Tinnitus-Tinnitus
(Ringing in the Ears and Other Ear Noise)
With tinnitus, you hear a noise that no one around you hears. This noise is usually a buzzing or ringing type sound, but it may be a clicking or rushing sound that goes along with your heartbeat. The sound is sometimes accompanied by hearing loss and dizziness in a syndrome known as Meniere's disease
Characteristics
Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise, but in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tingling or whistling sound, or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts (cicadas)", tunes, songs, beeping, or even a pure steady tone like that heard during a hearing test. It has also been described as a "wooshing" sound, as of wind or waves. Tinnitus can be intermittent, or it can be continuous, in which case it can be the cause of great distress. In some individuals, shoulder, head, tongue, jaw, or eye movements can change the intensity.
Most people with tinnitus have some degree of hearing loss, in that they are often unable to hear clearly external sounds that occur within the same range of frequencies as their "phantom sounds". This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.
The sound perceived might range from a quiet background noise to one that can be heard even over loud external sounds. The term tinnitus usually refers to more severe cases. Heller and Bergman (1953) conducted a study of 100 tinnitus-free university students placed in an anechoic chamber and found 93% reported hearing a buzzing, pulsing or whistling sound. Cohort studies have demonstrated damage to hearing (among other health effects) from unnatural levels of noise exposure is very widespread in industrialized countries.
For research purposes, the more elaborate Tinnitus Handicap Inventory is often used. Persistent tinnitus may cause irritability, fatigue, and on occasions, clinical depression, and musical hallucinations.
As with all diagnostics, other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of very high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is Radio Frequency (RF) Hearing, in which subjects have been tested and found to hear high-pitched transmission frequencies that sound similar to tinnitus.
Subjective tinnitus can have many possible 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. Tinnitus, along with sudden onset hearing loss, may have no obvious external cause. Ototoxic drugs can cause subjective 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
Subjective tinnitus is also a side effect of some medications, such as aspirin, and may result from an abnormally low level of serotonin activity. It is also a classical side effect of quinidine, a Class IA anti-arrhythmic. Over 260 medications have been reported to cause tinnitus as a side effect. In many cases, however, no underlying physical cause can be identified.
Tinnitus can also occur due to the discontinuation of therapeutic doses of benzodiazepines as part of the benzodiazepine withdrawal syndrome. It can sometimes be a protracted symptom from benzodiazepine withdrawal and persist for many months.
Causes of subjective tinnitus include:
Otologic problems and hearing loss:
Conductive hearing loss
external ear infection
acoustic shock
loud noise or music
cerumen (earwax) impaction
middle ear effusion
superior canal dehiscence
sensor neural hearing loss
excessive or loud noise
presbycusis (age-associated hearing loss)
Ménière's disease
acoustic neuroma
mercury or lead poisoning
ototoxic medications
analgesics:
aspirin
nonsteroidal anti-inflammatory drugs
antibiotics:
Ciprofloxacin
aminoglycosides, e.g., gentamicin
chloramphenicol
erythromycin
tetracycline
tobramycin
vancomycin
doxycycline (Vibramycin)
The basis of quantitatively measuring tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient's tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which he or she hears. The volume of the tinnitus will always be equal to or less than that of the sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above.) For example: if a patient has a pulsatile paraganglioma in his ear, he will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible, and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.
Objective tinnitus, however, is quite uncommon. Often patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods.
If the attention of a subject is focused on a sample noise, he can often detect it at levels below 5 decibels, which would indicate his tinnitus would be almost impossible to hear. Conversely, if the same test subject is told to focus only on the tinnitus, he will report hearing the sound even when test noises exceed 70 decibels, making the tinnitus louder than a ringing phone. This quantification method suggests subjective tinnitus relates only to what the patient is attempting to hear. Whilst it is tempting to assume patients actively complaining about tinnitus have simply become obsessed with the noise, this is only partially true. The noises are often present in both quiet and noisy environments, and can become quite intrusive to their daily lives. The problem is involuntary; generally, complaining patients simply cannot override or ignore their tinnitus.
Subjective tinnitus may not always be correlated with ear malfunction or hearing loss. Even people with near-perfect hearing may still complain of it.
What causes tinnitus?
