
stimulate the delicate hearing nerve endings which
in turn transmit an electrical impulse to the brain
where it is interpreted as sound.
Types of Hearing Impairment
The external ear and the middle ear conduct the
transformed sound; the inner ear receives it. When
there is some problem in the external or middle ear,
a conductive hearing impairment occurs. When the
trouble lies in the inner ear, a sensorineural or
hair cell moss is the result. Difficulty in both
the middle and inner ear results in a mixed (i.e.,
conductive and sensorineural) impairment.
Generally, most patients will not need any medical
treatment for their tinnitus. For patients who are
greatly bothered by tinnitus, they may use come masking
techniques such as listening to a fan or radio, which
would mask some of their tinnitus. In addition, other
sound sources generators can be obtained and be adjusted
to sound-like environmental sounds and this is effective
in masking tinnitus. This generally is more advantageous
if one is attempting to go to sleep and still use
some masking device. A tinnitus masker is utilized
in some select patients. It is a small electronic
instrument built into a post-auricular hearing aid
case (over the ear). It generates a noise which prevents
the wearer from hearing his own head noise. It is
based on the principle that most individuals with
tinnitus can better tolerate outside noise than they
can their inner head noise.
Biofeedback training is effective in reducing the
tinnitus in some patients. It consists of exercises
in hourly sessions in which the patient learns to
control the various parts of the body and relax the
muscles. When a patient is ale to accomplish this
type of relaxation, tinnitus generally subsides.
Most patients have express that the biofeedback offers
them better coping skills.
Other measures to control tinnitus include making
every attempt to avoid anxiety, as this will increase
your tinnitus. You should make every attempt to obtain
adequate rest and avoid over-fatigue because generally
patients who are tired seem to notice their tinnitus
more. The use of nerve stimulants is to be avoided.
Therefore, excessive amounts of coffee and smoking
should be avoided. Tinnitus will not cause you to
go deaf and statistically, 50 percent of patients
may express that their tinnitus with time decreases
or is hardly perceptible.
Other medications have been utilized to suppress
tinnitus. Some patients benefit with these drugs
and others do not. Each patient has an individual
response to medication, and what may work for one
patient may not work for another. Some of these medications
have been proven, however, to decrease the intensity
of the tinnitus and make it much less noticeable
to the patient. There is, however, no drug, which
will remove tinnitus completely and permanently.
Some drugs will also cause tinnitus. If you have
tinnitus and are on medication, you should discuss
the symptoms of tinnitus with your physician. In
many instances, once the drug is discontinued the
tinnitus will no longer be present.
Other Sources for tinnitus information
If you desire
more information about tinnitus, you may contact
American Tinnitus Association, P.O. Box 5, and Portland,