Tinnitus: causes, diagnosis, treatment

With over 11 million people affected, tinnitus is a relevant and very stressful phenomenon for many people. Because a continuous ear noise can be a psychological burden and often puts those affected to a hard test. Below, we introduce you to the basics, causes, and important aspects of treating tinnitus.

What is tinnitus?

The term tinnitus comes from the Latin "tinnire" (= ringing, jingling, ringing) and refers to a symptom in which those affected constantly hear sounds for which there are no external sound sources. Tinnitus, also called tinnitus, can be perceived as unilateral, bilateral or as "arising in the head". In Germany alone, more than 11 million people are affected by tinnitus.

Disruption of sensitive sensory cells in the ear

How ear noises arise, could not yet be clarified clearly. Circulatory disorders as well as general disorders of the inner ear are believed to be one of the main causes of tinnitus. By damaging the fine hearing sense cells, which are usually responsible for a smooth auditory impression, erroneous hearing impressions are transmitted from the ear to the brain, which settle there and become independent. The person concerned hears a noise. At the same time there is a hearing deterioration.

To compensate for this again, the nerve cells involved in the hearing processing can suddenly react overly active. In some people, it may be that this spontaneous overactivity persists for a long time, so the nerve cells are still overactive, although there is no disturbance of the hearing organ, and so false hearing impressions are passed.

In addition, physicians suspect that the internal filtering mechanisms that intercept disturbing noises in a healthy ear, confused by a defect in the hearing organ. In this way, faulty sound sources can reach the auditory center of the brain undisturbed and thus into the consciousness.

Everybody sounds different

Tinnitus can manifest itself in different ways. It can alternately occur louder or softer at different times of the day, disappear again or be a continuous tone. In addition, many sufferers report that their ear noises are often amplified by certain external factors such as stress, physical exertion or alcohol consumption.

Normally tinnitus is only perceptible by the person concerned, hence the term "subjective tinnitus". That is, only the person concerned can hear the noise in the ear, an external sound source does not exist. In contrast, the "objective tinnitus" must be distinguished, which actually has a (body-own) noise source. Typical of objective tinnitus is a throbbing or pulsatile noise that is often due to vascular disease (narrowed blood vessels or arteries that are near the ear). The objective form, however, occurs only very rarely, in one of a hundred cases.

Furthermore, the ear noise can be subdivided into different types (acute and chronic tinnitus) and degrees of severity (grade 1 for mild impairment to grade 4 for most severe impairment). If the ear noises last no longer than three months, one speaks of an acute Tinnitus. On the other hand, chronic tinnitus lasts longer than three months and rarely resolves on its own.

Causes: Common triggers of tinnitus

Your own well-being has a great influence on the development of tinnitus. Long-term stress, stressful life events, depression and anxiety disorders are among the most common causes of acute or chronic tinnitus besides noise and circulatory disturbances in the ear. In addition, the ear noise often occurs as a concomitant symptom of certain diseases or injuries and inflammation in the middle and inner ear.

Common triggers for acute tinnitus, which usually occurs suddenly, are:

Closure of the ear canal

In some people, the body produces too much earwax, which causes a hard earwax plug to form in the ear over time, which can clog the ear canal. As a result, the affected person suddenly hears worse and an unpleasant pressure or pain in the ear sets. In addition, the accumulation of too much earwax may favor tinnitus. Other foreign bodies in the ear can cause ear noise.

Inflammations and injuries in the middle and inner ear

An ordinary cold or a badly stuffy nose is enough to trigger a tinnitus. Since the mucous membrane now produces much more secretion than usual, the passageway (tube) between nasopharynx and middle ear clogged and swells. This can lead to ear noise. In addition, an acute or already chronic middle ear inflammation may trigger tinnitus with severe earache.

Sometimes the inner ear also becomes inflamed as a result of otitis media, causing pathogens to invade the inner ear space and cause otitis media with severe earache, tinnitus, dizziness, and fever. Also via injuries and tumors, pathogens can penetrate into the inner ear space and cause an acute middle ear infection with pus formation.

