Tinnitus is a symptom in which a person hears extraneous sounds (crackling, ringing, buzzing) in the absence of their obvious source. There are several etiological factors of this condition: exposure to loud sounds, diseases and tumors of the hearing organ, hypertension and other vascular disorders. To determine the cause of tinnitus, audiometry with tuning fork samples, X-ray examination of the skull, angiography, otoscopy, laboratory tests are performed. To relieve the symptom, psychotherapy methods, sedative herbal remedies are used.
Patients describe their subjective sound sensations differently: as a constant monotonous noise, a low hum, similar to the operation of the engine. Often patients say that they hear ringing or squeaking in their ears. Some people compare auditory sensations to a rumble or a crash. Noise occurs suddenly, and it is not always possible to trace the connection between its appearance and the influence of external factors. It lasts from a few minutes to several days and even weeks, which significantly reduces performance and causes negative emotions up to the development of depression.
Tinnitus can be both one-sided and two-sided. Sometimes the symptom is accompanied by severe pain in the ear and temples, hearing loss, dizziness and balance disorders. For some people, the noise is so strong that it completely drowns out the sounds of the surrounding world. Since subjectively unpleasant sound sensations can be caused by serious neurological or vascular disorders, it is urgently necessary to visit a specialist to find out the cause of the symptom and select an adequate treatment regimen.
According to the sound characteristics, tinnitus is divided into tonal – continuous sounds of the same frequency (ringing, whistling, low-frequency hum) and non-tonal – periodic unpleasant auditory sensations in the form of clicks, crackling, rumbling. By duration, the symptom is divided into acute (up to 3 months), subacute (from 3 to 12 months) and chronic (lasting more than 1 year). In clinical practice , tinnitus is classified depending on the cause of occurrence:
- Subjective noise. It is often caused by prolonged exposure to loud sounds on the auditory analyzer. Extraneous sounds are heard only by the patient, which prevents a person from focusing on the actions being performed, conversation.
- Neurological noise. This type of tinnitus is caused by damage to specific nerve receptors in the inner ear, which happens in Meniere’s disease. Patients feel a strong hum, usually accompanied by dizziness.
- Somatic noise. It can be associated with the defeat of any organ, pathological impulses from which excite the auditory analyzer. Somatic tinnitus in some cases is provoked by movements and touches.
- Objective noise. The rarest type of disorder, which is caused by deformities of the vessels of the ear, pathology of the muscular system. Extraneous “pulsating” sounds can be heard by a doctor when using a stethoscope.
To assess uncomfortable sensations, Soldatov’s classification is used, which divides ear noise by severity. At 1 degree, the working capacity is preserved, the person is adapted to extraneous sounds. The appearance of intense noise during the night period indicates the transition to stage 2. A constant strong hum, which interferes with the performance of habitual duties, worries at stage 3, with a complete loss of working capacity, the 4th degree of the disease is diagnosed.
Causes of tinnitus
The appearance of noise is provoked both by a single sound effect of exorbitant volume (shots from large-caliber weapons, fireworks, rock concerts) and by the constant influence of sounds, which is often found in people listening to loud music through headphones, workers of factories and sewing workshops. With acute trauma, a person temporarily loses hearing, against which a monotonous ringing or squeaking in the ears appears. There may be severe throbbing pain in the temporal part of the head, dizziness.
With chronic exposure to sound stimuli, symptoms increase gradually. First, there are complaints about short-term noise (for 1-2 hours), which begins after staying in a room with loud sounds, using headphones. As the condition progresses, the buzz in the ears becomes constant and is accompanied by hearing impairment. The frequent occurrence of noise that disrupts performance, combined with headaches and hearing loss, serves as an indication for seeking medical help.
Among people 55-65 years old, every fifth periodically notes the appearance of extraneous sounds, after 65 years the number of sufferers from buzzing and ringing in the ears increases to 40%. Complaints about two-way noise are characteristic, which at first feels very quiet and practically does not interfere with doing everyday things. Then the sounds seem more intense. Due to the increased symptom at night, patients tend to suffer from insomnia. Tinnitus in the elderly is caused by degenerative changes in the inner ear and is combined with hearing loss, which requires a doctor’s consultation.
