Tinnitus
synonym
Ringing in the ears, ringing in the ears
engl. tinnitus
definition
Tinnitus is a sudden onset and constant persistence of mostly one-sided painless noises in the ears of varying frequency and volume.
Also read on the topic: Ringing in the ears
Epidemiology / Occurrence
In Germany around 3 million people suffer from one Tinnitus. 800,000 of them with noises in the ears with extreme impairment of everyday life. There are around 270,000 new cases each year. According to a recent survey, 10% of adults report that they suffer from ringing in their ears, but they disappear again within 5 minutes. Only 7% of them therefore consult a doctor. Tinnitus in children is particularly common if the person already has a disease Ears suffer with accompanying hearing loss. 2.7% of hearing-impaired children between the ages of 12 and 18 report persistent tinnitus sounds. There are no gender differences among adults. The main age of disease has been described as 60-80 years of age. However, a shift to younger years can be observed in recent years.
Symptoms
The initial symptoms of one Tinnitus are mostly a sudden noise in one ear of different frequencies. The noise in the ear can be measured with a cotton wool and from the affected patients as "unreal“Listening experience can be described. Because of the mostly unilateral hearing loss, vertigo symptoms often occur, but these usually subside within a few hours while the ringing in the ear remains. Noises of very different types, frequencies and volumes are described. The noises can be whistling, humming, hissing, muffled or clear, and can be so quiet that they can only be heard in very quiet surroundings (e.g. during a Sleep) or so loud that they cause massive impairment in daily life. In the case of extreme forms, the accompanying symptoms described occur.
causes
Among the causes of tinnitus that are discussed, a distinction is made between the causes of a subjective and the causes of an objective tinnitus.
The subjective tinnitus is based on subjective sensations. The noises are only perceived by the person concerned. Possible causes of subjective tinnitus include e.g. an occlusion, an obstruction or a blockage of the external auditory canal, which can cause "ringing in the ear". These so-called obstructions of the external auditory canal can e.g. caused by tumors or foreign bodies in the ear that interfere with the transmission of sound. If there is ringing in the ears in this context, one speaks of conduction tinnitus.
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Another possible cause of subjective tinnitus can be a Damage to the cochlea be that e.g. can be triggered by a sound trauma. The noises in the ears are called sensoneurinal tinnitus described. It is believed that this is the most common cause of subjective tinnitus.
A possible cause is also mentioned Damage to the central auditory pathwayi.e. a damage in the brain discussed. In this case one speaks of central tinnitus.
For all the groups of causes mentioned, it is assumed that different psychological factors and stress have an influence on the symptoms of subjective tinnitus, or stress itself can be the cause. The objective tinnitus can be proven with aids.
At the objective tinnitus A distinction is made between “vascular-related” and “muscle-related” causes. Abnormal connections between an artery and a vein called a arteriovenous fistulas, can cause ringing in the ears. Here and with other vascular malformations that cause noises in the ears, one speaks of one vascular tinnitus.
An objective tinnitus, which is caused by violent, rhythmic movements of the internal muscles in the ear, the soft palate or the temporomandibular joint, is called myogenic tinnitus designated.
Some scientists describe the above causes more as triggers of the tinnitus and see the actual main cause in the brain. They assume that the above-mentioned “triggers” lead to remodeling work in the auditory cortex in the brain and consequently to the agonizing noises in the ear. When the hair cells in the inner ear, e.g. are destroyed due to an acoustic trauma, they cannot pass on any information to the nerve cells in the auditory cortex. These nerve cells are then virtually unemployed and do nothing. The frequencies for which they are responsible cannot be offered to the brain.
As in real life: where there is less work in one place, more work has to be done in another. In this case it means that the neighboring nerve cells are more busy and offer the brain a frequency in excess. This could cause ringing in the ears.
According to some researchers, it could also be the case that the unemployed nerve cells overreact and this leads to the noises in the ears. Since the noises in the ear are often perceived in the frequency range in which the greatest hearing loss can be detected, this theory could be true.
Certain researchers had also observed that in some people affected a certain area in the brain, the so-called prefrontal cortex often reduced in size was. The task of the prefrontal cortex is, among other things Noise, like suppressing tinnitus.
