Tinnitus

What Is Tinnitus?

Tinnitus is a common audiological complaint. Tinnitus is often described by patients as a buzzing or ringing sound in their ears, that does not go away or disappear with time. Often the onset may be subtle. The noise is often described as a high pitch (similar to the ringing in the ears after being exposed to loud noise such as standing next to a large speaker for an extended period), but any range of frequency is possible. Men are more often affected than women.

Tinnitus is not a disease, but rather a symptom of possible underlying problems. There are different conditions that can predispose to tinnitus including hearing loss, vascular abnormalities and an ENT condition called Meniere’s disease.

The difficulty with tinnitus is that no particular treatment can cure the symptom.  Often psychological factors such as depression and anxiety may result from the inability to improve the tinnitus experienced. If the underlying cause of tinnitus can be treated, it may improve or resolve the symptom.

Tinnitus may be either subjective or objective. In subjective tinnitus, the patient will hear a sound in the ear, without any external stimulus, and the sound cannot be heard by anyone other than the patient. In objective tinnitus, the sound may be loud enough that an examiner may hear it with a stethoscope or by ear.

Diagnosis of tinnitus is usually based on the patient’s subjective experience. Audiological and ENT examinations are performed first, to assess the hearing and structures of the ear. If malignant causes are suspected, radiological investigations such as CT scans or MRI may be done.

Chronic tinnitus is diagnosed when tinnitus is present for more than five minutes at a time, at least twice weekly.

What Is Tinnitus?

Tinnitus is a common audiological complaint. Tinnitus is often described by patients as a buzzing or ringing sound in their ears, that does not go away or disappear with time. Often the onset may be subtle. The noise is often described as a high pitch (similar to the ringing in the ears after being exposed to loud noise such as standing next to a large speaker for an extended period), but any range of frequency is possible. Men are more often affected than women.

Tinnitus is not a disease, but rather a symptom of possible underlying problems. There are different conditions that can predispose to tinnitus including hearing loss, vascular abnormalities and an ENT condition called Meniere’s disease.

The difficulty with tinnitus is that no particular treatment can cure the symptom.  Often psychological factors such as depression and anxiety may result from the inability to improve the tinnitus experienced. If the underlying cause of tinnitus can be treated, it may improve or resolve the symptom.

Tinnitus may be either subjective or objective. In subjective tinnitus, the patient will hear a sound in the ear, without any external stimulus, and the sound cannot be heard by anyone other than the patient. In objective tinnitus, the sound may be loud enough that an examiner may hear it with a stethoscope or by ear.

Diagnosis of tinnitus is usually based on the patient’s subjective experience. Audiological and ENT examinations are performed first, to assess the hearing and structures of the ear. If malignant causes are suspected, radiological investigations such as CT scans or MRI may be done.

Chronic tinnitus is diagnosed when tinnitus is present for more than five minutes at a time, at least twice weekly.

What Are The Symptoms Of Tinnitus?

Tinnitus can produce sound in any range or form. Whooshing, whistling, ringing or buzzing can all be sounds associated with tinnitus. One or both ears may be affected.

Patients with tinnitus may complain that the sound is often worse at night or early mornings. This is not actually the case, as the frequency remains the same. However, noise in the environment may distract from hearing the actual tinnitus when at work or during activities of everyday life.

Symptoms of Meniere’s include hearing loss, vertigo (with associated) nausea and vomiting. Patients may present with sudden attacks of vertigo that can last of to six hours. Symptoms may come and go, and there may be symptom-free intervals. However, tinnitus and hearing loss due to Meniere’s is often progressive and worsens with age. 

What Are The Causes Of Tinnitus?

Objective tinnitus is most often caused by benign causes such as wax impaction. Hearing loss due to ageing or trauma is the most common cause. Middle ear, as well as external ear canal infection, may be other possible causes. Non-benign causes of objective tinnitus include brain tumours or meningitis.

Subjective tinnitus is caused by structural or functional abnormalities the cranium, middle ear or sinus passages. These may include aneurysms, arteriovenous malformations or abnormal blood flow through the carotid arteries or jugular veins.

Medical conditions such as Meniere’s disease may also cause tinnitus. Meniere’s disease is a disorder of the labyrinthine system of the middle ear. Meniere’s disease can be caused by genetics, previous trauma or infections of the ear.

What Are The Things One Should Do To Manage Tinnitus?

Relaxation therapy and mindfulness may assist with the management of co-morbid anxiety and depression related to tinnitus.

What Are The Things One Should Avoid To Manage Tinnitus?

  • If the cause of tinnitus has not yet been diagnosed, don’t delay seeking help. Although tinnitus is usually benign, there may be some other sinister causes that need to be excluded.
  • Do not smoke. Nicotine has been linked to worsening tinnitus.
  • Don't  spend too much time on mobile phone.

What Are The Best Foods For Tinnitus?

  • Gingko Biloba is considered the best food for tinnitus.
  • Foods rich in vitamin B 12, like clams, crabs, cheese, eggs, liver, mussels, oysters, lobster, mutton, fish and fish eggs are known to improve symptoms of tinnitus.
  • Food rich in zinc like lamb mutton, oysters, liver,  sesame seeds, pumpkin seeds, watermelon seeds, and squash seeds is helpful in reducing tinnitus. Sesame seeds are traditionally used as medicine for tinnitus in eastern medicine system.
  • Tinnitus specialists advocate a healthy balanced diet, low in fats, sugars and artificial flavourings and colourants
  • A Mediterranean diet is advised as the best diet to follow for sufferers of tinnitus. This diet is high in unrefined carbohydrates and unsaturated fatty acids. Fresh fruits and vegetables are also an integral part of this diet.

