Ringing in ears should not be interpreted only as a superstition. The problem may be more serious than it looks, especially if it occurs in people that have passed the first youth. Tinnitus is defined as abnormal perception of sounds or noises in the ear, in the absence of external sound stimulus. The patient may perceive auditory sensations in various forms: rustling, crackling, hissing, ticking, etc.
The patient feels that the noise comes from inside or outside the ear. Sound or noise intensity is low or high, sometimes very intense (covers the external noise), perceived constantly or with periods of silence, in one ear or both ears. Bilateral tinnitus, is often associated with deafness or announces deafness which is usually sensory . Tinnitus is one of the most important events ear disorders along with hearing loss and vertigo. Occurs with a frequency of about 63% in people over 45 years.
The most common situations in that tinnitus occurs are those in which the ear system is impaired:
- Ear trauma
- Auricular foreign bodies
- Plug of wax
- Acute or chronic exposure to noise
- Ototoxic medications: aspirin, some antibiotics, chemotherapy
- Infections: otitis externa, otitis media, labyrinthitis, mastoiditis
- Atherosclerosis in middle ear or inner vessel
- Meniere’s syndrome
- Infections: syphilis, meningitis;
- Multiple Sclerosis
- Lead poisoning, phosphorus, mercury
- Head and neck tumors
A particular form of tinnitus is pulsatile tinnitus, which is synchronous with the heartbeat, is caused by a number of vascular diseases. More specifically, it can occur in cases of, arterial aneurysm, venous or arteriovenous malformation, vascular occlusive disease (carotid atherosclerosis).
Tinnitus Risk Factors
Occupations where the employee works in noisy enviroment represent risk factors for tinnitus. The most exposed are those working with military weapons, pilots, construction workers etc. In young population the noises in the ears appear especially in large consumers of coffee, tea, cigarettes and those with a chaotic lifestyle. Is thought to be harmful and a cause of tinnitus listening to music with headphones or at high volume. Stress and workplace noise are also a common cause of tinnitus, of which most unpleasant effects are sleep disorders and daytime fatigue.
Tinnitus can cause unpleasant symptoms such as intolerance to loud sounds, which can cause significant emotional distress. The condition is not actually a independent disease but a symptom that can occur in various neurological disorders or otorhinolaryngology, and sometimes can have psychological causes (anxiety, depression, insomnia). In patients with tinnitus, quality of life is changed in a negative way, can cause irritation, loss of attention and memory.
Treatment of tinnitus include the following general measures:
- Avoidance of excessive exposure to noise
- Avoidance of other extrinsic factors that may cause cochlear damage
- Tinnitus “masked” with music
- Reduction of tinnitus by amplifying normal sounds.
Usually, tinnitus masking is accomplished by the use of a hearing aid which often is beneficial. Drug treatment consists of intravenous administration of antiarrhythmics (lidocaine), which can reduce tinnitus in some patients. Studies to date suggest that such therapy administered per os (oral) for a long time, brings no real benefit. Of the many drugs that have been tested through studies, oral antidepressants (nortriptyline 50 mg orally at bedtime) were found to be most effective. Drug treatment also includes vasodilators, benzodiazepines or other drugs indicated in migraine. The psychotherapeutic approaches are cognitive-behavioral therapy, relaxation, education, information, biofeedback, hypnotherapy. The combination of these therapeutic techniques for 3 months leads to a decrease in subjective perceived intensity noise, the patient giving a score at the beginning and end of the treatment.