It was also found that in some sufferers the anterior cingulate damaged in the brain. This has the task of paying more or less attention to certain stimuli. If the anterior cingulum classifies the noises in the ears as significant, then it can be all the more difficult for those affected to hear away.
Whether the noises in the ear are perceived as negative, positive or neutral can depend on the person Amygdala, another area of the brain in the limbic system. In the case of chronic tinnitus, it is also assumed that a so-called tinnitus memory arises in the hippocampus. Some authors assume that the noises in the ears leave a kind of trail in the brain that invites the nerve cells to go down the "tinnitus path" again. The triggers, causes and theories of tinnitus continue to be very controversial.
Stress as a cause
Various studies have found a connection between stress and tinnitus. However, stress does not have to lead to tinnitus. Only when the stress is perceived as stressful can it cause unpleasant noises in the ears. This type of stress is known as Distress.
Stressors, too Stressors called, are all stimuli that cause stress and prompt the body to adapt. Tinnitus can be such a stressful factor. Often the noises in the ears of those affected are more intense and louder during stressful stress.
The extent to which the tinnitus or the stress experienced is perceived as burdensome varies from person to person. Studies have found links between psychological instability, coping with stress and tinnitus. A healthy lifestyle combined with stress management strategies showed a positive influence on the noises in the ears. It could be observed that in physically and mentally healthy people, in whom tinnitus was triggered by stress, this also disappeared again after the stress phase was over.
Some authors assume that tinnitus will also go through oxidative and nitrosative stress can be caused. This means that it is assumed that free oxygen radicals and nitrogen compounds in the body lead to cell damage and can thus trigger tinnitus, among other things. Whether this type of stress contributes to the development of tinnitus is controversial. But since the above-mentioned distress can trigger or worsen tinnitus, an individual stress management in case of noises in the ear seems helpful and sensible in any case.
Cervical spine as the cause
It is still unclear to what extent and how often the cervical spine and the temporomandibular joint are associated with tinnitus. 3 mechanisms are described that can cause tinnitus based on a cervical spine disease: originating from the nerve, originating from the muscle or through circulatory disorders.
The causes of tinnitus that start from the cervical spine are blockages, misalignments, whiplash injuries and incorrect or too rough chiropractic care.
If the tinnitus is caused by cervical spine disease, then it occurs mostly one-sided on. He is often called low hum or hissing noise when turning your head to listen. Furthermore, in the case of tinnitus caused by damage to the cervical spine, additional Dizziness and hearing impairment occur. A targeted diagnosis of the spine by an orthopedic surgeon and cooperation between the person affected, the ENT doctor and the orthopedic surgeon are then important.
Alcohol as the cause
Of the context between tinnitus and alcohol consumption is not yet fully scientifically researched. It is recommended to refrain from alcohol in the case of acute tinnitus. There are studies in which it has been observed that alcohol consumption can make tinnitus worse and even trigger it.
A connection is suspected, since alcohol acts directly on the brain and the brain also plays a role in the development of subjective central tinnitus. Some people affected reported a short-term lower noise in their ears after consuming alcohol. It is believed that this could be possible through a short-term relaxation. However, as we know of the long-term toxic effects of alcohol, we strongly advise against consuming it regularly or in large quantities.
diagnosis
The patient survey is of great importance in diagnostics (anamnese), which should explain how long the symptoms have persisted (differentiation between acute, subacute and chronic), whether the noise in the ear is so quiet that it can be masked by ambient noise, whether additional hearing impairment on the affected or on the other ear, whether the noise in the ear is influenced by psychological influences or physical stress, whether there is a change in the noise with different body or head positions, whether the type of tinnitus can be changed by certain drinks or food and whether concomitant diseases such as the heart -Circulatory disease, arteriosclerosis, metabolic disorders exist. Furthermore, the patient should be asked which medication he is taking. There are various drugs that can damage the ears and also lead to tinnitus-like symptoms.
From this point of view, one can distinguish the frequent tinnitus of unknown cause from the tinnitus caused by drugs, metabolic diseases and diseases of the circulatory system. After questioning the patient, you should then carry out corresponding examinations on the patient individually and not according to a strict scheme. You can choose between an ENT - medical examination of the ear including the eardrum and a nasopharyngoscopy (Examination and reflection of the nasopharynx) and the examination of the tube patency. The internal carotid artery should be monitored with a stethoscope (auscultated) or a so-called Doppler sonography can be carried out in order to rule out atherosclerotic changes and the associated circulatory disorders.
