Tinnitus Treatment Blog

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Tinnitus is an auditory disorder in which different types of sounds can be heard by the patients in the absence of any actual noise in the environment.  A swooshing sound in the ear is experienced by people who suffer from tinnitus or rather pulsatile tinnitus, to be more specific. A pulse can be produced if a tumor in the head or neck region pressurizes a blood vessel. If the ear perceives this pulse then it may lead to pulsatile tinnitus. Once the problem area gets identified accurately then the chances of a successful treatment of pulsatile tinnitus become quite high.

There are above 120 kinds of brain tumors and acoustic neuroma is one of them. The symptoms of an acoustic neuroma include tinnitus. The symptoms usually show up after the age of 30 since the tumor grows gradually. Due to the slow growth of these tumors the smaller tumors that have little or no symptoms can be safely observed with frequent MRI scans. They are usually left untreated until they grow in a dangerous fashion. In certain cases the elderly patients die because of other natural factors before the tiny, slow-growing tumor display symptoms.

If surgical method is used then its goal is to remove the tumor and avoid paralysis of the face. Preserving hearing is quite a daunting task and may be possible only if the tumor is removed during its early stages of growth. A patient cannot recover his or her hearing that was lost prior to the surgery.

Big tumors can be removed safely but the surgery often causes paralysis of some facial muscles. The goals of surgery in case of exceptionally large tumors are to treat the hydrocephalus and alleviate the pressure over the brainstem.

Strereotactic radio surgery is a type of radiation therapy that is done in cases of elderly or sick patients who are unable to endure a brain surgery. The patients those who suffer from an acoustic neuroma have various treatment options that include observation, Strereotactic radio surgery, surgical resection and fractionated radiotherapy.

Since the whooshing sound in the ears occurs mainly due to the brain tumor so once the tumor is treated successfully the whooshing noise also comes to an end.

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Although CT is the primary choice in the imaging modality for pathologies of the temporal bone, magnetic resonance angiogram or MRI has a noteworthy contribution to the diagnosis in the following ways:

• It shows the pathology of the membranous labyrinth.
• Assessment before a cochlear implantation.
• It shows complex inflammatory and infectious diseases
• It shows the extension and the location of temporal bone tumors.

Moreover, MRI is also the first choice in dealing with retro cochlear tumors or infections that cause neuro-otologic symptoms. It is also necessary in detecting all the kinds of lesions in the brain stem and brain that are related to the hearing pathways. In the recent years, MRI has been used extensively in detecting the causes of pulsatile tinnitus. Cerebral angiography is only preferred in selected cases. In case of objective pulsatile tinnitus, which can be heard on physical examination, MRI and conventional angiography is used widely for detecting the cause of the disease.

Dolichoectasia, which is a fusiform dilatation of an artery, can cause pulsatile tinnitus. MRI and MR angiography are mostly preferred for imaging investigations in the patients of dolichoectasia.

MRI is also often suggested in the younger patients who suffer from unilateral pulsatile tinnitus.

In order to understand the management and clinical spectrum of pulsatile tinnitus better a study was conducted in which the files of around 84 patients were analyzed. Non-invasive techniques such as MRI, CT and angiography were used to investigate the individual patients in a tailored way. The results showed that the patients of pulsatile tinnitus should be compulsorily investigated with non-invasive techniques. If these are negative then selective angiography is required for diagnosis and to guide treatment. MRI and MRA are more much more sensitive than CT.

By and large, the most significant part of evaluation for tinnitus is a detailed history and physical exam conducted by an otologist or ENT. A hearing test is also essential. Special tests such as MRI, blood tests, CT and auditory brainstem response are also needed sometimes.

Since, pulsatile tinnitus implies a vascular abnormality, the preferred imaging study is magnetic resonance imaging or MRI and contrast-enhanced computed tomography or CT of the brain.

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With the growth in industrialization the environmental noise pollution has increased manifolds. Prolonged ringing in the ears can imply two things:

• The ears have been exposed to potentially dangerous levels of noise for a prolonged period.
• There is some undetected disorder that has triggered ringing in the ears.

Our hearing system is quite sensitive and delicate. Awareness about the noise levels that are dangerous to our hearing system is essential.