The appearance of tinnitus is characteristic of patients suffering from high blood pressure, and the intensity of auditory sensations depends on blood pressure indicators. Extraneous sounds are caused by the turbulent movement of blood through narrowed vessels with a thickened wall. Hypertensive patients periodically hear a slight hum, which usually occurs against the background of headache and deterioration of the general condition. Increased noise, accompanied by excruciating nausea, flashing “flies” in front of the eyes, is a symptom of an incipient hypertensive crisis.
Pathological processes in the ear
Ear noise may indicate damage to the auditory analyzer, which is caused by impaired perception and analysis of sounds, discoordination of the work of different parts of the hearing organ. These causes often cause temporary sensations of buzzing or ringing, which cease to bother after the main pathology is stopped. With some lesions of the inner ear that are difficult to treat, the noise becomes constant. Tinnitus is caused by:
- Inflammatory diseases: otitis externa and otitis media, eustachiitis, labyrinthitis.
- Blockage of the auditory canal: sulfur plugs, foreign bodies, water ingress.
- Diseases of the inner ear: Meniere’s disease, otosclerosis.
Most often, the symptom occurs with atherosclerosis: the deposition of lipid plaques on the walls of the vessels of the inner ear disrupts the normal movement of blood, which is felt as a moderately intense “pulsating” noise. In most patients, the hum is more pronounced on the one hand, which is associated with the degree of damage to the vascular wall. Unilateral loud ear noise is observed in patients suffering from temporal artery aneurysm. In this case, uncomfortable auditory sensations are combined with periodic headaches, dizziness.
Tinnitus is most characteristic of benign formation – neurinoma of the auditory nerve. With this neoplasia, unilateral tinnitus becomes the first symptom. A person notes the appearance of a faint constant hum in one ear, which does not disappear even at night. As the disease develops, there is a gradual deterioration of hearing on the affected side, sound sensations become more intense. Pulsating one-sided noise in combination with swallowing disorders, asymmetry of the ocular fissure occurs in glomus tumors of the ear.
In case of problems with the spine, the occurrence of ringing or buzzing in the ears is associated with sharp turns or tilts of the head, prolonged stay in an uncomfortable position. The causes of noise are the compression of individual vessels that go from the neck to the ear and brain. The symptom is observed periodically, the intensity of sounds is low, so the efficiency of most patients does not suffer. With severe deformation of the cervical vertebrae, monotonous strong ear noise is possible, combined with dizziness, fainting, sharp pain in the neck.
Traumatic brain injuries
Light head bruises may be accompanied by short-term noise or ringing in the ears, which does not cause severe discomfort. With more significant injuries, unusual auditory sensations are detected against the background of severe nausea and vomiting, intense headaches. Sometimes the symptom does not appear immediately after the injury, but after a few days. The noise that has arisen after a head blow is the basis for an urgent visit to the doctor, since with a traumatic brain injury there is a risk of destruction of bone structures, intracranial hemorrhages.
Complications of pharmacotherapy
Tinnitus often develops 1-2 weeks after the start of etiotropic treatment of severe bacterial infections, due to the strong ototoxic effect of medications. The symptom also occurs in patients with hypertension who are forced to take medications from several groups daily. Side effects from the auditory analyzer provoke such groups of medications as:
- Antibiotics: aminoglycosides, tetracyclines, macrolides.
- Diuretics: furosemide, ethacric acid, hydrochlorothiazide.
- NSAIDs in high doses: indomethacin, diclofenac, aspirin.
- Tranquilizers: flurazepam, tranxen, phenazepam.
- Malformations of the auditory analyzer: Goldenhar syndrome, microtia, congenital sensorineural hearing loss.
- Endocrine pathology: hypothyroidism, pituitary adenoma.
- Diseases of internal organs: digestive system, kidneys.
- Neurological causes: multiple sclerosis, age-related degenerative processes in the brain.
- Defeat of the temporomandibular joint.
