The tinnitus is “parasitic” sounds a person hears without that they actually exist. These can be whistles, buzzing or clicking, for example. They can be seen in one ear or in both, but can also be present inside the head, front or back. Tinnitus can be occasional, intermittent or continuous. They result from a dysfunction of the auditory nervous system. This is a symptom that can have many causes.
A temporary tinnitus can occur after exposure to loud music, for example. It usually resolves without intervention. This sheet is dedicated to chronic tinnitus that is to say to those that persist and can become extremely annoying for those who suffer from it. However, in the vast majority of cases, tinnitus does not have a significant impact on quality of life.
In general, it is estimated that 10% to 18% of the population suffers from tinnitus. The proportion is 30% in adults. 1% to 2% of the population is seriously affected.
In Quebec, about 600,000 people would be affected by this problem, 60,000 of them seriously. The large-scale use of music players and MP3 players among young people raises fears of an increase in prevalence in the medium term.
Types of Tinnitus
There are 2 main categories of tinnitus.
Objective tinnitus . Some of them can be heard by the doctor or specialist consulted, because they are caused by disorders that, for example, make the blood flow more audible. They can also sometimes manifest themselves by repeated “clicks”, sometimes related to abnormal movements of the muscles of the ear that the entourage can hear. They are rare, but usually, the cause is identifiable and we can then intervene and treat the patient.
Subjective tinnitus . In their case, the sound is audible only by the person affected. These are the most common tinnitus: they represent 95% of cases . Since their causes and physiological symptoms are so far poorly understood, they are much more difficult to treat than objective tinnitus. On the other hand, the tolerance of the patient to these internal noises can be improved .
The intensity of tinnitus varies from one individual to another. Some people are poorly affected and do not consult. Others hear noises continuously, which can affect their quality of life.
Note. If you hear voices or music, it’s another disorder called auditory hallucination.
Causes of Tinnitus
Hearing tinnitus is not a disease in itself. It is rather a symptom very often related to a loss of hearing . According to one of the hypotheses put forward by the specialists, this would be a “ghost signal” generated by the brain in response to damage to the cells of the inner ear (see the section Risk Factors , for more details). Another hypothesis evokes the dysfunction of the central auditory system. Genetic factors may be involved in some cases.
Most often, the factors related to the appearance of tinnitus are:
In the elderly , hearing loss due to aging.
In adults , excessive exposure to noise.
Among the many other possible causes are the following:
Long-term use of certain drugs that can damage inner ear cells (see Risk Factors section ).
An injury to the head (such as head trauma) or neck (cervical sprain, etc.).
The spasm of a small muscle from the inner ear (stapedius).
The obstruction of the auditory canal by a plug of cerumen .
Some disorders or diseases :
- Meniere’s disease and sometimes Paget’s disease ;
- Otosclerosis (or otosclerosis), a disease that reduces the mobility of a small middle ear bone (the stirrup) and can lead to progressive deafness (see diagram);
- Infections of the ear or sinuses (eg repeated ear infections);
- A tumor located in the head, neck or auditory nerve;
- Misalignment of the temporomandibular joint (which allows movement of the jaw);
- Diseases affecting the blood vessels ; they can cause so-called tinnituspulsatile (about 3% of cases). These diseases, such as atherosclerosis, hypertension, or capillary , carotid, or jugular abnormality , can make the blood flow more audible. This tinnitus is of the objective type;
- Non-pulsatile objective tinnitus may be caused by an abnormality of the Eustachian tube, neurological disorders or abnormal contractions of the muscles of the throat or middle ear.
Evolution and possible complications
Some tinnitus develops in a very progressive way: before becoming permanent, they are perceived intermittently and only in quiet places. Others appear suddenly, as a result of a particular event, as a sound trauma.
Tinnitus is not dangerous, but when it is intense and continuous, it can become very disturbing. In addition to causing insomnia, irritability and poor concentration, they are sometimes associated with depression.
The list of types of noises heard by tinnitus sufferers is long. It seems that the most frequently mentioned noise is whistling , but patients also name the following sounds:
- rustling, etc.
Depending on their cause, tinnitus may be accompanied by hearing loss , nausea, drowsiness, dizziness, pain, or the persistent feeling of a plug in the ears.