Tinnitus can arise in any of the following areas: the outer ear, the middle ear, the inner ear, or by abnormalities in the brain. Some tinnitus or head noise is normal. I f one goes into a soundproof booth and normal outside noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body sounds, because outside noise masks them. Anything, such as earwax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or eardrum (tympanic membrane) can also cause tinnitus.
One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently chronic tinnitus.
Tinnitus Causes
Tinnitus is not a disease in itself but rather a reflection of something else that is going on in the hearing system or brain.
Probably the most common cause for tinnitus is hearing loss. As we age, or because of trauma to the ear (through noise, drugs, or chemicals), the portion of the ear that allows us to hear, the cochlea, becomes damaged.
Current theories suggest that because the cochlea is no longer sending the normal signals to the brain, the brain becomes confused and essentially develops its own noise to make up for the lack of normal sound signals. This then is interpreted as a sound, tinnitus.
This tinnitus can be made worse by anything that makes our hearing worse, such as ear infection or excess wax in the ear.
Tinnitus caused by ear trauma is usually noticed in both ears, because both ears are usually exposed to the same noises, drugs, and other influences
Loud noise exposure is a very common cause of tinnitus today, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise from firearms, high intensity music, or other sources.
Ten million Americans have suffered irreversible noise-induced hearing loss, and 30 million more are exposed to dangerous noise levels each day, according to the NIDCD.
Other causes of tinnitus include drugs such as aspirin (if overused), amino glycoside antibiotics (a powerful form of infection-fighting drug), and quinine.
Meniere's disease includes dizziness, tinnitus, and fullness in the ear or hearing loss that can last for hours, but then goes away. This disease is actually caused by a problem in the ear itself. The tinnitus is merely a symptom.
A rare cause of subjective tinnitus includes a certain type of tumor known as an acoustic neuroma. The tumors grow on the nerve that supplies hearing and can cause tinnitus. This type of tinnitus is usually only noticed in one ear, unlike the more common sort caused by hearing loss usually seen in both ears.
Causes of objective tinnitus are usually easier to find.
Pulsatile tinnitus is usually related to blood flow, either through normal or abnormal blood vessels near the ear. Causes of pulsatile tinnitus include pregnancy, anemia (lack of blood cells), overactive thyroid, or tumors involving blood vessels near the ear. Pulsatile tinnitus can also be caused by a condition known as benign intracranial hypertension-an increase in the pressure of the fluid surrounding the brain.
Clicking types of objective tinnitus can be caused by jaw joint misalignment (TMJ) problems or muscles of the ear or throat "twitching”.
Treatment
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 (what has caused it, the person's specific symptoms, and options for treatment).
Medical Treatment
Treatment for tinnitus depends on the underlying cause of the problem.
In the majority of cases, tinnitus is caused by damage to the hearing organ.
In these cases, there is normally no need for treatment other than reassurance that the tinnitus is not being caused by another treatable illness.
In the very rare instance where the tinnitus is extremely bothersome, there are a number of treatment options.
Some of the most helpful include anti-anxiety or antidepressant medication and sometimes maskers small devices like hearing aids that help to block out the sound of the tinnitus with "white noise”.
For people who are bothered by tinnitus only when trying to sleep, the sound of a fan, radio, or white noise machine is usually all that is required to relieve the problem.
Most people with tinnitus find that their symptoms are worse when under stress, so relaxation techniques can be helpful.
Avoiding caffeine is advised, as it may worsen symptoms.
Biofeedback may help or diminish tinnitus in some patients.
Avoid aspirin or aspirin products in large quantities
Hearing loss worsens the effect of tinnitus, so protection of hearing and avoiding loud noises is very important in preventing worsening of the symptoms.
In cases where the tinnitus is caused by one of the other rare problems (such as a tumor or aneurysm), treatment of the tinnitus involves fixing the main issue. Although this does not always resolve the tinnitus, some people note relief of their symptoms. Only a very few cases of tinnitus are caused by identifiable, repairable medical conditions.
Tinnitus medications
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 (ear specialists) 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.
The drug gabapentin (Neurontin, Gabarone), was studied in high doses, and reduced the annoyance level of the tinnitus in some patients, but did not decrease the volume of the noise, and was not found to be better than placebo.
A 2005 study in Brazil using acamprosate (Campral), a drug used to treat alcoholism, showed a nearly 87% rate of relief of symptoms. Studies of this drug for treatment of tinnitus are currently ongoing in the United States.
