What is Tinnitus?

Tinnitus can be defined briefly as a sensation of sound, while there is no real sound outside the head of the patient.

Objective Tinnitus

Inside the head it is possible to have two types of real sources: (1) Turbulent blood flow (see picture) inside some blood vessels. (2) Repeated objective tinnituscontractions of muscles close to the ear.

The most common diagnosis is Palatal myoclonus.

These two kinds of sources are generating pulsating sound that can be heard only by the examiner when he is using a stethoscope or amplifying device. It is called: objective tinnitus.

Subjective Tinnitus

Common type

The most common type of tinnitus is called: subjective tinnitus. This kind of sound can be heard by the patient, and no one else can hear it.

Typical sounds

The typical sounds are like: water falls, rain, wind, sea waves, electric engines, high voltage electric current, and discharge of air from a wheel of a car or whistling of a snack. Tinnitus patients may use the terms: ringing, hissing, roaring and buzzing.

Influence of noisy environment

In a noisy environment the patient is paying less attention to his tinnitus, and many of the patients are experiencing relieve.

Those who have severe hyperacusis can not tolerate any loud ambient noise.

Maskability of tinnitus

Decreases sufferer attention

When the sufferer of tinnitus receives external sound that decreases his attention to his tinnitus, it is called maskable tinnitus. The masking sound may minimize the tinnitus or cause a complete disappearance of the tinnitus.

Residual inhibition

Under experimental conditions there is a possibility that effective masking sound will be followed by another time interval (seconds to minutes) that the tinnitus will be affected by the masking stimuli even after the dis-continuation of the masking sound.

Such effect is called: residual inhibition (RI). In the past, some of the medical research was focused on attempts to extend the RI effect of the masking sound to longer time interval.

Masking devices today

Today, the masking devices are considered as effective means of reduction that is limited to the time that the sound generator is sending the effective masking stimuli.

The computerized revolution that includes the free-usage of many websites, enables tinnitus sufferers to download masking sounds from the internet to their digital devices (such as MP3) and use it as masking instruments.

Tinnitus and Meniere's Disease

Tinnitus is one of the four major symptoms in Meniere's disease.

Typically it starts in one ear. Although a uni-lateral tinnitus is more common as a first symptom of Meniere's disease, it is important to do imaging (MRI, MRA, CT-Scan) in order to rule out acute or chronic intra cranial structural abnormalities.

Common causes of subjective tinnitus

Noises at work

Tinnitus is usually a result of several causes. The most common causes are loud noises at work (factories, high power engines), high energy loudspeakers or military noise (explosions of bombs, target shooting, cannons or measles).

Head trauma

Head trauma (car crush, accidents in sport) may cause intracranial bleeding. In the geriatric population intracranial bleeding in the subdural space, epidural space, subarachnoid space or parenchyma of the brain can be found.

Other factors

Blood vessels malformations, usage of anticoagulants and head trauma are know risk factors.

Infections disease (viral, bacterial) of the ear (otitis media, acoustic neuritis, cochlea), meninges (meningitis) or brain (encephalitis), or systemic infection (flu or other viruses). Tumors such as acoustic neuromas or cerebello-pontine angle tumors.

Medications side effects includes a long list of molecules. Aspirin and Gentamycine are the most famous medications.

Tolerable and intolerable subjective tinnitus

Non-help seekers

In many people the tinnitus can be tolerated. Low grade volume, good coping mechanisms and ability to use ambient sound for masking can help such a sufferer to tolerate his tinnitus. Those people are called "non-help seekers".

When sound becomes louder

When the sound becomes louder, the patient feels that he can not cope with his tinnitus any more or he feels that the masking sound is not effective any more. He may say that he can not tolerate his tinnitus any more.

Usually he is also suffering from disturbances in his biological clock (inability to fall asleep, waking from sleep at night), feeling tiredness during the day, less productivity at work, irritability, anxiety, difficulties in his intellectual performance (decrease in memory for names and memory for short term tasks).

Pessimism may be part of the clinical picture. Medical disease such as hyperacidity in his stomach, joint pain (arthralgia), episodes of chest pain, irritable bowel and headaches are quite common.

In meniere's disease patients the tinnitus may start before the first vertigo attack or may be the first symptom of the meniere's syndrome.







































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