The Nature, Common Causes, Effects and Treatment of Tinnitus

Often described as a ringing in the ears, tinnitus is thought to affect as many as one person in ten of those living in the UK, and around half claim that its effects are moderately to severely distressing. The figures for the United States are quite similar, if a fraction higher, and seem to suggest that the incidence will be much the same in most developed nations and even many developing countries.

TinnitusNot always characterised by ringing, some report buzzing, whooshing and clicking sounds, while others complain of whistling and even sounds that appear to resemble voices. The one thing that all of these annoying sounds have in common, however, is that they originate within the ear, and not in the external environment. That said, they fall into two types. While most are indiscernible to an examining physician, some may actually be audible to the examiner. This has led to the phenomenon being classified as either subjective or objective tinnitus respectively. Although quite rare, in the latter category, the sounds are often due to anatomical anomalies that affect local blood flow, or the result of spasms in the tiny muscles of the middle ear.

In practice, it is the subjective form that is likely to result in the most stress among those affected. It is a symptom, rather than an illness, and one that almost everyone is likely to have experienced for a few hours, on occasions such as a New Year’s firework display, when the percussive effect of the explosions cause temporary muffling of sounds, which is invariably accompanied by the classical ringing sensation. Hunters and shooting enthusiasts who may neglect to wear ear defenders will also experience the same sensations. In practice, loud noises are a common cause of temporary deafness that, with repeated exposure, will inevitably become permanent. More than 90% of those affected by noise-induced hearing loss (NIHL) will also experience tinnitus, as will many of those whose hearing loss is due to the progressive deterioration termed presbycusis, a natural result of the aging process. That said, however, around one in three of all sufferers exhibit no sign of hearing loss, and also fail to display evidence of any other form of ear defect.

In addition to the effects of aging and exposure to loud noises, both of which are equally responsible for varying degrees of deafness, the other main causes of these persistent, inappropriate and ultimately stressful noises are essentially fivefold. One in ten chronic sufferers, for instance, can attribute their symptoms to an injury, either to the ear, the neck or the head. The middle-ear infection known as acute otitis media, though often painful, normally clears up within a day or two when treated with an appropriate antibiotic. However, in some patients, these infections may become chronic and can lead to the formation of an abnormal growth of skin cells termed a cholesteatoma. Until they are surgically removed, these benign growths will often tend to cause some degree of deafness, vertigo and, not surprisingly, tinnitus.

Another disease in which there is an abnormal growth of bone within the middle ear causes the three tiny ossicles responsible for conducting sounds from the externa ear to the inner ear, to become fused together. The result, once again, is hearing loss and the accompanying noises. The condition is known as otosclerosis and is recognised as a fairly common cause of hearing loss among young adults.

Among the more unfortunate factors that have become a frequent cause of these auditory disturbances are several types of medication. These include certain antibiotics, diuretics, non-steroidal anti-inflammatory drugs, chemotherapy drugs, and even aspirin in sufficiently high doses. Finally, while not universally cited as a direct cause of this, it is well-established that emotional stress can intensify the sensation and hinder the management of tinnitus, as if the condition itself was not stressful enough.

While it must be said that, to date, the condition remains incurable, all is not gloom and doom, as there are some very effective ways in which to manage it, and the first step should be to consult an audiologist. In this category, Ear Institute leads the field in South Africa. Often, a suitable hearing aid addresses both the hearing loss and the internal noises. Where this is not the case, we offer a combination of counselling, sound enrichment technology and aural health supplements that is enabling many South Africans to ignore their tinnitus and live normal lives.
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