Treatment
Many treatments for tinnitus have been claimed, with varying degrees of statistical reliability:
Objective tinnitus:
Gamma knife radiosurgery (glomus jugulare)
Shielding of cochlea by teflon implant
Botulinum toxin (palatal tremor)
Clearing ear canal (in the case of earwax plug)
Using a neurostimulator
Subjective tinnitus:
Drugs and nutrients
Lidocaine injection into the inner ear was found to suppress the tinnitus for 20 minutes, according to a Swedish study.
Older benzodiazepines, e.g. diazepam, are sometimes used for tinnitus; however, there are significant risks associated with the long-term use of benzodiazepines.
Tricyclics (amitriptyline, nortriptyline) in small doses
Avoidance of caffeine, nicotine, or salt can reduce symptoms,
however, tinnitus can also be induced by reducing caffeine and/or quitting smoking.
The consumption of alcohol has been found to both increase and decrease the severity of tinnitus. Therefore, alcohol's effect on the severity of tinnitus is dependent on the causes of the individual's affliction, and cannot be considered a treatment.
Zinc supplementation (where serum zinc deficiency is present)
Acamprosate
Etidronate or sodium fluoride (otosclerosis)
Lignocaine or anticonvulsants (usually in patients responsive to white noise masking)
Carbamazepine
Melatonin (especially for those with sleep disturbance)
Sertraline
Vitamin combinations (lipoflavonoid)
What Are Some Effective Treatments and Relief Remedies for Tinnitus?
- Tinnitus does not have a cure yet, but treatments that help many people cope better with the condition are available. Most doctors will offer a combination of the treatments below; depending on the severity of your tinnitus and the areas of your life, it affects the most.
- Hearing aids often are helpful for people who have hearing loss along with tinnitus.
- Counseling
- Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus.
- Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night.
- Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or will not go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music.
- Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve.
- Your doctor to improve your mood and help you sleep might prescribe antidepressants and anti-anxiety drugs.
- Other medications may be available at drugstores and on the Internet, as an alternative remedy for tinnitus, but none of these preparations has been proved effective in clinical trials.
Prevention
Do not place objects in your ear such as cotton swabs (Q-tips) to clean your ear. This can cause a wax impaction against your eardrum that can cause tinnitus. Take blood pressure medicines and other prescribed medications as your doctor orders them.
According to the American Tinnitus Association, there are several things you can do to protect yourself from excessive noise related tinnitus:
Protect your hearing at work. Your work place should follow Occupational Safety & Health Administration (OSHA) regulations. Wear earplugs or earmuffs and follow hearing conservation guidelines set by your employer.
When around any noise that bothers your ears (a concert, sporting event, hunting) wear hearing protection or reduce noise levels.
Even everyday noises, such as blow drying your hair or using a lawnmower, can require protection. Keep earplugs or earmuffs handy for these activities.
Tinnitus and hearing loss can be permanent conditions. If a ringing in the ears is audible following lengthy exposure to a source of loud noise, such as a music concert or an industrial workplace, it means lasting damage may already have occurred.
Prolonged exposure to sound or noise levels as low as 70 dB can result in damage to hearing. For musicians and DJs, special musicians' earplugs play an important role in preventing tinnitus; they can lower the volume of the music without distorting the sound and can prevent tinnitus from developing in later years. For anyone using loud electrical appliances, such as hair dryers or vacuum cleaners, or who work in noisy environments such as building sites, where earmuffs are impractical, earplugs are also helpful in reducing noise exposure. This is also the case while riding motorcycles, mopeds etc. While operating lawn mowers, hammer drills, grinders, and similar, earmuffs may be more appropriate for hearing protection.
It is also important to check medications for potential ototoxicity. Ototoxicity of multiple medicines can have a cumulative effect, and 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.
The prognosis of tinnitus depends on the type and severity of the cause.
Cannabis helps Tinnitus
One of the main theories of tinnitus is that it is a form of sensory epilepsy, sometimes arising from neuronal hyperactivity in the brainstem cochlear nucleus.
Antiepileptic drugs have therefore been explored as one potential treatment option.
Increasing evidence suggests that cannabinoid drugs can also have antiepileptic effects.
Recently, it has been reported that cannabinoid CB1, CB2 receptors, and the endogenous cannabinoid, 2-arachidonylglycerol (2-AG), are expressed in the cochlear nucleus.
