Pathogenesis (development of disease)
Subjective tinnitus is often a symptom of a wide variety of diseases. Objective tinnitus is often triggered by vascular changes and vascular malformations. The exact pathogenesis remains unclear, and various models are discussed. According to these models, the disturbance can be located in all sections of the central auditory pathway (auditory pathway) and probably leads to neural discharges that produce the ringing in the ears. The increased arousal here, similar to phantom laryngitis, may be attributed to the hearing loss that is often present. Furthermore, abnormal activity in somatosensory afferents (the body perception related influxes of information) may lead to an increase in activity in the central auditory pathway. This explains why craniomandibular dysfunction (CMD; malfunction of the temporomandibular joint) or cervical spine (C-spine) complaints may be of importance in the development of tinnitus.
Etiology (causes)
Biographical causes
- Genetic burden – depending on the exact cause, there may also be underlying genetic changes, as in otosclerosis (ossification of the ossicles)
- Occupations – occupations with increased noise exposure: for example, professional musicians have a 57 percent increased risk of tinnitus; furthermore, professions in construction and agriculture.
Behavioral causes
- Psycho-social situation
- Psychological stress
- Chronic stress
Disease-related causes
Blood, blood-forming organs – immune system (D50-D90).
- Anemia (anemia)
Endocrine, nutritional, and metabolic diseases (E00-E90).
- Thyrotoxicosis – hyperthyroidism with excessive hormone production.
Cardiovascular system (I00-I99)
- Vascular diseases such as abnormalities of the cerebral vessels: aneurysms, AV shunts, etc. (pulse synchronous tinnitus)
- Hypertension (high blood pressure)
- Hypotension (low blood pressure)
Infectious and parasitic diseases (A00-B99).
- Lyme disease
Musculoskeletal system and connective tissue (M00-M99)
- Cervical syndrome – syndrome of the cervical spine with nerve compression/damage.
Neoplasms – tumor diseases (C00-D48).
- Acoustic neuroma (AKN) – benign (benign) tumor arising from the Schwanńs cells of the vestibular portion of the VIII. Cranial nerve, the auditory and vestibular nerves (vestibulocochlear nerve), and is located in the cerebellopontine angle or in the internal auditory canal. Acoustic neuroma is the most common cerebellopontine angle tumor. More than 95% of all AKNs are unilateral. In contrast, in the presence of neurofibromatosis type 2, acoustic neuroma typically occurs bilaterally.
Ears – mastoid process (H60-H95).
- Chronic noise-induced hearing loss
- Ear canal obstruction due to cerumen obturans (cerumen; earwax) or foreign bodies (→ hearing loss)
- Hearing loss – acute hearing loss
- Bang trauma
- Meniere’s disease – inner ear disease with vertigo.
- Myoclonias (twitching) of the middle ear muscles.
- Open tuba auditiva – connection between the ear and nose, which is normally closed by mucosa.
- Otitis media (inflammation of the middle ear) – here especially the purulent and serous otitis media after chronic infections.
- Otosclerosis – increasing hearing loss due to bone remodeling processes.
- Pulse-synchronous ringing in the ears (pulse-synchronous tinnitus).
- Arterial causes (atherosclerosis/arteriosclerosis, dissection, fibromuscular dysplasia).
- Arteriovenous fistulas and vascular tumors at the skull base.
- Venous causes (intracranial hypertension and antomic normovarian basal veins and sinuses).
- Presbycusis (age-related hearing loss).
- Tympanic membrane perforation – rupture of the eardrum.
Psyche – nervous system (F00-F99; G00-G99)
- Depression
- Psychosomatic diseases
Injuries, poisonings and other consequences of external causes (S00-T98).
- Traumatic brain injury (TBI) – craniocerebral injuries.
Medication
- Antiarrhythmics
- Class Ib antiarrhythmics (quinidine, lidocaine, mexiletine (1-10%)).
- Class Ic antiarrhythmics (flecainide, propafenone).
- Unclassified (adenosine).
- Antibiotics
- Aminoglycosides (gentamycin (gentamicin), streptomycin).
- Cephalosporins (Cefepime, Cefpodoxime).
- Gyrase inhibitors
- Fluoroquinolones (ciprofloxacin, moxifloxacin)
- Macrolide antibiotics / macrolides (roxithromycin).
- Monobactams (aztreonam)
- Antidepressants
- Norepinephrine and dopamine reuptake inhibitors (NDRIs) – bupropion
- Selective serotonin reuptake inhibitors (SSRIs) – citalopram, paroxetine, sertraline (1-10%).
- Tetracyclic antidepressants (maprotiline).
- Tricyclic antidepressants (amitriptyline, clomipramine, imipramine).
- Antihistamines (cetirizine, loratadine).
- Antihypertensives
- Antimalarials (artesunate, chloroquine, quinine).
- Antifungal agent (posaconazole, voriconazole).
- Anticoagulants
- Platelet aggregation inhibitors (ticlopidine).
- Antirheumatic drugs, nonsteroidal (NSAIDs) – acetylsalicylic acid (ASA), ibuprofen, indometacin (> 10%), meloxicam, piroxicam (1-10%).
- Antidementives (galantamine)
- Antiepileptic drugs
- Functionalized amino acid (lacosamide).
- Gabapentin
- Classical antiepileptic drugs (valproic acid).
- Anxiolytics (buspirone, 1-10%).
- Beta-blockers Beta-blockers, systemic.
- Nonselective beta blockers (e.g., carvedilol, pindolol, propranolol, soltalol).
- Selective beta blockers (e.g., atenolol, acebutolol, betaxolol, bisoprolol, celiprolol, nebivolol, metoprolol).
- Bisphosphonates – risedronic acid.
- Codeine
- COX inhibitors – celecoxib, naproxen (1-10%).
- Diuretics
- Loop diuretics (furosemide, etacrine acid).
- HCV protease inhibitors – boceprevir
- Hormones
- Corticosteroids (loteprednoletabonate).
- GnRH analogues (buserelin, triptorelin).
- Oral contraceptives
- Prostaglandin E1 (misoprostol)
- Immunosuppressants (tacrolimus).
- Interferons (interferon alfa 2b, peginterferon alfa-2b).
- Intestinal anti-inflammatory (sulfasalazine (INN))
- Contrast agent (gadobenic acid)
- Lipid-lowering agent
- Statins (atorvastatin
- Local anesthetics (articaine, lidocaine).
- Monoclonal antibodies (adalimumab, alemtuzumab)
- Parasympatholytics (oxybutynin).
- Parkinson’s drugs (Budipin)
- Protease inhibitors (lopinavir)
- Proton pump inhibitors
- Sympathomimetics
- Triptans (frovatriptan)
- Antivirals (imiquimod)
- Cytostatic drugs (anagrelide, bortezomib, cisplatin, imatinib, temozolomide (1-10%)).
Further
- Craniomandibular dysfunction (CMD) – such as congenital malocclusion, bruxism (teeth grinding), unilateral chewing; myoarthropathy of the temporomandibular joint.
- Chronic noise exposure incl. recreational noise, e.g. portable music players (→ hearing loss).
- Reduced noise intolerance at a young age.