Tinnitus Treatment

It whistles, beeps, growls and clatters in the ear: Tinnitus is not dangerous, but the suffering of sufferers is often great.

Tinnitus is generally understood as the persistent or recurring subjective perception of a sound or sound. Other people can not hear the sound or noise. The technical term is tinnitus aurium.

Tinnitus is not strictly a disease - but rather a symptom that can have different causes. Tinnitus can manifest itself in the form of sounds or sounds of various kinds (for example, whistling, ringing, hissing, humming, sawing). The ear noises can be continuous or interrupted, become louder or softer and change their pitch.

Many sufferers experience tinnitus as threatening and very stressful, even though it is not dangerous at all. In part, as a result of tinnitus, other symptoms and health problems occur, such as:

  • sleep disorders
  • irritability
  • difficulty concentrating
  • muscle tension in the area of the cervical spine (cervical spine)
  • muscle tension in the area of the jaw muscles / masticatory muscles
  • gnashing of teeth
  • a headache
  • earache
  • dizziness
  • distorted sound impression, echoing sound perception (so-called dysakusis)
  • hypersensitivity to loud noises (called hyperacusis)
  • anxiety
  • depressive moods or depression

Together with tinnitus, these additional symptoms can severely affect your daily life and even lead to work disability. There is often a vicious cycle as the accompanying symptoms can lead to further stress and tinnitus.

Tinnitus can have many causes. Among other things, these differ from whether one has a subjective tinnitus, ie only hears the noises themselves, or an objective tinnitus, which can also be perceived by the doctor.

Subjective tinnitus: causes

A so-called subjective tinnitus, which is only perceptible by the person concerned, can occur as a concomitant of different diseases. The causes of the subjective ear noises can lie in different areas of the ear or in the brain, such as:

  • in the auditory canal: for example closure of the ear canal by earwax or foreign bodies (cotton wool or similar), projecting bones in the auditory canal (so-called exostoses)
  • in the middle ear: for example, tympanic membrane defect by rupture or perforation, tube dysfunction, coughing up, middle ear inflammation, eardrum immobility
  • in the inner ear: for example noise-induced hearing impairment such as blast trauma or deafness, sudden hearing loss, Ménière's disease (seizure-like vertigo and deafness), presbycusis, medication, severe drop in blood pressure with subsequently impaired perfusion of the inner ear, acoustic neuroma (auditory nerve)
  • in the brain: meningitis, brain tumors, multiple sclerosis

In addition, subjective ear noises can also occur in connection with:

  • emotional stress (stress, overwork, anxiety)
  • high blood pressure (hypertension)
  • too low blood pressure (hypotension)
  • anemia
  • alcohol intoxication
  • drugs
  • anesthetics
  • mental illness
  • problems of the cervical spine
  • problems with the jaw joints
  • gnashing of teeth

A subjective tinnitus can arise in different ways:

  • In the auditory nerve,
  • in the auditory center of the brain (so-called central tinnitus) or
  • through stress.

How this happens in detail is only partially understood.

Emergence in the auditory nerve

Noise or the influence of inner ear poisons (such as certain medications) can affect the function of the auditory nerve in the inner ear. Normally spontaneous electrical impulses occur in the nerve fibers and are not perceived. This so-called spontaneous activity changes when the ear is sounded. It then contains the information of the sound stimulus in encrypted form and forwards it to the sound center in the brain. In the diseased state, this spontaneous activity is diminished or changed in chronological order. It is believed that deviations from normal spontaneous activity in the brain lead to the perception of a hearing sensation and thus a subjective tinnitus can arise.

Emergence in the brain (central tinnitus)

The auditory center in the brain interacts with the inner ear. Nerve fibers that come from the brain transmit signals to the so-called hair cells in the inner ear and vice versa.

In central tinnitus, the brain incorrectly processes the information transmitted by the auditory nerves. As a result, the brain produces a non-existent sound or noise.

