Many of us have experienced that annoying buzzing sound known as tinnitus. It’s thought of as more of a symptom than as a diagnosis. It affects more than a million people worldwide and has been chronicled as far back as the first century AD. Only 20% of people with tinnitus seek treatment. That is most likely due to the fact that most tinnitus comes and goes and is tolerated to a degree in which we can function. Although in the United States, almost one third of patients who request treatment report symptoms that are debilitating.
Tinnitus is variable with the quality and loudness of the buzz, hiss or ringing that is often described. Prevalence increases with age, smoking, male gender and ethnicity, with the non-Latino white population statistically at greater risk. Some conditions such as diabetes and other autoimmune diseases are risk factors for tinnitus. A history of loud sound, which can be recreational (those crazy late night concerts!), occupational or environmental also can predispose a person to tinnitus.
The majority of tinnitus cases are considered Primary which is defined as having no identifiable cause. On the other hand, Secondary tinnitus has an identifiable cause which can include a long list of conditions such as certain medications (NSAIDS, chemotherapy, antibiotics), inner and outer ear disturbances, neurological and vascular causes, infections and nutrient deficiencies. Persistent tinnitus (lasting more than 6 months) can impact ones quality of life and can lead to depression, anxiety, insomnia and neurocognitive decline. It can really be devastating!
The cause of tinnitus is alittle more complicated than we once thought. It is not simply a cochlear (inner ear) phenomenon. It has to do with the damaged stereocilia (inner ear organelles of hair cells) located in the cochlea that exhibit an increase in a spontaneous firing rate in response to lost frequencies which are relayed to higher structures in the brain. It appears to be a maladaptive neural plasticity as it results in increased spontaneous firing rates and synchrony among neurons in central auditory structures, according to research by Shore and colleagues (Shore, SE, Roberts LE, Langgguth B. Maladaptive plasticity in tinnitus- triggers, mechanisms and treatment. Nat Rev Neurol. 2016;12(3):150-160.
So, what to do?
First, lab testing should be done to rule out causes of tinnitus. Imaging is usually unnecessary unless one questions a tumor or vascular cause. When no underlying pathology is identified for tinnitus, then a patient should be sent for a full audiology evaluation. Management involves treatment of perceived loudness and treatment of comorbid symptoms such as depression, anxiety, sleep disturbance, etc.
The leading recommendation made by The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) is cognitive behavioral therapy (CBT). The sound cannot be eliminated but the patient’s response to the sound can be modified. Tinnitus Retraining therapy (TRT) is another form of habituation therapy that has been successful. Unlike CBT, which is the idea that behaviors are modifiable thoughts that can be changed by teaching coping mechanisms such as relaxation, TRT aims to eliminate the perception of sound. A patient wears a device similar to hearing aids using broadband noise that closes the gap between silence and the perception of tinnitus. This device is worn for 6 hours a day for 12 months.
Other alternative non-medical therapies include Chinese herbal medications such as Ginko biloba, vitamins, zinc, manganese, and melatonin. Cannabinoids, which is a plant that contains hundreds of chemicals that each act differently on the brain may have an inhibitory effect on neurotransmitter release. Other modalities such as yoga, meditation, physical therapy and mindfulness have helped patients feel more relaxed but they had no effect on the severity of tinnitus.
Of course prevention cannot be underestimated. Occupational noise and recreational use of music devices put people at heightened risk for hearing loss and tinnitus. If you are suffering from tinnitus, see a practitioner for evaluation to help your symptoms.
Reference: Gillian Ross, W, Danielsen, R. What’s the Buzz? Treatment Strategies in Chronic Subjective Tinnitus. Clinician Reviews. September/October 2018/Vol 28,NO 10. p. 34-41.
