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COMMON CAUSES OF TINNITUS
Tinnitus affects millions of people to varying degrees. Fortunately, most people do not have a serious problem with it. million people visit an Ear, Nose and Throat physician (Otolaryngologist) annually seeking help for their condition. In many cases they are told there is nothing that can be done. In some cases, an organic cause is found that has a treatment option. Here we will attempt to explain the different causes of tinnitus and available treatment options. After brief descriptions there are links to deeper discussions of these issues.
Why doesn’t the tinnitus sound go away?
For individuals with long-term tinnitus, one or more of the causes above have, at some point, led to an auditory malfunction. The brain’s attempt to compensate for this malfunction is the start of a vicious cycle.
The auditory cortex is the part of the brain that is responsible for hearing. Every stimulus perceived by the ear is transmitted to and processed by the auditory cortex. The nerve cell assemblies in a specific area of the auditory cortex are 'tuned' to a certain frequency, similar to the arrangement of keys on a piano.
No matter what triggers may be responsible for the tinnitus – noise, medication, stress – they all lead to an interruption of the signal transmission from the ear to the auditory cortex. This means that some of your nerve cell assemblies no longer receive any signals. To stay with the piano image: some of the piano's keys no longer work and cannot be struck by the pianist.
However, these nerve cell assemblies do not react to the lack of stimulus by simply remaining 'silent'. Instead the nerve cells begin to 'chatter' spontaneously and become synchronously attuned to one another. Once they have become hyperactive and synchronous in this way, the nerve cells simulate a tone that the brain 'hears' – the tinnitus tone. Coming back to the piano; the broken keys have created their own permanent tone even without the keys being struck by the pianist.
Over time, this pattern strengthens and the tinnitus becomes permanently anchored – the brain has learnt a phantom sound.
Sensorineural Hearing Loss (SNHL)
Sensorineural hearing loss occurs when there is damage to the cochlea or to the nerve pathways from the inner ear to the auditory cortex in the brain. There are many causes of SNHL but the most prevalent two are age-related hearing loss and excessive noise exposure. 70% of all tinnitus is caused by noise exposure.
Age-related hearing loss occurs as we age and is called presbycusis. The aging process, coupled with nutritional deficiencies, environmental factors and individual differences, gradually degrades the hearing function and our ears don’t respond as well as when we were young. As hearing thresholds decrease, tinnitus is often the result.
Loud noise damages the hair cells inside the cochlea that are responsible for sensing sound vibration and converting it to an electric signal. Damage from noise exposure is cumulative; it can come from a single explosive incident or it can build up over time from a number of less traumatic but still damaging episodes. SNHL cannot be treated medically or surgically. It is considered permanent hearing loss.
Glutamate is a neurotransmitter used by the ear to transmit signals across the synapse leading to the brain. It is produced by the hair cells of the inner ear when converting vibrational sound into electrical signals. When the hair cells are damaged, they produce excess glutamate, which floods the neuro-receptors in the auditory nerve and brain. Excess glutamate overexcites the receptors and causes them to fire continuously until they become chemically depleted and eventually die. This process is known as glutamate neurotoxicity and is responsible for many neurological diseases such as Parkinson’s disease, Alzheimer’s disease, ALS, epilepsy and tinnitus. Tinnitus caused by glutamate toxicity is called Cochlear-Synaptic Tinnitus.
The frequency of a person’s tinnitus is typically found at the lower end of the range of hearing loss. That is, if someone has hearing loss in the 4,000 to 8,000 KHz range, tinnitus is frequently around 4,000 KHz. It is analogous to the “Phantom Limb Syndrome” which occurs when people lose a limb in an accident yet still feel pain in extremities that are no longer there. In this case, we hear noise in a frequency that experiences hearing loss. Most hearing loss from noise exposure is in the higher frequencies and high frequency tinnitus is very common.
Ototoxic Medications
Over 300 prescription medications can cause tinnitusor make it worse (as well some over-the-counter products), How much harm these medications do to our hearing depends on the individual drug and how long it is taken. If an individual discontinues taking an ototoxic medication shortly after tinnitus becomes noticeable, generally the cochlea will not suffer permanent damage. If it is continued, however, permanent hearing loss and tinnitus is the result.