Tinnitus through stress

Stress is one of the common causes of tinnitus. A stress stimulus causes a wealth of reactions in the body. Among other things, the body releases more of the stress hormone cortisol. This narrows the blood vessels and worsens the flow properties of the blood by stimulating the platelets to clump. In the smallest blood vessels (capillaries), it can lead to closures, such as in the inner ear. The inner ear is then no longer sufficiently supplied with blood. However, how this ultimately leads to tinnitus has not yet been completely clarified.

Causes of objective tinnitus

Objective ear noises, which can also be perceived by the doctor with special devices, are caused by the body's own sound sources, which are close to the inner ear. An objective tinnitus, for example, can have the following causes:

  • Vascular constrictions: The sound thus perceived is often pulse-synchronous.
  • Cramping of the internal muscle in the middle ear or the palate muscles: Clicking or cracking ear noises arise.
  • Closure defect of the Eustachian tube: The Eustachian tube (also called Eustachian tube) connects the middle ear to the nasopharynx. If the closure does not work properly, air can enter the middle ear. Affected then perceive, for example, breath-dependent ear noises.
  • Temporomandibular joints: Certain TMJ problems can cause ear noises, for example, when bone or cartilage surfaces rub against one another when closing or opening the mouth. It may result in crunching or grinding ear noises.

Frequency of tinnitus

Acute subjective ear noises are a common phenomenon. It has been estimated that about 25 percent of the population had ever had ear noises, but these occurred only temporarily.

In contrast, chronic subjective tinnitus is less common. It can occur at any age and affects about 4 percent of all adults. About half of those affected feel strongly affected by the tinnitus. Every year, around 250,000 people in Germany become ill with tinnitus. Women are more affected than men.

As the noise level increases in the leisure time, such as loud music (for example, by MP3 players, clubs, concerts), in many, tinnitus occurs now increasingly in young people. In Germany, more than 5 percent of adolescents and those under 29 are affected by tinnitus.

Objective tinnitus is present in only about one percent of all tinnitus cases - and thus occurs relatively rarely.

If there is a suspicion of tinnitus, the doctor first asks questions about the type and frequency of the ear noises. In addition, he undertakes various investigations to investigate the cause closer or to consolidate the diagnosis, for example:

  • Examination of the neck, nose and ears
  • Hearing tests
  • Analysis of tinnitus noise: Determining the frequency at which the ear noises are strongest, and determining their volume with a so-called audiometer; then sonication of the diseased ear with so-called. white noise, wherein a sound noise is generated, in which all audible frequencies for the ear are included
  • Tympanogram, Stapedius reflex:
    • A tympanogram is the testing of eardrum mobility with the help of a small probe placed in and closing the ear canal. The probe now generates targeted frequencies that hit the eardrum. In response, the eardrum begins to vibrate, which can be measured using the probe.
    • At the same time, the stapedius reflex is usually tested. This is the ability of the stapes muscle (musculus stapedius) to contract reflexively to a louder sound. In this case, a part of the stapes is tilted and causes attenuated by the sound vibrations arrive in the oval window of the inner ear. The stapedius reflex serves as a natural protection against excessive sound pressure.
  • Test for otoacoustic emissions: The inner ear not only picks up sounds, but also sends them back in inaudible intensity like an echo. These so-called otoacoustic emissions can be registered with high-performance microphones. The test can be used to check the functionality of the cochlea or the outer hair cells located there. If these emissions are missing, this indicates an inner ear damage.

The following examinations can also be used in the diagnosis:

  • Brain Stem Audiometry (BERA): This objective hearing test is used to examine the auditory nerve or the nerve reactions when processing auditory stimuli in the brain.
  • Balance Testing: Tinnitus is associated with a balance disorder in more than 20 percent of cases.

Depending on the suspected cause, further examination methods may be useful, such as:

  • Blood tests:
    • Differential blood count
    • Inflammatory markers
    • Tests for various antibodies to rule out infectious diseases such as herpes, measles, mumps, Lyme disease or syphilis
  • Magnetic resonance imaging (MRI) of the skull
  • Computed tomography (CT) of the skull
  • Functional examinations of the cervical spine and the masticatory apparatus

Subjectively perceived ear noises (subjective tinnitus) must be distinguished from objective ear noises (objective tinnitus). The latter are audible to the doctor with special devices and can arise, for example, by cramping the palate muscles.