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Tone audiometry with detection of the discomfort threshold (the point at which hearing a normal tone is painful), determination of the loudness of the tinnitus noise and determination of the type of tone and frequency, determination of the so-called masking level (which tone has to be supplied from the outside so that the patient no longer perceives his tinnitus tone), Examination of the eardrum and the stapedius reflex with regard to breathing activity, a brainstem audiometry, neural examination of the vestibular nerve, examination of the posture and the spine (this is to see whether postural damage caused by the spine may affect a vessel or nerve in such a way that the ear undersupply) as well as an examination of the teeth and the chewing apparatus should be carried out in every patient with tinnitus. These examination elements, which are part of the basic diagnosis, can be followed by further examinations in individual cases. If there is a suspicion of a mass (tumor) that leads to impairment of the auditory nerve with the resulting tinnitus, a computed tomography (CT) or magnetic resonance tomography (MRT) can be performed. In order to rule out certain autoimmune diseases or infections, a corresponding blood count of the patient can be carried out. The blood should be tested for: Lyme disease, HIV / AIDS, syphilis, rheumatoid factors, tissue-specific antibodies, blood sugar, blood lipids, liver enzymes and thyroid hormones. If the central nervous system is suspected of being involved, CSF diagnostics (Cerebral fluid examination) be performed. In addition to the internal examination of the blood vessels, a psychological component of the tinnitus should also be considered and carried out by a psychiatrist with a corresponding psychosomatic assessment. Tinnitus diagnosis is an interdisciplinary task that ENT specialists, internists, dentists, neurologists and psychologists can deal with.
Questionnaire for tinnitus diagnosis
A frequently used questionnaire was asked by Goebel and Hiller developed. It contains 51 questions that the patient is asked and which are then evaluated. The questions asked are divided into scales, which are named as follows: emotional impairments, cognitive impairments, penetrance of tinnitus, hearing problems, sleep disorders, somatic physical disorders. Depending on how the questions are answered, a classification of the Tinnitus be performed.
treatment
Acute tinnitus goes away in about 70-80% of cases with treatment of the cause or goes away on its own. In 20-30% of acute tinnitus cases, the noises in the ears persist. Diagnosis by an ENT doctor and possibly other doctors, e.g. Orthopedists or internists, depending on the cause of the tinnitus.
Of the chronic tinnitus no longer disappears, but there are now various ways in which those affected can deal with it well.
Inadequate or faulty education and information, as well as resignation or fear, tinnitus can take on the character of a disease. This can result in further illnesses and limitations in coping with and participating in everyday life. It is therefore important that the person concerned is informed, takes responsibility for his or her well-being and Support offers uses. One option is to visit one support group to exchange ideas with those affected. Some sufferers need (additionally) therapeutic support by a specialist. Addresses and information are stored at the German Tinnitus League.
Medication
There are no specific drugs for tinnitus. So far, research is still being carried out, but there are currently no special preparations against the noises in the ears. There are, however, several Psychotropic drugsthat act on the brain and reduce the tinnitus that emanates from there and the To soften ear noises. At the same time, they work against sleep disorders and, through improved sleep, can also have an indirect effect on the state of relaxation. With chronic tinnitus, problems falling asleep and staying asleep are very common. A lack of or restricted sleep can negatively affect the state of relaxation and manifest itself as distress. This in turn can worsen the tinnitus.
Tebonin®
At a acute tinnitus may it be beneficial that the Blood circulation and nutrient transport in the inner ear and brain is supported. This can e.g. can be achieved by taking Tebonin®. Blood cell components are made more flexible so that oxygen and nutrients can be transported more easily into the inner ear and brain.
At a chronic tinnitus Tebonin® can influence the cooperation of nerve cells in the brain. It can improve the adaptability of the brain and thus reduce the perception of annoying noises in the ear. In the case of chronic, subjective tinnitus, this can help ensure that further measures, such as targeted “listening away”, are more successful. The fact that the tinnitus is perceived quieter can lead to stress relief, better sleep and increased well-being and thus lead to an increase in the quality of life.