It is very important for people taking prescription medications to be aware of the potential side effects of these drugs. The pharmaceutical industry has a very large database of possible side effects and most of this is on the Internet. In all too many cases, doctors are not as aware of side effects as they need to be. It is up to us to be knowledgeable about what we ingest.
Nose sinusitis.
Somatic Tinnitus
Somatic tinnitusoccurs when sensory signals from the body cross talk with auditory signals from the cochlea. This occurs in an area of the brainstem called the Dorsal Cochlear Nucleus (DCN). This is the first relay point, or synapse, auditory signals cross on their way to the auditory cortex for further processing. It is also the synapse for sensory signals from the body traveling to other brain areas.
If the DCN is damaged, through noise exposure, injury such as whiplash or blow to the head, TMJ dysfunction, or muscle spasm, sensory signals become d intensity by changing head, neck, jaw or body position.
Although hearing loss is the single greatest cause of tinnitus, it is not the only one. Below is a discussion of other causes of tinnitus:
1 - Inflammation and Infection
The term “otitis media” refers to inflammation of the middle ear. This is often caused by infection and is very common in young children. Allergies can also cause inflammation of the middle ear. Acute otitis media is characterized by excess fluid in the middle ear, which can cause swelling, redness and pain. Inflammation causes blockage of the eustachian tubes, which prevents fluids from draining.
Inflammation and excess fluid in the middle ear can lead to tinnitus, which is generally resolved once the inflammation is controlled. A doctor will examine the patient and treat the condition depending on whether it is a viral or bacteriological infection or allergic response.
Occasionally, inflammation and excess fluid remain after treatment and the patient may be bothered by discomfort and tinnitus. The typical treatment for this condition consists of a steroid-based nasal spray to reduce inflammation and an antihistamine, where appropriate. This resolves the condition for most people. For those in whom it is not effective it becomes necessary to insert a catheter and drain the excess fluid.
2 - Bruxism,Temporomandibular Joint Dysfunction (TMJ)
Temporo mandibular joint dysfunctionoccurs when there is a misalignment of the jawbone where it hinges into the skull. This is usually the result of accidents, a blow to the head or whiplash. This misalignment puts strain on the temporomandibular joint, which often causes tinnitus. It can take months or years before the original injury degrades to the point of causing tinnitus.
3 - Otosclerosis
In otosclerosis, the consistency of the sound conducting bones of the middle ear changes from hard mineralized bone to spongy bone tissue. This causes a loss of conduction of sound to the inner ear.
Otosclerosis is a common cause of hearing impairment and tinnitus and is hereditary, although it can skip generations. The primary symptom of otosclerosis is a slowly progressive hearing loss beginning anytime between the age of 15 and 45, although it usually starts around age 20. Approximately three quarters of patients with otosclerosis will also develop tinnitus in the affected ear. In 25-30% of patients, balance problems may also occur, including unsteadiness, dizziness, vertigo, or other sensations of motion.
There is no known cure for otosclerosis. However, oral fluoride supplementation may slow or halt disease progression. Dizziness associated with active otosclerosis will usually respond within two weeks of oral fluoride therapy.
There is also a surgery, called stapedectomy. The procedure is usually performed under local anesthesia and can be carried out on an outpatient basis. Over 80% of these operations successfully improve or restore complete hearing to the patient. During this procedure, the surgeon removes the soft bone tissue and replaces it with a Teflon or metal prosthesis that allows sound vibrations to again pass from the eardrum to the inner ear. The hearing improvement obtained is usually permanent.
4 - Pulsatile Tinnitus
Problems with blood circulation are also known as vascular problems. They can be caused by plaque build-up on arterial walls, twisted arteries, vascular lesions and others. Sometimes an artery can lie too close to the cochlea. In many cases these problems result in pulsatile tinnitus, a condition where a person hears their heartbeat in the ears. This is a different problem than most tinnitus where the person hears continuous sounds.