Depending on the duration of the ear noises, doctors also distinguish:

  • Acute tinnitus: has existed for up to three months.
  • Chronic tinnitus: persists for more than three months.

In addition, tinnitus can be divided into different degrees of severity:

  • Compensated tinnitus (grade I to II): The affected person perceives the ear noise, but can handle it. There are no health problems, the quality of life is not further affected.
    • Grade I: Despite the ear noises, the person concerned has no suffering.
    • Grade II: The ear noises are predominantly perceived in silence and occur more frequently under stress and strain.
  • Decompensated tinnitus (grade III to IV): Tinnitus has a significant effect on health and creates a high level of suffering for the person affected.
    • Grade III: Continuous impairment in private and professional life; it comes to other complaints such. Concentration disorders, muscle tension, sleep problems or social withdrawal.
    • Grade IV: Those affected constantly perceive the tinnitus and perceive it as a disease that massively affects private and professional life. There are more and more health problems.

In the case of subjective tinnitus, that is to say, noises of the ear, which are only perceived by the person concerned, the treatment is not based solely on the cause, but above all on the duration of its existence. Within the first three months (acute tinnitus), the chances of tinnitus disappearing are best. The chances of recovery for those affected are therefore the better, the sooner they go to the doctor.

If subjective tinnitus has existed for more than three months (chronic tinnitus), the ear noises have usually already become independent at this time. That is, they are not going away in the true sense. Nevertheless, there are also treatment options for chronic tinnitus. These are mainly based on diverting attention away from tinnitus and giving it another, less burdensome meaning. Many sufferers are thus able to perceive the tinnitus less and less or even not to "hear". This gives them the impression that tinnitus is gone - even if the ear noises basically continue to exist.

Important for the treatment is also whether there is a hearing loss in addition to the tinnitus. If one equates these with a hearing aid, tinnitus can often be contained or even eliminated, as noises that were "lost" are consciously perceived again.

The daily intake of magnesium can have a positive effect on both acute and chronic tinnitus. Because the mineral affects certain receptors that prevent excessive influx of calcium into the hair cells in the inner ear. An excessive calcium influx is considered a damaging factor for the hair cells.

Acute subjective tinnitus

Acute tinnitus has existed for a maximum of three months. For the standard treatment of acute tinnitus, which does not improve itself within a short time, usually includes an infusion of anti-inflammatory agents (glucocorticoids). Alternatively, tablets with the appropriate active ingredients can be prescribed.

However, if the tinnitus cause is in the inner ear or is unknown, some doctors still treat the ear noises first, in part, with an infusion of circulation-promoting agents (possibly combined with anti-inflammatory agents) or anticoagulants. The infusion therapy with such agents is based on the assumption that a disturbed perfusion of the inner ear is the cause of tinnitus. And as a result of the circulatory disorder, the hair cells located there would be malnourished. (The hair cells are not actually supplied with blood, they are nourished by the tissue fluid that surrounds them.)

However, as we now know, a circulatory disorder is rarely the cause of tinnitus. How effective such an infusion therapy for tinnitus in individual cases, can not say exactly. Nevertheless, it seems to work for some sufferers, even if the exact reason for this could not yet be scientifically explored. Meanwhile, this treatment is not so often used.

If the cause of the acute tinnitus is an earwax plug, the doctor can remove it immediately without pain.

In tinnitus, the best chance of success is to start treatment as early as possible, preferably within the first 24 to 48 hours after the tinnitus event. A tinnitus is not an emergency, but a so-called rush case. "As early as possible" does not necessarily mean "immediately".

Therefore, do not panic in case of a sudden ear noise, but try to keep calm. As a rule, it is not a problem to sleep over it the next night. Frequently, the ear noises even disappear until the next morning. If the ear noises still be there in the morning, you should consult an ear, nose and throat doctor as soon as possible - at the latest, however, after two days.

If, in addition to tinnitus, you feel that you are hearing less, go to the ENT specialist immediately.

Hyperbaric oxygen therapy

If infusion therapy does not improve, acute tinnitus can also be treated with so-called hyperbaric oxygen therapy. However, this form of treatment is controversial and is not paid by the statutory health insurance.