A noise of 85 dB or above is risky and should be avoided at all costs. Prolonged ringing in the ears is usually the outcome of loud explosions, noisy workplaces such as construction sites, factories, war-torn areas and rock concerts.

There have been instances in which people practice gun shooting without using safety measures, namely ear plugs. Attending rock concerts is also quite a hip thing to do but the outcome can be a prolonged ringing in the ears coupled with some loss of hearing.

The following measures can be taken to prevent a prolonged ringing in one’s ears:

• Firstly, if the prolonged ringing in the ears is a noise-induced then one should avoid rock concerts, headphones and loud music to prevent any further damage.
• Magnesium supplements are helpful in minimizing the damage caused by loud noise.
• Ringing in the ears becomes prominent at night due to the silence. Lack of sleep can lead to stress. Hence, in order to get a good night’s sleep one should consider using a pillow or bedside masker.
• Using earplugs in noisy places is a sensible thing to do.
• Ototoxic medications such as aspirin and antibiotics can also cause ringing in the ears. Hence, one should check the medications that are being taken and ask one’s doctor for a substitute.
• Prolonged ringing in the ears can also occur if the root cause of tinnitus has not been detected. Hence, it is essential to increase one’s level of awareness about the plethora of causes of ringing in the ears and then try to find out the cause of one’s own problem.

Once the root cause is found and treated then a person can get relief from prolonged ringing in the ears.

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The ear canal is lined with glands and hair follicles that produce waxy oil known as cerumen.

This wax traps the bacteria, dust, micro-organisms and other foreign particles from entering into the ears, thereby shielding them.

In some individuals there is an over-production of ear wax by the glands. The amount of wax becomes too much for the ears too handle. This extra wax can become hard in the ear canal and this leads to ear blockage.

Wax build up is one of the most common causes of a hearing loss. Wax build-up can lead to the following problems:

1. Tinnitus
2. Compromised hearing
3. Itching of the ear
4. Ear ache
5. Dizziness

Such problems occur because the otic canal has to be completely clear to let the sound vibrations to create an impact on the tympanic membrane. Any kind of obstruction restricts one’s hearing to some level. Wax impaction can obstruct the free swinging movement of the cilia. When the cilia are unable to detect and translate external stimuli through the auditory nerve no impulse heads towards the brain. This implies that the brain will not have anything to translate into sound. Due to this factor the hearing ability gets affected. A total cerumen occlusion or blockage can lead to a conductive hearing loss that can be as severe as that experienced by those individuals who intentionally insert wax hearing protectors for preserving their hearing in the presence of unsafe levels of sounds.

Excessive ear wax can block the auditory nerve, thereby stopping the transference of impulses from the cilia to the brain. The lump of wax may create its own noise, thereby confusing the brain. The brain misinterprets this noise as sound, thereby causing tinnitus.

Excessive ear wax should be removed by an otolaryngologist (ENT specialist) or a qualified physician. Ear wax should not be removed oneself or else the cochlea can be damaged by the object that is inserted into your ear.

This goes on to show that wax build up can lead to ringing and sound loss in the ears.

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What is the Best Therapy to Cure Ear Diseases?

Ear diseases can be quite painful and they cause a lot of discomfort. They can cause a hearing loss which reduces the productivity of a person. Children may lag behind in academics due to hearing problems.

If the problem gets complicated then meningitis, facial nerve paralysis etc may occur. Such complications can be avoided through a timely and proper treatment. The ear diseases that may affect us are as follows:

• Otitis media
• Otosclerosis
• Meniere’s disease
• Accoustic trauma/ tumors.

Ageing and noise induced hearing loss or NIHL can also cause ear problems. These result in the damaging of the hair cells in our inner ear.

Since drugs such as antibiotics can cause side-effects so the natural therapy is considered to be the best method for curing ear diseases.