Many sufferers also suffer from loud noise intolerance or have a strong or painful perception of sounds perceived as normal or weak by healthy people. This condition is called hyperacusis.
In general, tinnitus is less troublesome during the day because they are “masked” by other noises in the workplace or at home. However, they are more noticeable in the evening and can cause sleep disorders in many people.
Old people. Aging often causes deterioration of hearing mechanisms, which can lead to tinnitus.
Men. They are more affected than women by this type of symptoms.
People exposed to noise:
- – people working in an industrial environment;
- – truck drivers and anyone whose profession requires them to use a car often;
- – car mechanics;
- – construction workers;
- – soldiers in conflict zone;
- – the musicians;
- – inhabitants of cities with a high population density;
- – people who regularly frequent nightclubs, nightclubs, concert halls and raves , or who listen to music at a high volume with their walkman or MP3 player;
Treatment of the underlying disease
In cases where tinnitus is related to a specific disease, it is possible to achieve improvement or even cure by treating the disease in question: otitis or other infection, otosclerosis , Paget ‘s disease, Meniere’s disease, etc. However, not all these diseases are easily curable. Removing a wax plug or removing a tumor can also stop tinnitus.
Modifying the medication
When medications are the cause of the problem, a change in treatment or a decrease in dosage may reduce or eliminate tinnitus.
If tinnitus is caused by hearing loss or hearing damage due to excessive noise exposure, there is currently no specific treatment. Different drugs have been used (vasodilators, baclofen, cinnarizine, benzodiazepines like clonazepam), but most have more side effects than positive ones.
In some special cases, drugs to control stress or depression (such as amitriptyline) may be prescribed with good results.
Some people have had some relief with niacin (vitamin B3) supplements, but the result is unpredictable (to be taken under medical supervision only).
Corticosteroid injections (dexamethasone) through the eardrum can also be effective in some cases 29.
The doctor may offer various medications, but without any guarantee of effectiveness.
The generator of white sounds. This device diffuses, in the affected ear, a ” white sound ” (a noise similar to that produced by a radio device tuned between 2 stations) at a low volume. This sound masks tinnitus and reduces the inconvenience in the patient. This device looks like a hearing aid; an audiologist can provide one. White tone generators are recommended for patients with normal or near normal hearing.
The hearing aid. The use of a hearing aid may reduce the discomfort of some patients with mild or moderate hearing loss by making their tinnitus less audible. When the prosthesis is insufficient, they can also use a white tone generator.
Therapies and techniques
Acoustic habituation therapy (TAH). This approach, developed by an American specialist (Jastreboff), is often referred to as Tinnitus Retraining Therapy (TRT). It includes therapeutic meetings allowing the person to live better with tinnitus. He is explained the mechanism of tinnitus and the influence of emotional factors, he is taught techniques of relaxation and diversion of attention, etc. It involves, among other things, reprogramming his brain so that it filters sounds selectively. The goal is for the person to hear only useful sounds and ignore unnecessary sounds.
The TAH also includes noise exposure to avoid silence, as well as the wearing, as appropriate, of a white tone generator or hearing aid. This therapy is spread over approximately 18 months and includes around 16 hours of personalized follow-up. It is ideally offered by a multidisciplinary team including an otolaryngologist, an audiologist and an occupational therapist. In 2010, a clinical study of 123 patients concluded that TAH was more effective than tinnitus masking 31 .
Cognitive behavioral therapy. This psychological approach can significantly improve the quality of life of a person suffering from tinnitus . It is based on techniques of relaxation, visualization and diversion of attention, and a remodeling of thoughts and beliefs about tinnitus. Swedish researchers have even achieved some success with subjects participating in a cognitive-behavioral therapy program offered on the Internet. The duration of treatment is usually 3 months. Cognitive-behavioral therapy can be supplemented by noise therapy: avoidance of silence, wearing of a white tone generator, ensuring that noise is maintained, and so on. According to a meta-analysis published in 2010, cognitive behavioral therapy does not reduce the “strength” of tinnitus, but it is effective against depression and improves the quality of life 30.
Experimental treatment: transcranial magnetic stimulation (SMT). This technique is used to treat major depression in people who do not respond to the usual treatments. A painless magnetic pulse is transmitted through the skull. In the case of tinnitus, we try to reduce the activity of neurons dedicated to hearing using a particular stimulation technique.