What Are The Worst Foods For Tinnitus?

No foods have been linked to causing tinnitus, but some may aggravate tinnitus and should be avoided:

  • Caffeine and other stimulants can worsen tinnitus
  • Salt should be restricted in Meniere’s disease
  • Alcohol
  • Sugar and unsaturated fatty foods
  • Artificial flavourings and colourants, especially MSG

What Are The Medicines For Tinnitus?

What Are The Tips To Manage Tinnitus?

There are no specific medications that have been found to be effective in tinnitus. Many different treatment options have been studied.

Conditions such as wax impaction and ear infections are easily treated by either ear rinsing or antibiotics (infection). Tinnitus associated with these conditions may improve as the infection wears off or ear canal obstruction improves.

Hearing loss due to old age may show improvement in tinnitus when wearing hearing aids

Psychological and behavioural treatments may be helpful in patients with persistent tinnitus. One of the mainstays is cognitive behavioural psychotherapy, where patients are assisted in lessening the anxiety and depression associated with tinnitus.

 Tinnitus retraining therapy is focussed on teaching the brain to ignore the sound frequencies of the individual's particular tinnitus; this includes sound therapy.

Meniere’s is managed with diuretics, antihistamines, and anti-nausea/motion sickness medications.  Surgical procedures can also be done on the middle ear, that has shown some benefit

What Are The Symptoms Of Tinnitus?

Tinnitus can produce sound in any range or form. Whooshing, whistling, ringing or buzzing can all be sounds associated with tinnitus. One or both ears may be affected.

Patients with tinnitus may complain that the sound is often worse at night or early mornings. This is not actually the case, as the frequency remains the same. However, noise in the environment may distract from hearing the actual tinnitus when at work or during activities of everyday life.

Symptoms of Meniere’s include hearing loss, vertigo (with associated) nausea and vomiting. Patients may present with sudden attacks of vertigo that can last of to six hours. Symptoms may come and go, and there may be symptom-free intervals. However, tinnitus and hearing loss due to Meniere’s is often progressive and worsens with age. 

What Are The Causes Of Tinnitus?

Objective tinnitus is most often caused by benign causes such as wax impaction. Hearing loss due to ageing or trauma is the most common cause. Middle ear, as well as external ear canal infection, may be other possible causes. Non-benign causes of objective tinnitus include brain tumours or meningitis.

Subjective tinnitus is caused by structural or functional abnormalities the cranium, middle ear or sinus passages. These may include aneurysms, arteriovenous malformations or abnormal blood flow through the carotid arteries or jugular veins.

Medical conditions such as Meniere’s disease may also cause tinnitus. Meniere’s disease is a disorder of the labyrinthine system of the middle ear. Meniere’s disease can be caused by genetics, previous trauma or infections of the ear.

What Are The Things One Should Do To Manage Tinnitus?

Relaxation therapy and mindfulness may assist with the management of co-morbid anxiety and depression related to tinnitus.

What Are The Things One Should Avoid To Manage Tinnitus?

  • If the cause of tinnitus has not yet been diagnosed, don’t delay seeking help. Although tinnitus is usually benign, there may be some other sinister causes that need to be excluded.
  • Do not smoke. Nicotine has been linked to worsening tinnitus.
  • Don't  spend too much time on mobile phone.

What Are The Best Foods For Tinnitus?

  • Gingko Biloba is considered the best food for tinnitus.
  • Foods rich in vitamin B 12, like clams, crabs, cheese, eggs, liver, mussels, oysters, lobster, mutton, fish and fish eggs are known to improve symptoms of tinnitus.
  • Food rich in zinc like lamb mutton, oysters, liver,  sesame seeds, pumpkin seeds, watermelon seeds, and squash seeds is helpful in reducing tinnitus. Sesame seeds are traditionally used as medicine for tinnitus in eastern medicine system.
  • Tinnitus specialists advocate a healthy balanced diet, low in fats, sugars and artificial flavourings and colourants
  • A Mediterranean diet is advised as the best diet to follow for sufferers of tinnitus. This diet is high in unrefined carbohydrates and unsaturated fatty acids. Fresh fruits and vegetables are also an integral part of this diet.

What Are The Worst Foods For Tinnitus?

No foods have been linked to causing tinnitus, but some may aggravate tinnitus and should be avoided:

  • Caffeine and other stimulants can worsen tinnitus
  • Salt should be restricted in Meniere’s disease
  • Alcohol
  • Sugar and unsaturated fatty foods
  • Artificial flavourings and colourants, especially MSG

What Are The Medicines For Tinnitus?

What Are The Tips To Manage Tinnitus?

There are no specific medications that have been found to be effective in tinnitus. Many different treatment options have been studied.

Conditions such as wax impaction and ear infections are easily treated by either ear rinsing or antibiotics (infection). Tinnitus associated with these conditions may improve as the infection wears off or ear canal obstruction improves.

Hearing loss due to old age may show improvement in tinnitus when wearing hearing aids

Psychological and behavioural treatments may be helpful in patients with persistent tinnitus. One of the mainstays is cognitive behavioural psychotherapy, where patients are assisted in lessening the anxiety and depression associated with tinnitus.

 Tinnitus retraining therapy is focussed on teaching the brain to ignore the sound frequencies of the individual's particular tinnitus; this includes sound therapy.

Meniere’s is managed with diuretics, antihistamines, and anti-nausea/motion sickness medications.  Surgical procedures can also be done on the middle ear, that has shown some benefit