Tinnitus refers to pathological ear noises that are either recurring or even occur continuously, i.e. chronically. In this case, the affected person hears an unpleasant tone or noise, which can be perceived mostly as whistling, ringing or humming. The main reasons for tinnitus can be psychological causes, as well as pathological and physical causes.
What is tinnitus?
A hearing test or audiometry is used to diagnose diseases of the hearing organs. Typical fields of application are an incipient hearing loss but also hearing noises such as tinnitus. Tinnitus (tinnitus auriumfg) is understood to be ear noises of various kinds. These can be persistent or recurring noises and sounds, which, without any external acoustic stimulation, can only be perceived subjectively by the affected person. The triggers for tinnitus can be in the ear or in the brain. A distinction is made between three different types. In the case of acute tinnitus, the symptoms last up to three months. If subacute tinnitus is present, the complaints last from three months to twelve months. Chronic tinnitus is said to be present if the ringing in the ears has already lasted longer than twelve months. Furthermore, there is a classification into four different degrees of severity. Compensated tinnitus is classified as grade I and II. This type does not yet cause any health problems. Grades III and IV are referred to as decompensated tinnitus. It already has severe effects on health.
Causes
The causes of tinnitus can lie in a wide variety of areas. Within the auditory canal, obstructions caused by earwax, protruding bones (exostoxen) or even foreign bodies can lead to tinnitus. In the area of the middle ear, this can be caused by a defect in the eardrum. However, tubal dysfunction, tympanic effusion, eardrum immobility or middle ear infection can also lead to tinnitus. The inner ear can be a trigger for tinnitus due to noise or age-related hearing impairment, as well as medication or a severe drop in blood pressure. Furthermore, meningitis, anemia, incorrect blood pressure, multiple sclerosis or a brain tumor can lead to tinnitus. However, ear noise or tinnitus can also occur as a symptom in the context of a hearing loss.
Typical symptoms and signs
The leading symptom of tinnitus is noise sensations in the ear. These can sound like hissing, humming, buzzing, crackling, ringing, hissing or whistling. Depending on the degree and intensity, tinnitus symptoms can be very distressing. Only in the case of objective tinnitus can another person perceive the sounds in the ear of the affected person. In most cases, these are ear noises that are described as subjective tinnitus. Only the affected person is bothered by it. Others may not perceive the ear noises, even though they are perceived as loud and debilitating. However, tinnitus noises are not imaginary. They can be caused by tense neck muscles, permanent stress, hearing damage or other triggers and are therefore real. At the appropriate level of intensity, they can stress sufferers to the point that they suffer from secondary complaints. Often the triggers of tinnitus are not identified, so that the symptoms persist. This can lead to secondary symptoms such as depression, irritability, concentration problems, headaches, dizziness, startle at high-pitched sounds, sleep disorders or inability to work. When symptoms are severe, participation in social activities is disrupted. Sometimes there is social withdrawal because hearing is made more difficult by the tinnitus. The above-mentioned accompanying symptoms are also called secondary symptoms by physicians. These can lead to a real tinnitus vicious circle. This culminates in depression, social withdrawal and inability to work.
Complications
Complications associated with tinnitus can be divided into two categories: First, complications related to an underlying medical condition and second, complications that may be triggered due to tinnitus per se. The former complications range from consequential damage due to nerve damage to the complications that can occur with inflammation, Meniere’s disease, vasoconstriction or thrombosis in the corresponding area.It is in cases where the underlying disease is known to consider. In most cases, however, tinnitus remains without complications even if untreated. Thus, only a few percent of all those affected experience serious or permanent symptoms. Rarely, the tinnitus itself (due to a vasoconstriction that triggers it) can lead to reduced hearing and deafness. Overstimulation of the sense of hearing (hyperacusis) is possible: affected persons suffer from an enormously increased perception of sounds, which causes pain. Chronic tinnitus can also set up and leads to a permanent burden for the affected person. At the same time, chronic tinnitus is not infrequently accompanied by psychological problems that can range from depression to suicide. However, adequate tinnitus therapy can prevent this.
When should you see a doctor?