The following strategies can be followed to cure ear diseases:

• Pomegranate juice is effective in curing Meniere’s disease when taken regularly for 2 weeks.
• If our body is not deficient in any vitamin or mineral then the immune system becomes strong. This helps the body in tackling the diseases. Supplements can be helpful if the diet lacks some nutrients.
• Reducing salt intake helps in overcoming acoustic trauma.
• Studies show that vitamin A when registered in high dosage for a short time period can improve the hearing loss problem.
• Vitamin B12 supplements are also helpful in regaining hearing.
• One can put a few drops of garlic juice to cure earache.
• If the cause of the earache is a rise in altitude then one can chew gum or yawn.
• To deal with a swimmer’s ear put some mineral oil into the ear before swimming.
• A few drops of hydrogen peroxide can help reduce the pain in the ears.
• 2 drops of holy basil leaf juice can also provide relief to ear pain.
• Zinc should be added to one’s daily diet as it helps in controlling infections.
• Have your ears cleaned professionally.
• Vitamin C helps in strengthening the immune system which in turn makes the body more efficient in fighting off the ear infections.

Thus, we find that natural therapy is the best option to cure ear diseases as it is safe and effective.

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Ear ringing or tinnitus has been divided into several groups such as vibratory and non-vibratory, pulsatile and non-pulsatile, objective and subjective, vascular and non-vascular etc just to name a few. In case of a pulsatile tinnitus the sound of the pulse can be heard in the ears. This type of tinnitus is also known as vascular tinnitus because of its vascular origin.

The following factors can lead to vascular tinnitus:

1. Infections of the middle ear or chronic inflammation are usually accompanied by an increased blood flow towards the inflamed tissue. Since this tissue is in the ear so some people can hear the increased blood flow.
2. Under normal conditions the middle ear is an air-filled space. However due to inflammations, infections or Eustachian tube dysfunction some fluid accumulates at the rear part of the middle ear and causes vascular tinnitus.
3. Vascular tumors of the middle ear such as the glomus tumors are benign, which implies that they are non-cancerous. However, because of their vigorous blood supply and location they can lead to vascular tinnitus.
4. Arteriovenous malformations or AVMs refer to large abnormal collections of veins and arteries that may sometimes occur inside the skull, close to the auditory nerve. These arteriovenous malformations beat against the auditory nerve and this leads to a vascular tinnitus.
5. The jugular vein traverses the ear while carrying the blood back to the heart from the brain. If there is turbulence in the blood flow anywhere along the course of the jugular vein then it is audible in the middle ear as a humming noise.
6. A carotid artery-cavernous sinus fistula, which is an abnormal link or passage between a very large vein and a very large artery within the skull, can also trigger vascular tinnitus.

If the root cause for vascular tinnitus is detected such as a high blood pressure or glue ear then the treatment is directed towards that particular condition. However, if the root cause cannot be understood, then certain coping strategies have to be used along with sound therapy, tinnitus retraining therapy or TRT and relaxation techniques.

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What are the Problems with Tinnitus Retraining Therapy?

Tinnitus or the ringing ears syndrome is a phantom auditory perception that can be quite unbearable. It is a common disorder that affects nearly 17% of the people throughout the world. Several methods have been developed to deal with it.

Tinnitus Retraining Therapy or TRT is a method of treatment of tinnitus that has gained much popularity in the last decade. The conceptual basis of TRT has been described in 1990 as a form of tinnitus treatment that is based on the neurophysiologic model of tinnitus that was developed by Pawel Jastreboff and JWB Hazell. This model suggested that the treatment of tinnitus should focus on the autonomic nervous systems and the limbic system.

It has been claimed that TRT is currently the most effective therapy for tinnitus which obtains a success rate that exceeds 80%. However, there are some loopholes in the TRT such as the following:

• There are many centers around the world that claim to be treating tinnitus according to the method devised by Hazel and Jastreboff. However, the published literature shows that there are significant differences in the way the Hazel and Jastreboff model is applied in the different centers.

• The authors of the case reports that show the effectiveness of TRT claim to have a success rate ranging between 50-80%. However, the evidence that is provided by this research is inconclusive because of the unclear criteria of patient selection, unavailability of controls and the variability of the tinnitus methods that are implemented.

• The interaction between emotional and neuroacoustic processes that has been emphasized by Jastreboff is neither new nor adequately elaborated in terms of the underlying psychological factors.

• If the current state of evidence is taken into account then one can conclude that there is no realistic empirical support that proves TRT to be superior to other treatments due to lack of comparative studies.

So we find that methodological limitations in the research which has been published so far rule out any claims about the effectiveness of TRT at present.