Hyperbaric oxygen therapy is based on the assumption that tinnitus can lead to a lack of oxygen in the inner ear. When staying in a hyperbaric chamber, the affected person inhales oxygen via a breathing mask. The increased pressure allows more oxygen to enter the tissues and blood, providing more oxygen to the inner ear as well. If the cause of tinnitus is a circulatory disorder, acute noises in this way can be reduced in some cases. In chronic tinnitus, however, hyperbaric oxygen therapy rarely shows any effect.

On the other hand, inhaling oxygen under normal pressure conditions makes no sense as a therapy, for example by simply inhaling oxygen through a nasal tube.

Chronic subjective tinnitus

Even with a tinnitus, which already exists for three months or longer, the doctor administered at the first treatment partially infusions with circulation-promoting agents (sometimes combined with anti-inflammatory agents such as glucocorticoids) or anticoagulants.

In addition, relaxation plays an important role in the treatment of chronic tinnitus. With the help of regular relaxation exercises, those affected should learn to be better able to cope with stress situations on the one hand and to overhear tinnitus on the other hand. The latter happens, for example, by focusing on other sounds in the environment. Because when trying to control tinnitus, sufferers often fix themselves very strong on the ear noises. However, this pushes them even more into the foreground. Relaxation techniques such as autogenic training, progressive muscle relaxation or yoga can help to gradually reduce tension and concentration on the ear noises.

Cognitive-behavioral therapy can help to better manage tinnitus and stressful situations, thereby facilitating relief.

Tinnitus Retraining Therapy (TRT)

A fairly successful method of treating chronic tinnitus is called tinnitus retraining therapy (TRT). The basis of this treatment is the realization that it is possible to suppress the tinnitus from the consciousness and thereby relieve the affected person. Tinnitus should be decoupled from the negative feelings and thoughts that it causes in the person concerned. However, healing in the true sense is not possible with TRT.

Subjectively perceived tinnitus can be different. How loud the initially harmless ear noises are perceived, can be the result of an unfavorable learning process: Because you pay more attention to the sound, you perceive it more and more and perceive it as unpleasant and loud. Even if it is basically very quiet. The sound becomes autonomous. Tinnitus finally triggers physical stress reactions, which in turn can increase tinnitus - a vicious circle.

Just as it is possible to increase a tinnitus perception through negative learning processes, however, one can also learn to get used to the ear noises. If that succeeds, you hardly notice it or you no longer feel it annoying. In this way, a tinnitus retraining therapy can break the vicious circle.

Normally, the brain filters background noise out of perception. In tinnitus, however, this does not seem to work properly. Tinnitus retraining therapy can be used to restore normal sound processing and retrain acoustic perception in the brain.

When tinnitus retraining therapy usually work an ENT doctor, a psychologist and a hearing care professional with the person concerned. The TRT usually consists of:

  • Counseling (counseling and education),
  • a psychological care,
  • a weakening of stress reactions through relaxation techniques as well
  • optionally a noise device or, in the case of a hearing loss, a hearing aid combined with a Rauscher.

In the counseling, the affected person learns what causes hide behind the tinnitus. Any misinformation that may have affected the subject tinnitus, can be corrected here. It is also clarified that the retraining does not lead to the ear noises are eliminated in the true sense. In most cases, however, it comes to an improvement, because one gradually perceives the tinnitus less and thus it virtually "disappears".

An important element of retraining is learning and practicing methods that altogether serve to distract from tinnitus, reduce stress and increase personal well-being. Often sufferers already have the necessary knowledge for this purpose, but first have to become aware of it.

In addition, so-called noise devices are adapted in many cases. Noise devices are sounders who carry the affected persons like small hearing aids behind or in the ear. They constantly produce a quiet, broadband noise (so-called white noise), which intentionally does not obscure the tinnitus, but distracts from the tinnitus and thus allows the brain to get used to the ear noises. Especially in the case of silence, such as falling asleep in the evening, sufferers perceive tinnitus more intensively and thus also as disturbing. If the affected person has a hearing loss, the noise devices can be combined with a hearing aid. The sounders can be adjusted independently. However, they should generally be set as loud or quiet as the ear noises are perceived, otherwise the tinnitus can not be effectively abtrainiert.

