by timothy c. hain, md
northwestern university medical school, chicago il - usa

last edited: 9/8/98 - disclaimer

tinnitus treatment and relief - book  the tinnitus handbook guide - $11.96 book

causes    diagnosis    treatment    if you have tinnitus

tinnitus defined
tinnitus (pronounced "tin-it-tus") is an abnormal noise in the ear.  tinnitus is rather common -- nearly 36,000,000 americans have tinnitus and more than half of the normal population has intermittent tinnitus. about 6% of the general population has what they consider to be "severe" tinnitus.  tinnitus can come and go, or be continuous.  it can sound like a low roar, or a high pitched ring.  tinnitus may be in both ears or just in one ear.  7,000,000 americans are so severely affected that they cannot lead normal lives.

the most common types of tinnitus are ringing or hissing ringing and roaring (low-pitched hissing).  some persons hear chirping, screeching, or even musical sounds.  note however that tinnitus always consists of fairly simple sounds -- for example, hearing someone talking that no one else can hear would not ordinarily be called tinnitus -- this would be called an auditory hallucination.

what causes tinnitus?
most tinnitus comes from damage to the inner ear or cochlea. there are many other causes. ear wax can cause tinnitus. other causes include middle ear infection or fluid, an injury to the nerve from the ear to the brain, and central nervous system damage. pulsatile tinnitus (tinnitus that beats with your pulse) can be caused by aneurysms, increased pressure in the head (hydrocephalus), and hardening of the arteries.

loud noise is the leading cause of damage to the inner ear. advancing age may also be accompanied by inner ear damage and tinnitus. many medications also can cause tinnitus (see list below).

drugs that commonly cause or increase tinnitus

nsaids (motrin, naproxen, etc)
aspirin and other salicylates
lasix and other "loop" diuretics
"mycin" antibiotics
quinine and related drugs

how is tinnitus diagnosed?
persons with tinnitus should be seen by a physician expert in ear disease.  this is usually an otologist or a neurotologist (see our clinic).   there should be an examination of the ears, and hearing should be tested.  the tmj joints of the jaw should be checked as about 28% of persons with tmj syndrome experience tinnitus.  the physician may also request a baer test (clicks in ears), an mri/mra test (scan of the brain), and several blood tests (ana, fta, esr, sma-24, hba-ic, fasting glucose, thyroid screen). in persons with pulsatile tinnitus, additional tests maybe proposed to study the blood vessels and to check the pressure inside the head. based on these tests, tinnitus can be separated into categories of cochlear, retrocochlear, central, and tinnitus of unknown cause.

how is tinnitus treated?
if a specific cause for tinnitus is found, then your doctor may be able to eliminate the noise.  examples of specific causes include medication, tumors, infections, m�ni�re's disease, tmj and otosclerosis.  to find a specific cause it may require a fairly extensive workup including x-rays, balance testing and blood tests. however, even after extensive workup, most causes of tinnitus go undiagnosed.

if a specific cause of tinnitus is not found, it is unlikely that the tinnitus can be gotten rid of.  at best, one might get partial relief from some of the strategies to be described in the next few paragraphs. however, even though treatment may not be available, tinnitus should be checked into, as tinnitus may be a warning sign of a serious disorder such as a tumor of the 8th nerve, or other disorder which may impair hearing.

medicines may occasionally help lessen the noise even though no cause can be found.

medications used in treatment of tinnitus

ativan or klonapin
amitryptaline or pamelor
cytotec (300 mg tid)
lasix (40 bid)
mysoline or tegretol
verapamil or nimodipine (30 tid)

what to do if you have tinnitus?

  1. avoid exposure to loud noises and sounds.
  2. decrease your intake of salt.
  3. avoid stimulants such as caffeine and nicotine.
  4. exercise daily, get adequate rest, and avoid fatigue.
  5. avoid medications known to increase tinnitus

diet:  we recommend that persons with tinnitus limit salt (no added salt), and refrain from drinking caffeinated beverages, other stimulants (like tea), and chocolate.

hearing aids and other devices called "maskers" may also help alleviate tinnitus. if you have tinnitus associated with a hearing loss, a hearing aid is the first thing to try. be sure that you try the hearing aid before buying one, as tinnitus is not always helped by an aid.

maskers are based on the idea that tinnitus is usually worst when things are very quiet. listening to the interstation static on the fm radio, tapes of ocean surf, and the like may be helpful. pillow speakers sold by radio shack may be helpful in order to avoid disturbing others. tinnitus maskers are fitted and sold by audiologists. however, controlled studies of maskers have failed to clearly demonstrate efficacy.

psychological help: sometimes, anxiety or depression which accompanies tinnitus may be as big a problem as the tinnitus itself. in this instance, consultation with a psychologist or psychiatrist expert in this field may be helpful. hypnosis may be effective and increase tolerance to tinnitus.

surgery: only rarely is surgical treatment indicated, and even more rarely, is tinnitus relieved. you should certainly consider surgery if your tinnitus is due to a tumor. surgery may be an option to consider if your diagnosis is otosclerosis, fistula or m�ni�re's disease, or if your tinnitus pulsates with your heart.

self help:  consider joining - american tinnitus association, p.o. box 5, portland, or 97207, (503) 248-9985.  local support groups are in most major cities.

links to other tinnitus materials:

tinnitus faq sheet
tinnitus poetry

links to other related material:

northwestern otoneurology home page
education index

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tinnitus treatment and relief - book  the tinnitus handbook guide - $11.96 book

ear congestion - tinnitus resource

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