In the worst case, even the eardrum can rupture because it no longer withstands the pressure of the accumulated purulent secretions in the middle ear. In addition, a sinusitis on the middle or inner ear can go over or head injury lead to damage to the middle and inner ear.

Eardrum injury, deafness and hearing loss

Other causes of tinnitus may include injuries to the eardrum (such as cracking or puncturing), bony prominences (exostoses) in the ear canal, and middle and inner ear bone disorders (otosclerosis). Furthermore, tinnitus often occurs in connection with a hearing loss or a hearing loss. Even a blast and explosion trauma can bend the fine hairs in the ear due to the sound vibration and lead to a permanent hearing impairment (tinnitus).

Rare causes: Meniere's disease and acoustic neuroma

Menière's disease, a relatively rare inner ear disease, can be associated with tinnitus, as is multiple sclerosis. Typical of the disease are symptoms such as dizziness, nausea and vomiting, accompanied by a general hearing loss. The hearing loss and ear noises can even become chronic. Otolaryngias can also be extremely rarely caused by a tumor on the auditory nerve. The tumor then presses on the auditory nerve and can spread in the inner ear.

Baro disease and diving disease

Changes in pressure conditions in the ear, for example when flying or diving, often lead to tinnitus and / or hearing loss. If the aircraft rises, the ambient pressure drops. However, the pressure in the ear remains the same, resulting in a massive feeling of pressure (overpressure) in the middle ear. In addition, certain compressed air disorders such as caisson disease, also called diving disease, or Baro's disease, which results in a rapid pressure change in the middle ear to a painful eardrum injury, damage our hearing and go along with unpleasant ear noise and earache.

Besides disorders in the ear itself, there are other possible causes of tinnitus:

Cardiovascular disease

Tinnitus sometimes occurs as part of cardiovascular disease. Since our organ of hearing needs to be supplied with enough oxygen and nutrients through the bloodstream to function, the health of our ears also depends on a well-functioning and well-balanced metabolism. Vascular calcifications (arteriosclerosis) or cardiac arrhythmias, for example, may be associated with tinnitus. Similarly, too high or low blood pressure, anemia and metabolic disorders (diabetes, lipid metabolism problems) can affect the blood circulation of the brain and cause ear noises.

Orthopedic causes

Tinnitus can sometimes be the result of tension in, for example, the neck, jaw, and masticatory muscles, or injury to the cervical spine (whiplash). The reason for this is that the neck muscles or the temporomandibular joints are connected to our ears via a fine network of nerves. There is, so to speak, a certain interaction between TMJ, neck muscles and ears. Anyone who suffers from recurring tinnitus should perhaps also consult the dentist: Malocclusion, nocturnal teeth grinding (bruxism) or a sore tooth of wisdom could be the cause.

drugs

A whole series of drugs can cause ear noises as a side effect. These include, but are not limited to, certain painkillers and rheumatic drugs, antihypertensive drugs (beta-blockers), chemotherapy drugs, diuretics and drugs for the treatment of depression (especially tricyclic antidepressants).

In addition, special antibiotics (such as aminoglycosides), chloroquine, an antimalarial drug, and the anti-baby pill as a trigger in question. Also, the well-known analgesic acetylsalicylic acid (for example, contained in aspirin) can cause as a side effect tinnitus, but it is necessary for a very high dosage.

arteriosclerosis

Throbbing noises in the ear area ("pulse-synchronous throbbing") may indicate too high blood pressure, which is triggered for example by vascular calcification and constriction (arteriosclerosis). The blood must be pumped through the arteries with increased pressure, which increases the pressure in the arteries. This can lead to ear noises in the case of blood vessels that are located near the auditory organ (eg carotid artery).

Stress and tinnitus

Stress, both physical and mental, can not directly trigger tinnitus, but it can be beneficial. This is even the case relatively often, because long-term stress, depressive moods or critical life events burden not only the psyche, but also the hearing system. The ear noises can be understood, so to speak, as a kind of "cry for help of the soul". In general, one's own mental state has a very large impact on the development of tinnitus.

