Tinnitus, the complaint of noises in the ears, is common and difficult to relieve. The tinnitus may be constant or intermittent and usually varies in its intensity and character. It is more apparent in quiet surroundings and is aggravated by fatigue, anxiety and depression. It is not a disease but a symptom.
The management of tinnitus is a severe test of a doctor’s art because
so often little can be done to eliminate it. However, several points will be helpful as a guide.
1) Take the patient’s fears and complaints seriously and obtain a thorough history.
2) Examination of the patient should also be thorough. A quick look at the tympanic membranes is only a gesture.
3) If an abnormality of the ear, such as impacted wax or serous otitis media, is found, treatment will often cure the tinnitus.
4) Tinnitus due to chronic degeneration, such as presbycusis, ototoxicity or noise-induced deafness, is usually permanent in some degree and it is dishonest to suggest that one day it will disappear.The patient will become increasingly disappointed. It is far better that the patient understands the nature of the condition and, with time, the tinnitus will obtrude less as he or
she adjusts to it and avoids circumstances that aggravate it.
5) Many patients fear that tinnitus indicates serious disease of the ear or a brain tumour. Reassurance will be more credible if examination of the patient has been adequate.
6) Drug treatment, such as sedatives and antidepressants, may help the patient but will not eliminate tinnitus. Anticonvulsant drugs and vasodilators occasionally may be of benefit but their effectiveness cannot be predicted.
7) Patients with depression are particularly susceptible to the effects of tinnitus and it should be treated thoroughly and expertly.
8) If the patient with tinnitus is also deaf, a hearing aid is very helpful in masking the tinnitus as well as in relieving the deafness, and many patients are very grateful for this simple advice.
9) Tinnitus maskers, by producing white noise, will also make tinnitus less obtrusive.The masking device looks like a postaural hearing aid and its output characteristics can be adjusted to obtain the most effective masking.
10) If the patient is kept awake by tinnitus, a radio with a time switch may help.
11) Relaxation techniques have been found to be helpful by many patients.
12) Acupuncture and herbal remedies are of unproved value in tinnitus.
Local causes for Tinnitus
Tinnitus may be a symptom of any abnormal condition of the ear and may be associated with any form of deafness. Certain conditions deserve special mention:
- Presbycusis—often causes tinnitus
- Menière’s disease—tinnitus is usually worse with the acute attacks
- Noise-induced deafness—tinnitus may be worse immediately after exposure to noise
- Otosclerosis? tinnitus may be relieved by stapedectomy but should not be the major indication for surgery
- Glomus jugulare tumour—tinnitus is pulsating and may be audible through a stethoscope
- Aneurysm,vascular malfomation and some vascular intracranial tumours can also cause tinnitus,which may even be heard by an examiner.
General causes for Tinnitus
Tinnitus is often a feature of general ill-health as, for example, in:
- fever of any cause
- cardiovascular disease—hypertension, atheroma,cardiac failure
- blood disease—anaemia, raised viscosity
- neurological disease—multiple sclerosis, neuropathy
- drug treatment—aspirin, quinine, ototoxic drugs
- alcohol abuse.
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