Pulsatile tinnitus due to vascular problems can often be resolved through medication or surgery. A vascular specialist can diagnose the problem and propose treatment methods.
5 - Acoustic Neuroma
Acoustic neuroma are rare, non-malignant growths that occur on the eighth cranial nerve leading from the brain to the inner ear. They are very slow growing, developing over many years, and are not cancerous. They do not spread but continue growing from the point where they begun. When they occur, they grow on the vestibular nerve where it passes through the auditory canal. Eventually they will grow to the point where they press against the brain and can become life threatening.
Because these are slow growing tumors, observation is recommended for elderly patients to determine rate of growth. For others, the tumors must be removed. They can be removed through surgery or, in the case of smaller tumors, radiation. Permanent hearing loss and tinnitus results in a significant percentage of patients who have these tumors removed.
6 - Meniere’s Disease
The underlying cause of MENIERE'S disease is unknown. What occurs is a fluid build-up in the semicircular canals inside the ear, which helps us keep our balance. This fluid build-up increases pressure on vestibular hair cells. The result is the brain is sent signals that tell it the body is moving or spinning when it is not.
Meniere’s disease causes a feeling of fullness in the ears, severe dizziness and vertigo and hearing loss. If it continues for any length of time, the hearing loss becomes permanent even though the Meniere’s disease may be treated and be controlled.
7 - Other Disease Conditions
A number of disease conditions can also cause tinnitus. Among the more common of these is thyroid dysfunctionand Lyme disease. Fortunately, successful treatment of these conditions usually results in resolution of tinnitus.
Dysfunction of the thyroid gland leads to numerous problems including lowered energy levels, increased sensitivity to pain, weight gain, depression and tinnitus. Tinnitus is a very common effect of thyroid dysfunction.
Lyme disease is an infectious disease caused by bacteria. The bacteria is carried by ticks that feed on infected mice and deer. Left untreated, as many as 48% of patients with late-stage Lyme disease may develop hyperacusis, tinnitus and/or sensorineural hearing loss.
Tinnitus affects millions of people to varying degrees. Fortunately, most people do not have a serious problem with it. million people visit an Ear, Nose and Throat physician (Otolaryngologist) annually seeking help for their condition. In many cases they are told there is nothing that can be done. In some cases, an organic cause is found that has a treatment option. Here we will attempt to explain the different causes of tinnitus and available treatment options. After brief descriptions there are links to deeper discussions of these issues.
- exposure to loud noise
- a side effect of medication
- ear or head injuries
- diseases of the ear
- ear infections
- emotional stress
Why doesn’t the tinnitus sound go away?
For individuals with long-term tinnitus, one or more of the causes above have, at some point, led to an auditory malfunction. The brain’s attempt to compensate for this malfunction is the start of a vicious cycle.
The auditory cortex is the part of the brain that is responsible for hearing. Every stimulus perceived by the ear is transmitted to and processed by the auditory cortex. The nerve cell assemblies in a specific area of the auditory cortex are 'tuned' to a certain frequency, similar to the arrangement of keys on a piano.
No matter what triggers may be responsible for the tinnitus – noise, medication, stress – they all lead to an interruption of the signal transmission from the ear to the auditory cortex. This means that some of your nerve cell assemblies no longer receive any signals. To stay with the piano image: some of the piano's keys no longer work and cannot be struck by the pianist.
However, these nerve cell assemblies do not react to the lack of stimulus by simply remaining 'silent'. Instead the nerve cells begin to 'chatter' spontaneously and become synchronously attuned to one another. Once they have become hyperactive and synchronous in this way, the nerve cells simulate a tone that the brain 'hears' – the tinnitus tone. Coming back to the piano; the broken keys have created their own permanent tone even without the keys being struck by the pianist.
Over time, this pattern strengthens and the tinnitus becomes permanently anchored – the brain has learnt a phantom sound.
Sensorineural Hearing Loss (SNHL)
Sensorineural hearing loss occurs when there is damage to the cochlea or to the nerve pathways from the inner ear to the auditory cortex in the brain. There are many causes of SNHL but the most prevalent two are age-related hearing loss and excessive noise exposure. 70% of all tinnitus is caused by noise exposure.