CB1 receptors appear to negatively regulate the release of glutamate, and it is possible that their down-regulation during the development of tinnitus is responsible for the neuronal hyperactivity associated with the condition.
Cannabinoid drugs might be useful in the treatment of tinnitus.
Previous studies in animals and humans have shown that, in some cases at least, anti-epileptic drugs can reduce the severity of tinnitus. Given that cannabinoid receptor agonists have been shown to exert anti-epileptic effects in some circumstances, we investigated whether two synthetic CB(1)/CB(2) receptor agonists, WIN55,212-2, and CP55,940, could inhibit the behavioral manifestations of salicylate-induced tinnitus in rats in a conditioned suppression task. We found that neither WIN55, 212-2 (3.0 mg/kg s.c) nor CP55, 940 (0.1 or 0.3 mg/kg s.c), significantly reduced conditioned behavior associated with tinnitus. However, both 3 mg/kg WIN55, 212-2 and 0.3 mg/kg CP55, 940 did significantly increase tinnitus-related behavior compared to the vehicle control groups. These results suggest that cannabinoid receptor agonists may not be useful in the treatment of salicylate-induced tinnitus and that at certain doses; they could actually exacerbate the condition.
Cannabinoid CB1 receptors have not been systematically investigated in the brainstem cochlear nucleus, nor have they been investigated in relation to tinnitus. Using immunohistochemistry and cell counting, we showed that a large number of neurons in the rat cochlear nucleus possess cannabinoid CB1 receptors. Following salicylate injections that induced the behavioral manifestations of tinnitus, the number of principal neurons in the ventral cochlear nucleus expressing CB1 receptors significantly decreased, while the number of CB1-positive principal neurons in the dorsal cochlear nucleus did not change significantly. These results suggest that CB1 receptors in the cochlear nucleus may be important for auditory function and that a down-regulation of CB1 receptors in the ventral cochlear nucleus may be related to the development of tinnitus.
One of the most important uses of cannabis is as a substitute for other, more dangerous or costly pharmaceutical drugs.
Many patients report substantial reductions in use of narcotics, non-steroidal anti-inflammatories, anti-depressants, tranquilizers, sleeping pills and other drugs once they started using cannabis medicine.
CBD is an anticonvulsant.
Cannabis is powerful medicine for mixed syndromes.
Use Indica’s with high CBD levels.
Use Indica dominant hybrid with high CBD levels.
REFERENCES
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2. Shulman A. Subjective Idiopathic Tinnitus Clinical Types: A System of Nomenclature and Classification. In H Feldmann (ed), Proceedings of the Third International Tinnitus Seminar. Karlsruhe: Harsch Verlag, 1987;136-141.
3. Shulman A. Clinical Types of Tinnitus. In A Shulman, JM Aran, H Feldmann, et al. (eds), Tinnitus Diagnosis/Treatment. Philadelphia: Lea & Febiger, 1991;323-341.
4. Shulman A, Aran, JM, Feldmann H, et al. Tinnitus Diagnosis/Treatment. Philadelphia: Lea & Febiger, 1991.
5. Shulman A, Strashun AM, Goldstein B, Afriyie MO. NeuroSPECT cerebral blood flow studies in patients with a central type tinnitusa preliminary study. Tinnitus 91:211-215, 1992. Kugler Public, Amsterdam.
Arda, H.N. et al. The role of zinc in the treatment of tinnitus. Otol Neurotol. 2003 Jan;24(1):86-9.
Azevedo, A.A. et al. Tinnitus treatment with acamprosate: double-blind study. Braz J Otorhinolaryngol. 2005 Sep-Oct;71(5):618-23. Epub 2006 Mar 31.
Megwalu, U.C. et al. The effects of melatonin on tinnitus and sleep. Otolaryngol Head Neck Surg. 2006 Feb;134(2):210-3.
Zheng Y, Baek JH, Smith PF, Darlington CL.
Arda, H.N. et al. The role of zinc in the treatment of tinnitus. Otol Neurotol. 2003 Jan;24(1):86-9.
Azevedo, A.A. et al. Tinnitus treatment with acamprosate: double-blind study. Braz J Otorhinolaryngol. 2005 Sep-Oct;71(5):618-23. Epub 2006 Mar 31.
Megwalu, U.C. et al. The effects of melatonin on tinnitus and sleep. Otolaryngol Head Neck Surg. 2006 Feb;134(2):210-3.
