Understanding Tinnitus -- Diagnosis and Treatment

What is Causing My Tinnitus?

To determine what underlying medical condition may be causing your tinnitus, your doctor will give you a general physical exam, including a careful examination of your ears. Be sure to inform your doctor of all medications you are taking, because tinnitus can be a side effect of some drugs.

If the source of the problem remains unclear, you may be sent to an otologist or an otolaryngologist (both ear specialists) or an audiologist (a hearing specialist) for hearing and nerve tests. As part of your examination, you may be given a hearing test called an audiogram. An imaging technique, such as an MRI or a CT scan, may also be recommended to reveal any structural problem.

What Are the Treatments for Tinnitus?

If your tinnitus is a symptom of an underlying medical condition, the first step is to treat that condition. But if the tinnitus remains after treatment, or if it results from exposure to loud noise, health professionals recommend various non-medical options that may help reduce or mask the unwanted noise (See Masking Devices below). Sometimes, tinnitus goes away spontaneously, without any intervention at all. It should be understood, however, that not all tinnitus can be eliminated or reduced, no matter the cause.

If you are having difficulty coping with your tinnitus, you may find counseling and support groups helpful. Ask your doctor for a referral.

If the cause of your tinnitus is excessive earwax, your doctor will clean out your ears by suction with a small curved instrument called a curette, or gently flush it out with warm water. If you have an ear infection, you may be given prescription ear drops containing hydrocortisone to help relieve the itching and an antibiotic to fight the infection.

Surgery may be necessary in rare cases of a tumor, cyst, or otosclerosis (a calcium deposit on the ear bone).

If your tinnitus is the result of temporomandibular joint syndrome -- sometimes called TMJ -- your doctor will probably refer you to an orthodontist or other dental specialist for appropriate treatment.

Medications for Tinnitus

Many drugs have been studied for treating tinnitus. For some, treatment with low doses of anti-anxiety drugs -- such as Valium or antidepressants such as Elavil -- help reduce tinnitus. The use of a steroid placed into the middle ear along with an anti-anxiety medicine called alprazolam has been shown to be effective for some people. Some small studies have shown that a hormone called misoprostol may be helpful in some cases.

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Lidocaine, a medication used for the treatment of certain types of abnormal heart rhythms, has been shown to relieve tinnitus for some people, but it must be given intravenously or into the middle ear to be effective. However, the benefits of lidocaine are almost always outweighed by the risks of the drug and it is therefore not recommended and not used for tinnitus.

Hearing Aids

If your tinnitus is accompanied by some hearing loss, a hearing aid may be helpful.

Masking Devices

Many people have also benefited from tinnitus maskers, devices resembling hearing aids that play a sound more pleasant than the internal noise produced by the tinnitus. A newer device is a tinnitus instrument, which is a combination of hearing aid and masker.

Tinnitus Retraining Therapy (TRT)

TRT depends upon the natural ability of the brain to "habituate" a signal, to filter it out on a subconscious level so that it does not reach conscious perception. Habituation requires no conscious effort. People frequently habituate many auditory sounds -- air conditioners, computer fans, refrigerators, and gentle rain, among them. What they have in common is that they have no importance, so they are not perceived as ''loud.'' Thus, the brain can screen them out.

TRT has two parts:

  1. The person with tinnitus will play some source of neutral sound everywhere he or she goes, including wearing in-the-ear sound generators.
  2. The person with tinnitus receives one-on-one counseling.

This form of tinnitus treatment takes 12 to 24 months and is highly successful in experienced hands.

Cognitive Therapy

This is a form of counseling that helps a person to modify his or her reaction to the tinnitus. It works best when combined with other forms of therapy, such as masking or medication.

Biofeedback

This is a relaxation technique that helps people to manage stress by changing their reaction to it. Some people find it is helpful in reducing tinnitus.

Dental Treatment

Some professionals believe tinnitus can be caused by a problem with the temporomandibular joint (TMJ), the area where the jaw bone attaches to the head, just in front of the ear. They suggest that dental treatment may relieve symptoms of tinnitus, because the muscles and nerves in the jaw are closely connected to those in the ear.

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Cochlear Implants

These devices, implanted in the ear, are mostly used to treat severe deafness. They seem to also help some people with tinnitus-related hearing loss that is significant. The device works by sending electrical signals from the ear to the brain. However, this surgery is not performed for tinnitus alone and is used only for hearing problems.

Alternative Treatments

Although no vitamin supplements or other alternative therapies have been proven beneficial to treat tinnitus, some people try herbal preparations such as ginkgo biloba or minerals such as zinc or magnesium with varying results. Others have experienced relief with acupuncture, magnets, or hypnosis.

Talk to your doctor for before trying any of these treatments.

How Can I Prevent Tinnitus?

Your risk of developing tinnitus increases with exposure to loud noises, so hearing protection is an important intervention. If you are around a noise that is so loud you cannot speak at a normal conversation level, you should wear ear plugs, move away from the noise source, or turn it down.

WebMD Medical Reference Reviewed by Neha Pathak, MD on 6/, 017

Sources

SOURCES:
American Tinnitus Foundation.
American Academy of Otolaryngology-Head and Neck Surgery.
The Mayo Clinic.
University of Texas Medical Branch.

 

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