Age-related hearing loss occurs as we age and is called presbycusis. The aging process, coupled with nutritional deficiencies, environmental factors and individual differences, gradually degrades the hearing function and our ears don’t respond as well as when we were young. As hearing thresholds decrease, tinnitus is often the result.
Loud noise damages the hair cells inside the cochlea that are responsible for sensing sound vibration and converting it to an electric signal. Damage from noise exposure is cumulative; it can come from a single explosive incident or it can build up over time from a number of less traumatic but still damaging episodes. SNHL cannot be treated medically or surgically. It is considered permanent hearing loss.
Glutamate is a neurotransmitter used by the ear to transmit signals across the synapse leading to the brain. It is produced by the hair cells of the inner ear when converting vibrational sound into electrical signals. When the hair cells are damaged, they produce excess glutamate, which floods the neuro-receptors in the auditory nerve and brain. Excess glutamate overexcites the receptors and causes them to fire continuously until they become chemically depleted and eventually die. This process is known as glutamate neurotoxicity and is responsible for many neurological diseases such as Parkinson’s disease, Alzheimer’s disease, ALS, epilepsy and tinnitus. Tinnitus caused by glutamate toxicity is called Cochlear-Synaptic Tinnitus.
The frequency of a person’s tinnitus is typically found at the lower end of the range of hearing loss. That is, if someone has hearing loss in the 4,000 to 8,000 KHz range, tinnitus is frequently around 4,000 KHz. It is analogous to the “Phantom Limb Syndrome” which occurs when people lose a limb in an accident yet still feel pain in extremities that are no longer there. In this case, we hear noise in a frequency that experiences hearing loss. Most hearing loss from noise exposure is in the higher frequencies and high frequency tinnitus is very common.
Ototoxic Medications
Over 300 prescription medications can cause tinnitusor make it worse (as well some over-the-counter products), How much harm these medications do to our hearing depends on the individual drug and how long it is taken. If an individual discontinues taking an ototoxic medication shortly after tinnitus becomes noticeable, generally the cochlea will not suffer permanent damage. If it is continued, however, permanent hearing loss and tinnitus is the result.
It is very important for people taking prescription medications to be aware of the potential side effects of these drugs. The pharmaceutical industry has a very large database of possible side effects and most of this is on the Internet. In all too many cases, doctors are not as aware of side effects as they need to be. It is up to us to be knowledgeable about what we ingest.
Nose sinusitis.
Somatic Tinnitus
Somatic tinnitusoccurs when sensory signals from the body cross talk with auditory signals from the cochlea. This occurs in an area of the brainstem called the Dorsal Cochlear Nucleus (DCN). This is the first relay point, or synapse, auditory signals cross on their way to the auditory cortex for further processing. It is also the synapse for sensory signals from the body traveling to other brain areas.
If the DCN is damaged, through noise exposure, injury such as whiplash or blow to the head, TMJ dysfunction, or muscle spasm, sensory signals become d intensity by changing head, neck, jaw or body position.
Although hearing loss is the single greatest cause of tinnitus, it is not the only one. Below is a discussion of other causes of tinnitus:
1 - Inflammation and Infection
The term “otitis media” refers to inflammation of the middle ear. This is often caused by infection and is very common in young children. Allergies can also cause inflammation of the middle ear. Acute otitis media is characterized by excess fluid in the middle ear, which can cause swelling, redness and pain. Inflammation causes blockage of the eustachian tubes, which prevents fluids from draining.
Inflammation and excess fluid in the middle ear can lead to tinnitus, which is generally resolved once the inflammation is controlled. A doctor will examine the patient and treat the condition depending on whether it is a viral or bacteriological infection or allergic response.
Occasionally, inflammation and excess fluid remain after treatment and the patient may be bothered by discomfort and tinnitus. The typical treatment for this condition consists of a steroid-based nasal spray to reduce inflammation and an antihistamine, where appropriate. This resolves the condition for most people. For those in whom it is not effective it becomes necessary to insert a catheter and drain the excess fluid.
