The Tinnitus are sounds perceived without the presence of an auditory stimulus, it would be like a "phantom sound". Tinnitus are not a cause of deafness and deafness is not the cause of tinnitus, but both entities are often associated, although the patient sometimes does not perceive it.
Tinnitus can be very variable in its characteristics of frequency, , intensity and loudness, but these characteristics have no relation to its severity.
They can affect up to 10% of the population permanently and in fact virtually everyone has had tinnitus at some point in their life. But of the total number of people suffering from persistent tinnitus, half suffer from it as a problem and for 10% of them it is a serious problem.
The incidence of tinnitus increases with age and is more frequent after the age of 50 years old, although it can appear at any age.
Causes of Tinnitus
In 85% tinnitus is a symptom of some otological disease such as hearing loss (hypoacusia), middle or inner ear problems (Ménière's disease, acoustic nerve tumor). In turn, more than 80% of people with hearing loss have some degree of tinnitus.
There are several types of diseases involved in the origin of tinnitus: ear, genetics, neurological, vascular, endocrinological or pharmacological, but in more than half of cases the cause of chronic subjective tinnitus is not determined.
All diseases of the auditory system can produce them, from a wax plug to a tumor. On the other hand there are a lot of diseases related to tinnitus, either as triggers or as aggravating factors, such as cervical problems, cranio-encephalic trauma, cardio-vascular diseases, allergies, thyroid disorders, as well as alcohol consumption, tobacco or stimulants (coffee, tea, chocolate) or medications (for example cytotec).
Types de Tinnitus
Tinnitus can correspond to very different sounds (crickets, water, rain, motors, sparks, whistles …). Normally they are earings of pure tones in certain frequencies, sharp or loud, but sometimes they are more complex and consist of a mixture of sounds of different intensity.
From a clinical point of view, they are divided into objective and subjective tinnitus. Objective are those that can be audible by another person, such as those due to vascular tumors of the ear, but they are really rare. Subjective tinnitus are much more common.
Chronic subjective tinnitus aredifferently tolerated according to patients. . Although the majority of patients live with them without problems, others are triggered to obsessive symptoms with affectation of sleep and concentration and cause stress. In the worst suffered cases, tinnitus are considered to produce an impairment of the limbic and autonomic systems of the central nervous system.
According to the American Tinnitus Association, these are the third most disabling symptom that an individual can suffer after pain and balance disorders.
In more than half of the cases, chronic subjective tinnitus affects both ears, although in 35% they are located on one side and the rest inside the head.
Treatment of Tinnitus
There are lots of therapeutic options for patients with tinnitus, which usually means the limited effectiveness of all of them.
Among these treatments we can mention drugs ( oral, intravenous or intratimpanic), naturopathy, natural therapies, acupuncture, hypnosis, chiropractic or osteopathy.
Evidence-based studies give greater relevance to the results of Tinnitus Retraining Treatment ( TRT). This treatment learns to ignore the noise. To change the perception and habituation to tinnitus, the neuronal plasticity of the limbic and autonomic system is exploited by means of a psychological therapy of re-training of tinnitus exposure (psychological therapy). This therapy combined with relaxation exercices allow to eliminate the anxiety generated by the fact that the patient is concentrated in the noise and associated with the mental sensation of danger. This therapy is performed in conjunction with the use of a masking sound that deafences one's own tinnitus. The masking noise must be a broadband noise with a frequency close to the own tinnitus that diminishes the neuronal activity that this last produces (sound therapy).
The duration of the treatment is variable but it is usually lasts for several months.
There are masks of different types of sounds (white, pink and red) natural or oceanic, and adjustable for I-phone and Android.
Advice for patients
First of all it is important to explain to the patient the nature of tinnitus and the fact that they do not mean that he is becoming deaf. Anxiety and stress have to be avoided, because they stimulate the auditory system which is particularly sensitive in these patients.
In this sense stimulants of the nervous system such as coffee should be avoided, alcohol or tobacco.
It is recommended to sleep properly. It is advisable to sleep with your head in the raised position to reduce the cervical congestion . If the noise prevents to sleep it can be masked with ambient sound, based mainly on nature sounds such as ocean waves, rain, rivers and birds. There are even pillows with speakers for this purpose.
If the patient perceives it right it can be useful to use an auditory masking. Likewise, If there is associated hearing loss it is also recommended the use of corresponding headphones.
It is important that patients avoid the overlesion of the auditory system and not be exposed to intense noise, to treat any other process that may affect the auditory system (recurrent otitis, pressure changes,…) and avoid substances, chemical or pharmacological, that might be toxic for hearing (aspirine, aminoglycosides, quinine, quinidine, carbon dioxide,…).
Some people find benefit in tinnitus patients associations.