Tinnitus

An auditory perception in the absence of an auditory stimulus.

It is hypothesized to be caused by the top down or bottom end up auditory attention theory.

Theoretically its auditory perception stems from lost sensory input from the cochlea to the auditory thalamus and or reorganization of key neural networks responsible for attention, emotion, and audition.

Neuroimaging studies have identified neural system abnormalities including attention, default mode, limbic, auditory, somatosensory, and visual brain network changes.

It probably involves abnormal function of different networks for individual patients and these abnormal networks are likely a result of persistent chronic abnormal auditory function for some patients, and pre-existing vulnerability for others.

Refers to the experience of noise without external stimulation and thought to represent a phantom sensation.

May be associated with exposure to a loud noise, chronic hearing loss, emotional stress, or a spontaneous occurrence.

Among individuals exposed to occupational noise, the prevalence of tinnitus is 15 per 100.

Estimated the tinnitus is burdensome and chronic for approximately 20 million individuals and extreme and debilitating for 2 billion US individuals.

It may interfere with sleep, concentration, cognitive function.

Among military veterans receiving service connected disability, 42% receive compensation for tinnitus.

The number of veterans who receive compensation due to tinnitus is nearly 60% greater than the number of veterans who receive compensation for hearing loss.

Estimated 60 million people in US have tinnitus.

Affects about 21 million adults and for more than 1 million it impairs daily living, concentration, and emotional well-being.

Related to loud noise exposure and other forms of acoustic trauma, hearing loss and aging.

The perception of a noxious disabling internal sound without an external source.

Roughly affects fifteen percent of the population.

Associated with concentration problems, sleep disturbances, anxiety, depression and extreme fatigue.

Tinnitus and hearing loss are the two most common disabilities among recently discharged military personnel.

Significant number of patients are not bothered by the process and do not seek treatment.

Patient may experience bothersome symptoms including disruption in attention, concentration, perception, and emotions causing significant decreased functional status and quality-of-life.

Sometimes impairs daily functioning.

No cure available.

Pitch ranges from a low roar to a high squeal or whine.

Affects as many as 36 million Americans.

The National Institute on Deafness and Other Communication Disorders (NIDCD) states almost 12 percent of men who are 65 to 74 years of age are affected.

More frequently in whites, and the prevalence in the U.S. is almost twice as frequent in the South as in the Northeast.

Affects 20% of Americans.

90% of cases associated with hearing loss, and men more than women experience hearing loss.

Tinnitus can arise in any of the four sections of the hearing system: the outer ear, the middle ear, the inner ear, and the brain.

Most common type of tinnitus is known as subjective tinnitus, which cannot be heard by others.

A much more uncommon problem is objective tinnitus, meaning the noise may be heard by a physician..

Not a disease, but a common symptom, and because it involves the perception of sound or sounds.

The inner ear is most often responsible.

Most of the time, it is subjective.

May be caused by excessive ear wax, middle ear infection or the buildup of new bony tissue around one of the middle ear bones, otosclerosis, muscle spasms of one of the two muscles attached to middle ear bones.

Damage and loss of the tiny sensory hair cells in the inner ear may be commonly associated with the presence of tinnitus.

The pitch of the tinnitus often coincides with the area of the maximal hearing loss.

A preventable cause of inner ear tinnitus is excessive noise exposure, and tinnitus can be the first symptom before hearing loss develops, so it should be considered a warning sign.

Incidence increases with age.

Medications can also damage inner ear hair cells and cause tinnitus, and includes aspirin.

Hearing loss associated with aging involves loss of and damage to the hair cells.

Pulsatile tinnitus may indicate the presence of a vascular tumor in the general vicinity of the middle and inner ear.

Acoustic neuroma or vestibular schwannoma can cause unilateral tinnitus and may or may not be accompanied initially by a hearing loss.

May be a result of lesions on or in the vicinity of the auditory cortex due to traumatic injuries, skull fracture, or whiplash-type injuries, and meningiomas.

May be related to hypertension, thyroid abnormalities, and chronic brain syndromes, stress and fatigue.

In most cases, there is no specific treatment.

If evaluation reveals a specific cause for your tinnitus their may be a specific treatment.

Evaluation depends on the presumed inciting and events-acoustic trauma, type of tinnitus pulsatile or not, associated with other audiologic conditions such as sensoryneural hearing loss.

A complete head and neck, neurologic examination, and  audiogram is recommended.

With pulsatile tinnitus which may be a symptom of increased intracranial pressure, AV fistula, or other vascular lesion, abnormalities on physical examination, or abnormal audiogram require further diagnostic testing including MRI of the temporal bone.

Most commonly used treatment for phantom noise perception involves behavioral, what are audiological, and pharmacological therapies including education, sound based therapies, counseling, sound maskers, cognitive behavioral therapy, mindfulness based stress reduction, medications, dietary changes, supplements, and acupuncture.

Repetitive transcranial magnetic stimulation of the brain creates a magnetic field beneath the stimulating coil, which passes through the scalp and skull and induces an electric current in the brain that can stimulate or depress neuronal activity.

Is defined as the perception of sound without an acoustic stimulus.

Only 20% of patients with tinnitus seek medical attention.

Most cases have no underlying identifiable cause, however, unilateral tinnitus, pulsatile tinnitus, tinnitus with a focal neurologic defect, or tinnitus with an asymmetric hearing loss may be a warning sign of serious problems.

Unlateral, nonpulsatile tinnitus with hearing loss is usually the consequence of a retrocochlear pathology, and requires contrast-enhanced magnetic resonance imaging.

Pulsatile tinnitus should make one suspect a vascular etiology, requiring computed tomography (CT) scan of the temporal bone.

Otorhinolaryngology consultants should be utilized when a patient’s tinnitus is unilateral, persistent, or associated with hearing difficulties.

Deep brains simulation may result in clinical improvement.

In patients with tinnitus and hearing difficulties, hearing aid trials may be helpful.

Treatment measures include kinesis retraining treatment and behavioral therapies.