Chronic tinnitus: psychological and physical overload

In many patients with chronic tinnitus, the constant ringing of the ears itself is a major stress factor. Due to the constant beeping, buzzing or humming in the ear, those affected often find it difficult to relax or concentrate on anything other than tinnitus. The ear noises are as it were over present and awaken negative associations such as fear, loss of control and helplessness against the Tinnitus. Possible consequences may include difficulty falling asleep, concentration problems, depression and anxiety disorders.

In summary, tinnitus has a massive impact on all areas of life of those affected and is associated with a high level of suffering (decompensated tinnitus). In therapy, therefore, medical treatment can be synonymous with psychotherapeutic counseling.

In addition, tinnitus may also result from a mental illness (anxiety disorder, depression). Mental and physical suffering then mutually reinforce one another.

For completeness, it should be said that there are also many sufferers who have learned to deal well with the ear noises and thereby hardly perceive them (compensated tinnitus).

Diagnosis of tinnitus

After a concert visit or a visit to the football stadium, for example, the ears can "ring" for some time. In this case, you should give your ears sufficient rest and protect them from further sources of noise. Normally, the fine hair cells in the ear recover completely by themselves after 24 hours. But it can also take up to three days for the ears to function normally again.

However, if the ear noises persist for more than three days or the tinnitus returns again and again, sufferers should consult an ENT specialist to clarify the possible causes. In addition, the doctor can start immediately with an appropriate therapy in an emergency. As a general rule, the sooner a therapy is started, the greater the likelihood that the tinnitus will disappear again.

Detailed questions and many investigations

To diagnose tinnitus, the ENT specialist will ask a series of specific questions: When did the tinnitus first appear? How does he sound? Does the noise increase in certain situations? In addition, the specialist will determine which tinnitus is exactly (subjectively or objectively). Following the initial interview, a series of investigations will be carried out. The physical examination involves several steps and is important in order to narrow down the possible causes of the ear noises.

First, the ENT specialist will examine the external auditory canal and the eardrum using an ear microscope. In addition, the nose and pharynx are screened and the patient's blood pressure is measured. Furthermore, it is possible that the doctor listens to the neck arteries with a stethoscope for pathological flow noise, in order to rule out further underlying diseases.

Testing of the hearing

Subsequently, the hearing of the tinnitus patient is usually checked. This is done with a so-called tone threshold audiogram. For the examination, the patient takes place in a screened room and puts on headphones. Subsequently, the headphones are used to play sounds in certain frequencies - first only on one ear, then only on the other. The sounds are quiet at the beginning and gradually become louder, in steps of 5 decibels, until the patient perceives them. At the push of a button, he signals when he hears a tone. The hearing threshold indicates, so to speak, at which pitch and at what volume the patient can just hear an acoustic signal. After the data of the patient are recorded in a diagram, a hearing curve results for each ear. If the curves are different, this can be a sign that there is a hearing loss in one ear.

Examination of the nerves and accurate analysis of tinnitus

Another frequently used procedure by which the ENT specialist can exclude a (benign) tumor on the auditory nerve or an inflammatory auditory nerve disease is brainstem audiometry, or BERA for short (Brainstem Electric Response Audiometry). The examination measures the rate of auditory nerve conduction (i.e., the activity of the nerves involved in the hearing) of the patient.

In the tinnitus analysis, different tones are recorded, which the patient must compare with his own ear noise. In addition, the doctor can determine by another test, whether the tinnitus masked by other sounds ("masking") leaves. For this, the doctor must determine the volume and frequency of the covering tones.

Depending on the patient, the physician may perform further examinations such as balance tests, computed tomography of the ear and brain as well as cardiovascular tests or a blood test. In addition, it may be necessary to refer the patient to another specialist (for example, orthopedist, dentist, neurologist) for further investigation.