Cortisone
The German Society for Ear, Nose and Throat Medicine recommends treatment with cortisone in its guideline "Tinnitus" in acute and subacute tinnitus. When the phase of possible self-healing (1-2 days) after an acute tinnitus is over, according to the guideline, it is recommended to consider cortisone treatment.
Cortisone is not a specific drug for tinnitus. However, an improvement in blood circulation and positive effects on the immune system as well as an anti-inflammatory effect were observed. It has also been observed that it contributes to swelling in the ear canal and inner ear. The exact effect of cortisone on tinnitus is still being scientifically researched. It is believed that the cortisone acts on the recipients, the so-called receptors, in the cochlea.
To get the best possible effect from cortisone, it is over Syringes or via a Drip treatment given. Usually the cortisone is administered in high doses over 3 days. After that, it is slowly reduced. As a rule, cortisone treatment lasts for acute or subacute tinnitus about 10 days.
physical therapy
For tinnitus caused by a cervical spine disease, physiotherapy treatment can sometimes be helpful. The content of the treatment should be tailored to the individual. A physiotherapist with additional training in manual therapy is often recommended. Some sufferers have had positive experiences with approaches from osteopathy or kinesology. Contents such as the manual treatment of tendons, ligaments, muscles, skin and subcutaneous tissue, as well as active movement exercises were perceived as supportive.
Also learning a cheap one posture, learning and performing individual exercises, learning a balance between exercise and physical rest, as well as improving Body awareness had positive effects on those affected. Cold treatments to stimulate blood circulation and thus promote relaxation, alleviate pain and improve the state of stretching of the muscles were also found to be effective in some sufferers.
homeopathy
Specialist authors describe a possible, supportive homeopathic treatment if you have tinnitus. When using it, a detailed questioning of the person affected and extensive knowledge of the treating person are necessary. As different as the causes of tinnitus and its individual characteristics can be, the use of homeopathic remedies can be just as different. It will Globules used, which children like to take. examples are Phosphorus, petroleum, Rectificatum, Cocculus, Nux vomica and Arnica.
It is usually used in potency D12 and the recommended dosage is usually 5 globules 3 times a day. Which globules are used depends on the nature of the noises in the ears, additional complaints and the patient's medical history.
Phosphorus is sometimes used for those affected who are sensitive to weak noises and other stimuli and who quickly or frequently complain of mental and physical exhaustion. Affected people who complain of hearing loss and a “dull” noise, as well as itching, throbbing, and burning in the ear are sometimes treated with Phosphorus.
petroleum is e.g. Used for pounding noises in the ears, sometimes associated with dizziness and itching in the throat and external ear canal, as well as nausea.
Another example is Arnicawhich is given in acute noise trauma. Noise trauma can cause swelling, which arnica can have a decongestant effect.
It is important that the cause of the tinnitus before a homeopathic (self) treatment fclarified by a doctor becomes.
Noiser
In the case of chronic tinnutis, a "noise generator", a so-called noiser, can help in some cases. A noiser can be placed behind or in the ear. However, it is important to ensure that the external auditory canal remains free so that everything can continue to be heard. A noiser has to be selected and adapted very individually.
When a tinnitus longer than 3 months lasts, it is usually one chronic tinnitus. It occurs at the same time in more than half of those affected Hearing loss on. A built-in noiser in a hearing aid often has a supportive effect. This so-called tinnitus noiser can easily be built into various hearing aid models. The noiser creates a calming, quiet noise. Often this noise is perceived as pleasant by the person concerned.
This noiser calms the auditory pathway in the brain. At best, the brain's filter system reacts after a while in such a way that it classifies both the tinnitus and the tinnitus noiser as unimportant and filters them out and thus “eliminates” them. When this happens, the tinnitus is no longer noticed.
A noiser forms the Basis for retraining therapy. Here, the affected person should learn to no longer perceive the noise in the ear as annoying and tormenting, as well as learn to "listen away" in a targeted manner. This form of treatment is designed for long-term success. It can take about 6 months for the affected person to notice the first successes.
