Tinnitus
It is an auditory sensation within the ears or head in the absence of any
relevant external stimulus to cause it.
Tinnitus is a very common and annoying symptom. It may be defined as a
noise in the ear or head. Tinnitus may occur with a benign disease, or it may be a
warning signal of a serious disorder which needs to be diagnosed by thorough
investigations. Tinnitus is one of the most difficult symptoms to treat, as it may
persist even after the ailment causing it has been cured.
TYPES OF TINNITUS
Tinnitus may be unilateral or bilateral. It may be classified as follows:
(1) Subjective Tinnitus: When a sound like ringing, whistling or roaring is heard
by the patient without the existence of such a sound, it is called tinnitus. This is an
auditory hallucination, but the term auditory hallucination is reserved for those
conditions where an individual hears voices and sentences due to functional
disturbances.
(2) Objective Tinnitus: It is heard not only by the patient, but also by the
examiner.
CHARACTERISTICS OF TINNITUS
(1) Intermittent: Tinnitus may be continuous or intermittent, with long or short
irregular intervals of absence of tinnitus.
(2) Continuous tinnitus is present all the time.
(3) Fluctuant: Tinnitus may vary in intensity. It is more marked when the patient is
emotionally perturbed, or when he is in a quiet atmosphere, as at night.
(4) Pitch of tinnitus may be high or low. Sometimes the pitch may vary.
CAUSES OF TINNITUS
(A) Subjective tinnitus
(1) Tinnitus with deafness
(i) Local: Any disease of the ear which can cause deafness may also produce
tinnitus.
(ii) General: All the general causes of deafness may also be responsible for
tinnitus.
(2) Tinnitus without deafness
Tinnitus may occur without deafness in conditions like:
(i) Anaemia.
(ii) Hypertension.
(iii) Hypotension.
(iv) Carious teeth or impacted wisdom tooth.
(3) Functional: Emotional factors may cause tinnitus, but tinnitus itself may lead to
anxiety and depression.
(4) Idiopathic: No cause for tinnitus is detected.
(B) Objective Tinnitus
Following are some causes of objective tinnitus.
(1) Clicking temporomandibular joint.
(2) Aneurysm and arteriovenous shunt around the ear.
(3) Intracranial vascular tumours.
(4) Live insects in the ear.
(5) Clonic contractions of the palatal or tympanic muscles.
(6) Patulous Eustachian tube. (=Wide spread open distended.)
INVESTIGATIONS
The investigations for tinnitus are similar to the investigations for deafness (p.
122).
Haemogram for anaemia is also advised.
Carotid angiography may be advised.
TREATMENT
(1) Cause should be treated.
(2) Routine treatment is the same as for deafness. Mild sedative anxiolytic drugs,
vasodilators, carbemazepine, vitamins have been tried with varying results.
(3) Masking of tinnitus by a tinnitus masking device, alarm clock or radio may be
useful in a quiet atmosphere.
(4) Resistant cases
(i) Reassurance: In spite of all the treatment, tinnitus may persist. The patient
should be reassured that tinnitus is not dangerous, but has a nuisance value only.
(ii) Surgical treatment: Sectioning of cochlear nerve may be tried, but it may not
help the patient.
