DISEASES OF EAR:TINNITUS

Perception of ringing sound/noise heard in the ear and not from any external source. 

Mostly unilateral, can be bilateral.

The sounds heard are variously described by the patients(other than ringing) as: hissing, buzzing, rustling etc.

TYPES:

1. Subjective: Heard by the patient(subject)
2. Objective: Heard by the physician by the help of stethoscope
3. Pulsatile and non-pulsatile (by nature)
4. Acute(where patients "experience" it) and chronic (patients "suffer" for six or more months)

PREVALENCE: Men>women, incidence increases with age, smokers(high risk)

ETIOLOGY:

Vascular lesions most commonly give rise to pulsatile/objective tinnitus. 

DIAGNOSIS:

Tinnitus is frequently associated with hearing loss or other cochlear injury.

HISTORY TAKING: 

Appropriate history should include 

1. Description of the tinnitus: 

•  episodic or constant,
•  pulsatile or non-pulsatile,
•  rhythmicity,
•  pitch(quality of the sound)
•  inciting or alleviating factors. 

    2. History of past complaints :previous ear disease, noise exposure, hearing status, head injury, and symptoms suggesting temporomandibular joint (TMJ) syndrome

3. History of past illness: hypertension, atherosclerosis, neurologic illness, and prior surgery.

PHYSICAL EXAMINATION:

( A complete head and neck examination)

•  Including cranial nerve examination (Click here to know more)
•  Evaluation of the tympanic membrane,

TREATMENT STRATEGIES:

1. Alleviation of the tinnitus exacerbating factors (prior to initiation of therapy): Factors include depression, insomnia, vascular disorders, ototoxic drugs, hearing aids in presbycusis

      2. Behavorial Therapies:

• Tinnitus retraining therapy (TRT)
• Stress reduction programme
• Cognitive behavorial therapy (CBT)

TINNITUS RETRAINING THERAPY (TRT):

Therapeutic model which aims to attenuate connections between auditory, limbic and autonomic nervous systems and thus create tinnitus habituation.

Includes:

•   Habituation of reaction: Uncoupling brain and body from negative reactions to tinnitus.
•  Habituation of tinnitus: With this therapy, patients suffering from tinnitus lose awareness of tinnitus and also do not get annoyed even when they do have tinnitus.