2 - Bruxism,Temporomandibular Joint Dysfunction (TMJ)
Temporo mandibular joint dysfunctionoccurs when there is a misalignment of the jawbone where it hinges into the skull. This is usually the result of accidents, a blow to the head or whiplash. This misalignment puts strain on the temporomandibular joint, which often causes tinnitus. It can take months or years before the original injury degrades to the point of causing tinnitus.
3 - Otosclerosis
In otosclerosis, the consistency of the sound conducting bones of the middle ear changes from hard mineralized bone to spongy bone tissue. This causes a loss of conduction of sound to the inner ear.
Otosclerosis is a common cause of hearing impairment and tinnitus and is hereditary, although it can skip generations. The primary symptom of otosclerosis is a slowly progressive hearing loss beginning anytime between the age of 15 and 45, although it usually starts around age 20. Approximately three quarters of patients with otosclerosis will also develop tinnitus in the affected ear. In 25-30% of patients, balance problems may also occur, including unsteadiness, dizziness, vertigo, or other sensations of motion.
There is no known cure for otosclerosis. However, oral fluoride supplementation may slow or halt disease progression. Dizziness associated with active otosclerosis will usually respond within two weeks of oral fluoride therapy.
There is also a surgery, called stapedectomy. The procedure is usually performed under local anesthesia and can be carried out on an outpatient basis. Over 80% of these operations successfully improve or restore complete hearing to the patient. During this procedure, the surgeon removes the soft bone tissue and replaces it with a Teflon or metal prosthesis that allows sound vibrations to again pass from the eardrum to the inner ear. The hearing improvement obtained is usually permanent.
4 - Pulsatile Tinnitus
Problems with blood circulation are also known as vascular problems. They can be caused by plaque build-up on arterial walls, twisted arteries, vascular lesions and others. Sometimes an artery can lie too close to the cochlea. In many cases these problems result in pulsatile tinnitus, a condition where a person hears their heartbeat in the ears. This is a different problem than most tinnitus where the person hears continuous sounds.
Pulsatile tinnitus due to vascular problems can often be resolved through medication or surgery. A vascular specialist can diagnose the problem and propose treatment methods.
5 - Acoustic Neuroma
Acoustic neuroma are rare, non-malignant growths that occur on the eighth cranial nerve leading from the brain to the inner ear. They are very slow growing, developing over many years, and are not cancerous. They do not spread but continue growing from the point where they begun. When they occur, they grow on the vestibular nerve where it passes through the auditory canal. Eventually they will grow to the point where they press against the brain and can become life threatening.
Because these are slow growing tumors, observation is recommended for elderly patients to determine rate of growth. For others, the tumors must be removed. They can be removed through surgery or, in the case of smaller tumors, radiation. Permanent hearing loss and tinnitus results in a significant percentage of patients who have these tumors removed.
6 - Meniere’s Disease
The underlying cause of MENIERE'S disease is unknown. What occurs is a fluid build-up in the semicircular canals inside the ear, which helps us keep our balance. This fluid build-up increases pressure on vestibular hair cells. The result is the brain is sent signals that tell it the body is moving or spinning when it is not.
Meniere’s disease causes a feeling of fullness in the ears, severe dizziness and vertigo and hearing loss. If it continues for any length of time, the hearing loss becomes permanent even though the Meniere’s disease may be treated and be controlled.
7 - Other Disease Conditions
A number of disease conditions can also cause tinnitus. Among the more common of these is thyroid dysfunctionand Lyme disease. Fortunately, successful treatment of these conditions usually results in resolution of tinnitus.
Dysfunction of the thyroid gland leads to numerous problems including lowered energy levels, increased sensitivity to pain, weight gain, depression and tinnitus. Tinnitus is a very common effect of thyroid dysfunction.
Lyme disease is an infectious disease caused by bacteria. The bacteria is carried by ticks that feed on infected mice and deer. Left untreated, as many as 48% of patients with late-stage Lyme disease may develop hyperacusis, tinnitus and/or sensorineural hearing loss.
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