In addition to various hearing aid models that allow the installation of a tinnitus noiser, there is also a smartphone tinnitus balance app. Here you can get access to a kind of library of sounds and music that can be used for tinnitus.
prophylaxis
Since the cause of tinnitus is largely unknown, there is really only the prophylactic recommendation to avoid atherosclerosis of the vessels (risk of Circulatory disorder of the ear) as well as reducing stress and poor posture.
forecast
In some cases the noises in the ears spontaneously disappear even without treatment. At a acute tinnitus healing processes in 60%-80% recorded. In chronic or subacute tinniti, healing is often much less common. Even if there are different assessments of acute therapy and its effectiveness, according to the current guidelines, rapid treatment for acute tinnitus should still be started and the healing probabilities should be positively influenced under certain circumstances. In the case of subacute and chronic processes, the noises in the ears go less often, but with appropriate behavioral therapy, the level of suffering can be reduced and a more normal life with the noises in the ears can be made possible.
Celebrities with tinnitus
That Tinnitus is a very old disease is also shown by various traditions of historical celebrities who also suffered from tinnitus. These include: Martin Luther, Beethoven, Rousseau, Smetana and Goya
Historical aspects of tinnitus
The clinical picture of tinnitus and unknown noises in the ears were described very early on. First traditions could already be found on ancient Egyptian papyri, on Babylonian clay tablets and in the Ayur Veda, the book of Indian medicine. In Babylonian medicine in the 17th century BC, the prevailing opinion was that noises in the ears were hidden messages to spirits and gods that were whispered to patients. Attempts have been made to treat the disease by introducing various mixtures into the ear. Casting various spells should also improve the symptoms. Hippocrates found that most of the noises in the ears disappeared when the patient approached a louder source of noise. He suspected that the tinnitus is solely due to a pulsation of blood vessels. Pliny 23-79 AD then coined the term tinnitus for the first time and recommended a brew made from rose oil, honey and pomegranate bark for treatment.
Summary
Under a Tinnitus one generally understands the presence of noises in the ears which cannot originate from the immediate surroundings of the patient. The complaints are painless, but mostly associated with cotton-wool hearing or hearing disorders and, in some cases, symptoms accompanying dizziness. The reason is the unfamiliar one-ear hearing that is Equilibrium system messes up. The causes of tinnitus are largely unexplained. The different theories focus on neural factors, circulatory disorders and psychogenic factors. The noises in the ears are usually described by the patients as permanent and sometimes of increasing volume. The type of noises in the ears can be caused by different frequencies and perceived by the patient as whistling, humming, hissing or squeaking sounds. On the one hand, Tinniti can be classified according to the place of origin (lens= pulsating vessel or pressure exerting nerve; subjective= Location is unknown) according to the duration of the illness (acute= in the past three months, subactual= between 3 months and a year; chronic= more than a year) and divide it into 4 grades according to the patient's condition, grade 1 hardly being perceived by the patient and more likely to be overheard, grade 4 being so strong that the patient's everyday life is severely impaired. These impairments can result in difficulty concentrating, irritability, sleep disorders, Anxiety and depressions express. In very extreme cases, thoughts of suicide or committed suicides also arise. The diagnosis must be individually adapted to the respective patient. For reasons of cost and because of the high level of effort, the full diagnostic program should only be carried out in patients for whom no treatment could be carried out after the basic diagnosis. An important diagnostic criterion is the patient survey, in which the duration of the illness, type of complaints and impairment in daily life should be asked. The diagnosis of tinnitus patients is a cross-disciplinary diagnosis in which ENT doctors, neurologists, internists and, if necessary, psychologists should be involved. Treatment of patients with acute tinnitus should be carried out quickly in order to increase the prognosis of a cure accordingly. Blood-thinning drugs are used, Local anesthetics or anti-inflammatory cortisone for use. In patients with chronic tinnitus, attention needs to be directed rather to psychogenic treatment, which focuses on behavioral therapy and autogenic training concentrated. These patients must be taught that the noise in the ear will probably not go away completely, but that appropriate cognitive training will regulate the perception of the tinnitus downwards. The treatment of acute tinnitus and the subacute form is a mixed treatment of acute and chronic forms of therapy. Some therapies, some of which are very promising, are currently still in clinical testing, e.g. the hyperbaric oxygen treatment, in which the patient is given oxygen in a hyperbaric chamber, or a form of treatment in which the patient hears the same sound through a small one Hearing aid gets permanently recorded. Despite promising results, these treatments are not yet covered by health insurance and have to be financed by the patient himself. Acute tinnitus goes away by itself in 60% -80%. The prognosis of the subactute and the chronic form is much worse and may have to be. be endured all of life.
