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Tinnitus (literally “ringing” in Latin) is characterized by ringing, buzzing, or noises that originate in the ear or the head, and can cause discomfort and stress.

Though this condition is usually not dangerous, it can be a symptom of another health problem or underlying condition. Tinnitus can cause many stressful side effects, including fatigue, sleep problems, concentration difficulty, memory problems, depression, anxiety, and irritability.

The actual mechanism responsible for tinnitus is not yet known. We do know that it is real-not an imagined symptom of something that has changed in the auditory or neural system. There is reason to be hopeful; current research efforts using a physiological model may soon provide the necessary information for identifying its causes.

What Causes Tinnitus?

At this time, the actual physiological cause or causes of tinnitus are not clear. The following factors have been known to cause tinnitus or worsen tinnitus if it already exists: noise exposure, wax build up in the ear, certain medications (aspirin, some antibiotics, etc.), ear or sinus infection, stress and depression, allergies, jaw or bite misalignment (TMJ-temporomandibular joint disorder), cardiovascular disease, a tumor on the auditory nerve, degeneration of bones in the middle ear, under active thyroid, head or neck trauma and neck strain.

Is Tinnitus associated with hearing loss?

In most cases, tinnitus is associated with some hearing loss. Usually, tinnitus will be identified as a high-pitched tone in the region of hearing loss. Tinnitus can be perceived as being in the ears or in or around the head, and can have a variety of different sounds such as ringing, hissing, or roaring. In some cases, tinnitus is present where there is no loss of hearing. Hearing aids can greatly diminish tinnitus in those who suffer from hearing loss.

In patients without hearing loss, tinnitus can be a sign of musculoskeletal disorders, Eustachian tube dysfunction, allergies, head trauma, overuse of stimulants such as caffeine, nicotine, and chocolate.

How is Tinnitus Treated?

There are various options for treating tinnitus that might provide relief:

Amplification (hearing aids): If a patient has a hearing loss, a hearing aid will often allow the wearer to hear normal sounds that can take the focus away from the tinnitus. Hearing aids are the best treatment if a hearing loss is present.

Sound Therapy: The hearing aid manufacturer, Widex has a sound masking feature available in their hearing aids called Zen Making Therapy. Zen masking programs offer varying tones sounding similar to wind chimes) which provide a relaxing masking effect to the auditory system and make tinnitus less noticeable. Zen programs are based upon each patient’s hearing loss and the frequencies of their tinnitus to ensure adequate amplification and masking. Widex Zen Therapy combines sound stimulation, counseling, stress reduction and amplification. Another manufacturer, Oticon also has hearing aids that provide tinnitus masking assistance similar to Zen therapy but use narrow band noises and sinusoidal stimuli or “ocean sounds” for masking. For some patients this combination of amplification and sound therapy can be an effective way of relieving daily tinnitus.

Non-amplification Masking: Ear-level tinnitus maskers resemble hearing aids (but are not amplifiers) and produce a pleasant sound of their own to “mask” the clamor of tinnitus. The effective use of masking sometimes provides the added bonus of canceling the tinnitus for varying lengths of time when the masker is turned off; a phenomenon called “residual inhibition.” Environmental masking such as turning on a fan or the radio or TV at a low volume also can provide the effect of masking.

Cognitive-Behavior Therapy: This counseling technique alters the way the individual perceives his or her tinnitus by disrupting their maladaptive thoughts and behaviors surrounding their tinnitus. By changing these perceptions the individual can learn to cope with their tinnitus in a more positive way.

Auditory Habituation: This therapy attempts to retrain the ear to ignore (or habituate) the tinnitus. Patients wear hearing aid type devices that emit a “broad band noise” – noise that is slightly louder than the tinnitus. The course of this treatment can last more than one year.

Drug Therapy: Many medications have been investigated for use in tinnitus treatment. Currently, medications are primarily used to help with anxiety, depression, and sleep difficulties. Treating these problems can indirectly help the tinnitus patient. Any medications should be discussed with your primary care physician prior to beginning drug or supplement therapy.

Acupuncture: Acupuncture therapy operates on the principle that health depends on the free flow of “life energy” through the body. If the flow is disturbed, illness will result. This procedure can bring relief for some tinnitus patients.

Do Certain Things Make Tinnitus Worse?

Yes! The way the ear and tinnitus react to different situations varies greatly from person to person, but everyone should be aware of the following:

1.Caffeine/Alcohol/Nicotine/Chocolate can exacerbate tinnitus. Some tinnitus patients also find that their tinnitus is made worse by allergies and consuming certain foods. (Cheese, salt and red wine have been mentioned.)

2.Over-exposure to noise can cause or worsen tinnitus and hearing loss. It is very important, especially if you already have tinnitus, to avoid further exposure. When around noise or anticipating a noisy event, always carry and use proper hearing protection (earplugs or muffs). Remember the potential danger of noise from common sources such as lawnmowers, stereos, hair dryers, chain saws, leaf blowers, motorcycles, concerts, movies, and noise on the job.

3.Certain medications: Many drugs are ototoxic (damaging to the ear) and can make tinnitus worse. Tinnitus can be caused by loop diuretics such as Lasix, erythromycin, Biaxin, aspirin and some intravenous antibiotics. Chemotherapy, Cisplatin, Carboplatin and Topical Neomycin can cause hearing loss if absorbed. Discuss the side effects of medications with your primary care physician and if you have hearing loss mention that to him or her. A non-ototoxic medication may need to be prescribed as an alternative.

4.Stress. Tinnitus causes stress; stress causes tinnitus: it can be a vicious cycle. Anything you can do to reduce stress will help break the cycle. Relaxation therapies such as yoga, meditation, and exercise can be useful. Consider counseling or meditation therapy and discuss these concerns your doctor if you cannot relieve stress issues.