Treatments for Tinnitis

Tinnitus is the medical term for the perception of sound in one or both ears or in the head when no external sound is present. It is often referred to as "ringing in the ears," although some people hear hissing, roaring, whistling, chirping or clicking. Tinnitus can be intermittent or constant-with single or multiple tones-and its perceived volume can range from subtle to shattering.

Many treatments for tinnitus have been claimed, with varying degrees of statistical reliability:

Objective tinnitus:

Gamma knife radiosurgery (glomus jugulare)

Shielding of cochlea by teflon implant

Botulinum toxin (palatal tremor)

Clearing ear canal (in the case of earwax plug)

Using a neurostimulator

Subjective tinnitus:

Drugs and nutrients

Lidocaine injection into the inner ear was found to suppress the tinnitus for 20 minutes, according to a Swedish study.

Older benzodiazepines, eg. diazepam, are sometimes used for tinnitus; however, there are significant risks associated with the long-term use of benzodiazepines.

Tricyclics (amitriptyline, nortriptyline) in small doses

Avoidance of caffeine, nicotine, or salt can reduce symptoms, but, tinnitus can also be induced by reducing caffeine and/or quitting smoking

The consumption of alcohol has been found to both increase and decrease the severity of tinnitus. Therefore, alcohol's effect on the severity of tinnitus is dependent on the causes of the individual's affliction, and cannot be considered a treatment

Acamprosate

Etidronate or sodium fluoride (otosclerosis)

Lignocaine or anticonvulsants (usually in patients responsive to white noise masking)

Carbamazepine

Melatonin (especially for those with sleep disturbance)[56]

Sertraline

Vitamin combinations (lipoflavonoid)

Electrical stimulation

Transcranial magnetic stimulation or transcranial direct current stimulation

Transcutaneous electrical nerve stimulation

Direct stimulation of auditory cortex by implanted electrodes

Berthold Langguth, German neurologist, would apply an electric or magnetic current for stimulation over the head of the patient to reduce ringing sound. Dirk De Ridder, Belgian neurosurgeon, implanted electrodes to the brain of sufferers to normalise overactive neurons. Cambridge University scientists also found lidocaine, an anaesthetic, reduces the sound in 2/3 of patients for 5 minutes, but it needs another drug to suppress its dangerous effects.

Vagus nerve stimulation

Surgery

Repair of the perilymph fistula

External sound

Low-pitched sound treatment has shown some positive, encouraging results.(UC, Irvine press release)

Tinnitus masker (white noise, or better 'shaped' or filtered noise)[66

Tinnitus retraining therapy

Auditive stimulation therapy (music therapy)

Auditive destimulation therapy (also called "notched music" therapy) uses individually designed music with the patients' favorite music altered to remove the musical tones that match the aural frequencies associated with their tinnitus. The removal of these tones alleviates the tinnitus by destimulating brain activity for these specific frequencies.

Compensation for lost frequencies by use of a hearing aid.

Ultrasonic bone-conduction external acoustic stimulation

Avoidance of outside noise (exogenous tinnitus)

Psychological cognitive behavioral therapy

Prognosis

The prognosis of tinnitus depends on the type and severity of the cause.

For tinnitus due to acute acoustic trauma, approximately 35% of cases report subsiding tinnitus at 3 months after the trauma, with approximately 10% of these cases being the degree of complete disappearance of the tinnitus, as studied among young men having acquired tinnitus from gunshots.

If you see an audiologist, the following tests may be performed.

Battery of tests used to assess the type and severity of the hearing loss as well as the health and condition of the auditory pathway and surrounding anatomy. This evaluation reveals whether a hearing loss is the result of a treatable medical condition that warrants medical or surgical management or if the hearing loss is the result of a non-medical condition such as noise exposure or aging. Procedures include otoscopy, middle ear analysis, acoustic reflex testing, air and bone conduction pure tone threshold testing, word recognition/speech testing and otoacoustic emissions.

Otoacoustic Emissions (OAE):

The OAE test is used to determine cochlear (inner ear) status and is performed by placing an earphone in the patient's ear canal and introducing various sounds. It requires no behavioral response from the patient so it can be done on patients of all ages, and even a sleeping or comatose patient. The results can be used to: screen hearing in neonates, infants, or difficult to test individuals with developmental disabilities; differentiate between the sensory and neural components of sensorineural hearing loss; estimate hearing sensitivity within a limited range, and; test for functional or feigned hearing loss.

Videonystagmography (VNG):

Series of tests to evaluate the balance system. When the head is in motion, the inner-ear balance organs send signals to the eye muscles to keep vision in focus making eye movements a non invasive way to evaluate the balance system. Specialized video goggles with infrared cameras are used to record and measure eye movements as patients follow a moving light with their eyes and as they sit and lie in different positions. Each ear canal is stimulated by warm and cool water (caloric test) irrigations. The water causes a temperature change in the inner ear fluids which creates characteristic eye movements (called nystagmus) that can be measured and compared for each ear as well as to a large group of normative data. The information obtained from the VNG helps diagnose patients' complaints of dizziness, vertigo and imbalance

BAHA (Bone Anchored Hearing Aid) Evaluation and Fitting:

The BAHA is a partially implanted hearing system for patients who cannot be helped by traditional hearing aids. Candidates for the BAHA include people who lack an outer ear or ear canal opening, people who have chronic middle ear infections, chronically draining ears, people who have a conductive hearing loss that cannot be treated medically, and patients who are deaf in one ear with normal or near normal hearing in the other ear. A surgical procedure is performed to place a small titanium implant in the skull behind the ear. After healing, a sound processor is attached to the implant. The sound is delivered to the inner ear through bone conduction, bypassing the outer and middle ear and stimulating the inner ear. In patients with single sided deafness the sound is delivered directly to the good ear via bone conduction and eventually the brain is able to distinguish between sound that comes from the deaf side via the BAHA and sound that comes directly from the hearing ear. To learn more about the BAHA, visit the Hearing Health Care Support & Resource Center. If you think you may receive benefit from this type of device schedule an appointment with one of our ENT physicians and the Audiologist. They will work together to determine if this system is appropriate for you.

Sources:

Tinnitus, Wikipedia

American Tinnitus Association