In addition, sufferers who are very heavily burdened by their ear noises should consult a psychotherapist after the ENT examination. This person can classify the severity of tinnitus in a personal conversation and if necessary initiate further steps.

treatment

1. Treatment of acute tinnitus

Depending on whether it is an acute or chronic tinnitus, various treatment methods can be used. If the ear noises last longer than 24 hours, you should definitely consult an ENT specialist. Because the earlier an acute tinnitus is treated, the better the chances of recovery.

Infusions and tablets

Acute tinnitus without recognizable (organic) cause is usually treated by medication in the form of infusions or tablets. While previously used almost exclusively to circulation-promoting drugs, nowadays usually cortisone preparations such as prednisolone (a chemically "recreated" endogenous hormone) are used. The aim is to improve cell metabolism in the auditory sensory cells and the electrical conductivity of the auditory pathways.

A sudden loss of hearing is also treated by the administration of cortisone preparations (less often by circulation-enhancing drugs). In order to relieve the acute symptoms quickly, the cortisone is usually injected directly into the patient by means of an injection into the bloodstream or else administered by infusion. Depending on the cause, the doctor initiates the appropriate therapy.

A blast or explosion trauma and acute noise damage also require immediate treatment with infusions. If medications do not relieve the symptoms (i.e., tinnitus and hearing loss do not disappear), hyperbaric oxygen therapy may help.

Important: A drug therapy promises only in the first two to three months after onset of tinnitus chances for recovery. If the symptoms persist or are already chronic tinnitus, other treatment options (including hearing aid treatments and targeted tinnitus therapies) are used.

Hyperbaric oxygen therapy - a sensible procedure?

Oxygen hyperbaric therapy, also known as hyperbaric oxygenation (HBO), is often used when the ear noises can not be treated with medication. For treatment, the patient takes place in a pressure chamber in which a certain overpressure is generated (corresponds approximately to an overpressure, as it prevails approximately in 18 meters water depth). Then the patient puts on a mask and inhales pure oxygen. Through the oxygen therapy, the damaged sensory cells are again better supplied with blood and supplied with sufficient oxygen to recover. However, oxygen therapy only makes sense, if at all, for 30 to 90 days after the onset of acute tinnitus. There are no scientific evidence of efficacy for the therapy.

2. Therapies for chronic tinnitus

A chronic tinnitus that has lodged in the ear can best be treated by combining several forms of therapy, with all procedures pursuing the same goal: to displace the disturbing hearing impression. This can be done, for example, by wearing special hearing aids, also called "Rauscher" or "Masker".

Very good treatment successes also promise all psychotherapeutic methods that help to reduce stress and promote physical and mental relaxation. Patients suffering from a very severe form of tinnitus may also be required to stay in a tinnitus clinic.

Tinnitus Counseling

Chronic tinnitus is rarely curable. In other words, patients who have become a constant companion to tinnitus must learn to better deal with their ear noises. Many ENT doctors and psychotherapists offer special tinnitus consultations, in which sufferers are fully informed about the development of tinnitus and its effects on body and soul. This form of counseling and education is also called Tinnitus Counseling.

biofeedback

Muscle biofeedback is a procedure that is relatively commonly used in tinnitus.It is a modification of classic biofeedback and is often used in patients with malpositions or muscle tension in the neck and jaw area. Through a special biofeedback device, the patient can see the state of tension of his muscles on a screen or hear it acoustically. At the same time he tries to relax his muscles. In several sessions, the person concerned learns to better control his body in stressful situations and consciously achieve a desired state of mind. An advanced form of biofeedback is the so-called neurofeedback, which has been used more and more in recent years.

Cognitive behavioral therapy

Cognitive-behavioral therapy can help sufferers to better manage their tinnitus. The aim of the therapy is that patients change their negative attitude towards tinnitus, so that it is experienced in everyday life as less threatening. The behavior therapy promises good results and is usually used in combination with other treatment programs such as tinnitus retraining therapy.
Tinnitus retraining therapy

With the help of Tinnitus Retraining Therapy (TRT), the patient learns to consciously fade out the ear noises. It is a kind of "Lost Program" (hence the name "retraining"), in which the person concerned learns to perceive the inner sounds as no longer disturbing, until they finally disappear completely out of his consciousness , In addition, TRT long-term therapy combines different forms of treatment that require the collaboration of several specialists, including the ENT specialist, psychologist, behavioral therapist, relaxation trainer and hearing care professional.