When the typical ringing or beeping in the ears occurs, a doctor should be consulted. Constant or repeated ear noises indicate tinnitus, which should be examined by a doctor. A doctor should be consulted within a week if the symptoms have not subsided in the meantime. In 50 percent of cases, the tinnitus lasts only a few hours to days. If it disappears by itself, no medical clarification is necessary. If the symptoms recur, the ear specialist should be consulted. Accompanying symptoms such as headache, dizziness or fever indicate a serious cause. The affected person must quickly consult a specialist and have the complaints clarified. Otherwise, the tinnitus may increase or even persist permanently. In the worst case, hearing loss is imminent. Patients suffering from chronic tinnitus should inform the doctor about increasing complaints. Tinnitus is treated by an ear specialist. An initial tentative diagnosis can usually also be made by the family doctor. In the case of stress-related tinnitus, the patient may need to see a therapist so that the causes of the stress can be broken down and remedied. The earlier the tinnitus is treated, the better the chances of recovery.
Treatment and therapy
A successful therapy of tinnitus depends as much on the causes as on the duration of the disease, Therefore, there is also the already mentioned classification. The success of treatment is more likely, the earlier the treatment is started. In case of acute tinnitus in the area of the inner ear or with unknown cause, a sugar solution infusion or a combination of saline solution with glucocorticoids is administered. This should lead to a renewed activation of the sensory cells. Furthermore, hyperbaric oxygen therapy can be used. This eliminates a lack of oxygen in the inner ear. If the cause of the tinnitus is an obstruction of the auditory canal, the reason for this can often be removed without difficulty. In the case of subacute or chronic tinnitus, the chances of treatment are much lower. Here, too, the infusions already mentioned are administered. This is done in conjunction with psychotherapy. By learning relaxation techniques such as yoga, autogenic training or progressive muscle relaxation, the discomfort caused by the tinnitus should be alleviated. If all this could not lead to an improvement of the complaints, a tinnitus retraining therapy according to Jastreboff is applied. Here, the tinnitus is to be displaced from the consciousness.
Aftercare
Follow-up care is concerned with maintaining the patient’s quality of life and identifying ways to cope with tinnitus. Since tinnitus becomes chronic in many cases and is not curable, once diagnosis and treatment have been completed, it is a matter of patient acceptance. In the case of depressive moods, it is advisable to consult a psychotherapist. In therapy, patients can learn to live with the ear noise and to focus on other areas of life again. Furthermore, a visit to a hearing aid acoustician should be made. Since tinnitus is often accompanied by hearing loss, hearing aids can help to improve hearing and at the same time divert attention away from the tinnitus. If there is no hearing loss, a so-called noiser or masker is an option. This is a hearing aid that produces an adjusted noise. This is intended to mask the tinnitus and helps many sufferers in everyday life. However, some do not need such a noise permanently.For many, tinnitus is only disturbing in quiet situations. Here it can be helpful to switch on a counter noise, such as soft relaxation music or the sound of the sea. Last but not least, sufferers should take care to avoid stress and listen better to their bodies. Provided that the cause of the tinnitus is known, it should be avoided in the future.
What you can do yourself
Tinnitus is a disease of hearing, where patience and stress reduction are very important. Patients can therefore do a lot for themselves and their health in everyday life. First, it helps to think that tinnitus can heal spontaneously or at least improve significantly. Since tinnitus is often a warning signal from the body to pay more attention to one’s own health and, above all, to the needs of the psyche, relaxation is especially important. This can be done by methods such as progressive muscle relaxation according to Jacobsen (PMR) or autogenic training. Yoga with its mixture of physical exercises, breathing exercises, meditation and relaxation can also reduce stress and restore the inner balance. Rest is helpful with tinnitus, but should not be confused with social withdrawal. Thus, asking for sick leave is certainly helpful, especially in a stressful job, and loud music should also be avoided, at least in the acute phase. Maintaining social contacts is important to prevent the tinnitus from causing isolation. Nicotine and alcohol, including coffee, should ideally be significantly limited. However, a sufficient amount of drinking is important. It is best covered by water or also herbal teas. Self-help groups that specialize in the topic of tinnitus, offer helpful exchange of experience and hold valuable tips for those affected.