What is tinnitus?
Tinnitus is a ringing, swishing, or other type of noise that seems to originate in the ear or head. In many cases it is not a serious problem, but rather a nuisance that eventually resolves.

It is not a single disease, but a symptom of an underlying condition. Nearly 36 million Americans suffer from this disorder. In almost all cases, only the patient can hear the noise.

What causes tinnitus?
Tinnitus can arise in any of the following areas: the outer ear, the middle ear, the inner ear, or by abnormailities in the brain. Some tinnitus or head noise is normal. If one goes into a sound proof booth and normal outside noise is diminished, one becomes aware of these normal sounds. We are usually not aware of these normal body sounds, because outside noise masks them. Anything, such as wax or a foreign body in the external ear, that blocks these background sounds will cause us to be more aware of our own head sounds. Fluid, infection, or disease of the middle ear bones or ear drum (tympanic membrane) can also cause tinnitus.

One of the most common causes of tinnitus is damage to the microscopic endings of the hearing nerve in the inner ear. Advancing age is generally accompanied by a certain amount of hearing nerve impairment, and consequently tinnitus. Today, loud noise exposure is a very common cause of tinnitus, and it often damages hearing as well. Unfortunately, many people are unconcerned about the harmful effects of excessively loud noise, firearms, and high intensity music. Some medications (for example, aspirin) and other diseases of the inner ear (Meniere's syndrome) can cause tinnitus. Tinnitus can in very rare situations be a symptom of such serious problems as an aneurysm or a brain tumor (acoustic tumor).

There are two main types of tinnitus?

1)Pulsatile (like a heartbeat) tinnitus is often caused by sounds created by muscle movements near the ear, changes in the ear canal, or blood flow (vascular) problems in the face or neck. You may hear sounds such as your own pulse or the contractions of your muscles.
2)Non-pulsatile tinnitus is caused by problems in the nerves involved with hearing. You may hear sounds in one or both ears. Sometimes this type of tinnitus is described as coming from inside the head.

The most common cause of tinnitus is hearing loss that occurs with aging (presbycusis), but it can also be caused by living or working around loud noises (acoustic trauma). Tinnitus can occur with all types of hearing loss and may be a symptom of almost any ear disorder.

 Other possible causes of tinnitus include:
A build-up of earwax.
Medicines, especially antibiotics or large amounts of aspirin.
Drinking an excessive amount of alcohol or caffeinated beverages.
Ear infections or eardrum rupture.
Dental or other problems affecting the mouth, such as temporomandibular (TM) problems.
Injuries, such as whiplash or a direct blow to the ear or head.
Injury to the inner ear following surgery or radiation therapy to the head or neck.
A rapid change in environmental pressure (barotraumas).
Severe weight loss from malnutrition or excessive dieting.
Repeated exercise with the neck in a hyper extended position, such as when bicycle riding.
Blood flow (vascular) problems, such as carotid atherosclerosis, AV malformations, and high blood pressure (hypertension).
Nerve problems (neurological disorders), such as multiple sclerosis or migraine headache.

Other diseases. These may include:
Acoustic neuroma.
Anemia.
Labyrinthitis.
Meniere’s disease.
Otosclerosis.
Thyroid disease.

Most tinnitus that comes and goes does not require medical treatment. You may need to see your doctor if tinnitus occurs with other symptoms, does not get better or go away, or is in only one ear. There may not be a cure for tinnitus, but your doctor can help you learn how to live with the problem and make sure a more serious problem is not causing your symptoms.

How is tinnitus evaluated?
A medical history, physical examination, and a series of special tests can help determine precisely where the tinnitus is originating. It is helpful for the doctor to know if the tinnitus is constant, intermittent or pulsating (synchronous with the heart beat), or is it associated with hearing loss or loss of balance (vertigo). All patients with persisting unexplained tinnitus need a hearing test (audiogram). Patterns of hearing loss may lead the doctor to the diagnosis.

Other tests, such as the auditory brain stem response (ABR), a computerized test of the hearing nerves and brain pathways, computer tomography scan (CT scan) or, magnetic resonance imaging (MRI scan) may be needed to rule out a tumor occurring on the hearing or balance nerve. These tumors are rare, but they can cause tinnitus.

What is the treatment of tinnitus?
After a careful evaluation, your doctor may find an identifiable cause and be able to treat or make recommendations to treat the tinnitus. Once you have had a thorough evaluation, an essential part of treatment is your own understanding of the tinnitus (what has caused it, and your options for treatment).

In many cases, there is no specific treatment for tinnitus. It may simply go away on its own, or it may be a permanent disability that the patient will have to "live with." Some otolaryngology's have recommended niacin to treat tinnitus. However, there is no scientific evidence to suggest that niacin helps reduce tinnitus, and it may cause problems with skin flushing.
 

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