Through the combination of counseling, stress reduction and intoxication devices, the hearing system in the brain learns to react to acoustic stimuli again normally, so that the tinnitus loses its negative meaning. The tinnitus retraining therapy can be performed on an outpatient basis and lasts between one and two years.

Further therapy options

For chronic tinnitus, depending on the cause, further treatment options may be considered:

  • Cervical spine: If the tinnitus is related to changes or muscle tension in the area of ​​the cervical spine (cervical spine), treatment by means of manual therapy or osteopathy may be useful.
  • Temporomandibular joints / chewing gums: Changes in the area of ​​the temporomandibular joints or the masticatory system can also cause tinnitus. Here, as part of a treatment, appropriate experts should be consulted, e.g. an orthodontist or a dentist with functional therapeutic orientation.

Ginkgo for tinnitus

Among other things, ginkgo biloba preparations are supposed to promote blood circulation. For this reason, ginkgo is used again and again in tinnitus. Whether he actually works, however, is questionable. Because study results on the effect of ginkgo in tinnitus are contradictory. For example, recent major studies and comparative analyzes of other studies (meta-analyzes) conclude that ginkgo in tinnitus basically works better than a placebo (a dummy treatment).

What you can do with tinnitus yourself

In both acute and chronic subjective tinnitus, there are strategies that can be used to counteract the noise of the ears and the strain it causes. Various measures can help to reduce the noise of the ear and to cope with it:

  • Silence avoid: Especially in silence, ear noises are very noticeable, because the acoustic distraction is missing. To fall asleep here a little quiet music, nature sounds, a room well or other quiet background noise, which are perceived as pleasant, be helpful.
  • Stress reduction: Avoid stress as much as possible or reduce it. Learn a relaxation technique, such as autogenic training or progressive muscle relaxation, and use it regularly (preferably daily at the beginning).
  • Being active: If you retire and devote too much thought to tinnitus, you are in a vicious circle. Hobbies and other activities can help you to focus on positive things.

To learn to listen to tinnitus and hear the sounds of the ear, the following exercise can be helpful: Listen to about ten minutes of classical music every day (or a piece of music of your choice with multiple instruments) and adjust the volume so low that you just hear it can. Now focus on an instrument and try to follow it through active listening.

Use tinnitus as a stress signal

In many sufferers with chronic tinnitus, the noises become louder through stress. Instead of spiraling into the background and letting the tinnitus into even greater stress, sufferers can tackle this phenomenon and use it as a kind of "early warning system". Tinnitus can often be reinterpreted positively and becomes a help when it comes to pulling the brakes and paying attention to sufficient time-out or stress-balancing for yourself.

Objective tinnitus: treatment

In the case of objective tinnitus - ie ear noises that the doctor can perceive with special devices - the treatment depends on the causes behind the ear noises. Elimination of the cause is not possible in all cases.

In many cases, tinnitus (ear noises) disappears or improves during the course of treatment. In about 70 percent of people with acute tinnitus, the ear noises go away again.

How long a tinnitus occurs in an individual case is not predictable. Sometimes the ear noises go away after a short time or only after months or years. Partly the ear noises also disappear spontaneously. Overall, treatment success is more likely the sooner sufferers seek medical help.

However, it is not always possible to get rid of tinnitus completely. Often sufferers must learn to live with the ear noises. However, many sufferers manage well with the appropriate instructions, so that the tinnitus is still there, but does not affect the quality of life. A helpful concept for this is, for example, tinnitus retraining therapy. Tinnitus self-help groups also offer the opportunity to seek advice and support from those affected.

Specific measures by means of which you can reliably prevent tinnitus (ear noises) are unknown. Among other things, however, noise can be a trigger for ear noises. Therefore, it is recommended, for example, during concerts or club visits, in which noise is to be expected in a hearing-damaging extent to use earplugs. In addition, it is beneficial to learn a conscious and relaxed handling of stressful situations.

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