Tinnitus Masker / Noiser

A Tinnitus Masker or Tinnitus Noiser is a device that has been specially developed for tinnitus treatment and is used as part of the TRT. The device generates a low-pitched noise (hence a noise device), for example, a sound of the sea, which is intended to distract or mask the patient from his tinnitus. The goal is that the affected person tinnitus only little (or no) attention and hides the noise, so it gradually disappears from the consciousness.

The noise device is used like a hearing aid in the ear or can be worn behind the ear. A training effect can come after two months - or after two years. Unfortunately there is no guarantee that the wearing of a tinnitus masker or noise canceler will completely erase the ear noises.

music therapy

Music is often used as a companion to tinnitus treatment. During the therapy, various music therapy procedures can be used, such as resonance exercises. The patient tries to recite his / her personal tinnitus tone as accurately as possible while the therapist determines the frequency of the sound using a special device (sine wave generator). The therapist then halves the number of oscillations of the tone, creating a new tone that the patient must now sing along. The "similar" sound should stimulate the auditory nerves and the auditory center in the brain.

The positive effect of resonance exercises has already been proven by studies at the University of Applied Sciences Heidelberg. Almost 80 percent of the subjects had symptoms that improved, with the effect lasting at least three months.

In addition, scientists at the University of Münster suspect that especially classical pieces of music with a large frequency range can have a positive effect on tinnitus.

Tinnitus clinics

For many people, the ear noise is a great psychological and physical burden. Social isolation, loneliness, anxiety disorders and depression can be the result. In the worst case, tinnitus can become so unbearable that the person is committing suicide.

For sufferers who feel a very strong suffering, it is advisable to stay in a psychosomatic clinic. In Germany, there are now several clinics that specialize in the treatment of tinnitus. In a long-term therapy, sufferers learn to better deal with their tinnitus using various treatment methods.

Self-help: What helps against tinnitus?

Ear noises, even if they occur only occasionally, are always a warning sign of the body that something is out of control. Above all, constant stress and constant overstrain in the job or everyday life can also put the hearing system under pressure and promote the emergence of tinnitus. It is therefore particularly important for people who are always prone to tinnitus to learn stress management strategies in good time. Often it is enough to stop several short breaks a day to reduce stress.

For occasional noises: follow the 24-hour rule

If the tinnitus occurs suddenly (acute) or repeatedly appears at shorter intervals, you should definitely visit within 24 hours an ENT specialist to clarify the possible cause. This is especially true when tinnitus is associated with other complaints such as hearing loss and dizziness.For then he can appear as a concomitant of a hearing loss (or illness), which must be treated immediately.

For chronic tinnitus: seek psychological help

If the tinnitus has become chronic and you permanently suffer from ear noises, you should be informed and consulted by doctors and psychologists who specialize in tinnitus in detail. Above all, it is important to pay as little attention to tinnitus as possible so that it is pushed into the background and can not torment you any further. In addition, ask trained specialists to find out which therapeutic measures can help you with this.

What you can do yourself against tinnitus

  • Take care of (acoustic) distraction: Absolute silence can cause the person concerned to concentrate even more on the ear noise and perceive it more strongly.
  • Stress Management: Attend courses designed to help you manage stress better. Yoga, autogenic training, Qi Gong, mediation, as well as stress management and life balance courses can help to manage stress better.
  • Support from self-help groups: Often it can help sufferers to interact with like-minded people.
  • Take care of a healthy lifestyle: Sleep well and exercise regularly. A balanced and varied diet is also important, so that the hair cells in the inner ear are supplied with all the essential nutrients.
  • Noise abatement: Avoid loud music and noise and, for example, wear ear plugs during a concert to lessen the noise.
  • Psychotherapeutic Consultation: Visit an expert to learn how to better manage tinnitus

Author: Nina Schratt-Peterz