When tinnitus appears, the patient is sent for examination to an otolaryngologist, who identifies the otogenic causes of the symptom. The diagnostic search is aimed at a detailed study of the functionality of the auditory analyzer and the structure of all parts of the ear. A comprehensive examination involves instrumental and laboratory methods, the most informative of which are:
- Instrumental examination of the auditory canal. Otoscopy is necessary to exclude inflammatory diseases of the outer and middle ear, ruptures of the eardrum. To assess the degree of mobility of the tympanic membrane, a pneumatic Zigle funnel is used. The method is supplemented by the determination of the patency of the auditory tubes.
- Audiometry. To detect hearing disorders, special devices are used that generate sounds of a given frequency. Speech audiometry is designed for rapid evaluation of the function of the auditory analyzer. With the help of tuning fork samples, the pathologies of the middle and inner ear are differentiated among themselves.
- X-ray examinations. Ear noise is often caused by neurological causes, so patients usually have an X-ray of the skull bones. In patients with symptoms of osteochondrosis, it is necessary to examine the spine. For more detailed visualization of volumetric formations and structural disorders of the brain, CT and MRI of the head are prescribed.
- Angiography. If an aneurysm or atherosclerotic lesion of the cerebral vessels is suspected, a contrast angiogram is recommended, which allows you to visualize the structure of the vascular bed and establish the exact localization of pathological changes. An even more modern method of vascular examination is MR angiography.
Laboratory methods are used as auxiliary, the examination plan includes general and biochemical blood tests, with a possible infectious cause of the disorder — serological reactions (IFA, PCR). In inflammatory processes accompanied by a discharge from the ear, bacteriological seeding is performed. In complex diagnostic cases, consultations of other specialists (neurologist, oncologist) are required to determine the cause of ear noise, and psychiatric examination is shown to some patients.
Help before diagnosis
It is possible to completely get rid of tinnitus only after therapy of the underlying disease that caused unpleasant sensations. Therefore, if extraneous sounds appear for no reason, you can not postpone a visit to the doctor. To reduce discomfort before identifying the cause of the disorder, light herbal sedatives and soothing herbal teas are recommended. In some cases, self-massage of the auricles helps: rubbing movements, pressing palms on the ears.
Since tinnitus is caused by various causes, treatment regimens are selected strictly individually, taking into account the underlying disease and concomitant pathology. A prerequisite for the effectiveness of therapy is the elimination of provoking factors (refusal of loud music in headphones, change of place of work, avoidance of noisy parties and visits to nightclubs). Etiotropic therapy includes antibiotics, anti-inflammatory and antihistamines, angioprotectors, other groups of drugs, and their combinations. For the symptomatic treatment of tinnitus , use:
- Sedatives. Herbal and synthetic drugs reduce the excitability of the brain and the speed of nerve impulses. Medications also normalize the emotional state.
- Antidepressants. Medications are effective with constant noise, which is caused by chronic diseases, Meniere’s disease. Drugs affect the centers in the brain, increase the concentration of serotonin.
- Tranquilizers. They are indicated for severe ringing or buzzing in the ears, leading to insomnia and reducing performance. The effectiveness of the funds is due to their sedative and hypnotic effect.
Tinnitus retraining therapy (TRT) is an innovative direction, which is a kind of cognitive behavioral therapy. The program involves individual classes with the use of psychotherapeutic methods, during which a person is taught ways of relaxation, methods of switching attention. The component of treatment is individually selected sound therapy. The patient is offered to listen to a pleasant noise (the splash of waves, the rustle of leaves, the sound of rain). Over time, the brain learns to block these sounds, while the perception of pathological noise decreases.
If the hum, ringing, tinnitus are associated with purulent inflammatory diseases, it is necessary to open and drain the tympanic cavity, which significantly accelerates the recovery process. When tumors of the auditory analyzer are detected as the main cause of the disorder, their removal is carried out with a mandatory cytomorphological examination. Treatment of malignant neoplasms involves a combination of surgery with chemotherapy and radiation therapy. With aneurysms, the affected vessel is clipped.