Suggestions have been made to undertake randomized and controlled studies which include no-treatment and placebo conditions.

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Exposure to loud noise can cause acoustic trauma which may lead to tinnitus. The steriocilia or tiny hair cells found in the inner ear are responsible for converting the sound energy into electrical impulses which then travels to the brain and gets processed there. When there is an acoustic trauma the steriocilia get destroyed. Although research is being done to find out ways of regeneration of the damaged hair cells yet, as of now, once they get destroyed they can not be regenerated. When the steriocilia are destroyed through prolonged exposure to loud sounds, it leads to deafness to some sound frequencies. The damaged hair cells relay random signals to the brain which the brain interprets as sound. This is the most plausible theories regarding the onset of tinnitus due to damaged steriocilia.

If case of noise-induced tinnitus the first priority of the person suffering from it should be to prevent any further damage to the hearing system. For this it is essential that loud noise should be avoided. Incase of loud-noise induced tinnitus it is often suggested that one should avoid listening to any loud noise till a few days after the acoustic trauma. This gives the auditory system a chance to relax and recover from the damage.

A visit to a loud music concert or working at a noisy workplace can trigger tinnitus. If even after such an experience the affected  person does not behave cautiously and does not protect his or her ears from loud noise exposure then the tinnitus gradually becomes more clear and longer lasting.

Hence, it is evident that the best way to prevent tinnitus from worsening is to protect the ears from loud noise in the environment. For this one may use earplugs or earmuffs in places where exposure to loud noise is unavoidable. Special plugs such as motorcycle plugs are also available and can be worn conveniently beneath the helmet by the motorcyclists.

Listening to loud music may seem to be quite entertaining for some but the aftermath can be quite painful because the sound is directed towards the ear drum for maximum impact and hence it may cause irrevocable damage. Therefore, in case of tinnitus, one should listen to music on ipods at low volumes.

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What is the effect of hearing aids on tinnitus and Meniere’s disease?

Meniere’s disease is a combination of tinnitus, hearing loss, fullness in the affected ear, and dizziness caused due to the abnormal fluctuation in the fluid levels in the inner ear.

The hearing loss is one of the initial symptoms of Meniere’s disease but it is usually overlooked because it is the tinnitus that is considered to be more irksome.

There is a mistaken belief that hearing aids are of no help for those suffering from Meneire’s disease. However, with the introduction of digital sound processing integrated with the hearing aid technology, there is an increased chance of an enhanced hearing in Meneire’s disease. The modern hearing aids can amplify sounds to match the hearing loss very accurately and they can also reduce loud sounds to a more comfortable level.

When a hearing aid is successfully fitted the patients of Meniere’s disease can obtain the following benefits:

• The every-day sounds become clearer,
• The discomfort of recruitment gets reduced by compressing distressingly loud sounds to a more bearable volume,
• Reduction in the tinnitus perception to a less agonizing level.

The following facts should be kept in mind before choosing a hearing aid for Meniere’s disease:

• First and foremost it should be kept in mind that a hearing aid is a medical gadget and not a fashion accessory.
• The quality of the hearing aid is very important for those with Meniere’s disease.
• A suitable hearing aid should be selected only after the fluctuating hearing loss has been established on the basis of a series of hearing tests.

Tinnitus is an auditory disorder that is often found to be associated with a hearing loss. A study showed that 60% of the tinnitus patients who were surveyed experienced some amount of relief due to hearing aids whereas 22% indicated a major relief by using hearing aids.

The hearing aids apparently provide the following benefits to the tinnitus patients:

• Improvement in attention span
• The helps in focusing better.
• There is less fatigue, stress and tension.
• There is less irritability and anger
• There are lesser chances of social avoidance due to awkwardness.

Thus, we find that the hearing aids play an important role in the treatment of tinnitus and Meniere’s disease.

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What is the treatment for extremely loud tinnitus?

At times, tinnitus may cause less distress and is not too distracting. However, some people have to face extremely loud tinnitus that is discomforting enough to throw anyone off balance. This may happen in cases when a person is subjected to stress till long durations. In such cases extremely loud bouts of tinnitus are experienced. This happens due to the fact that the hypothalamus, which is an important part of the brain, stops producing certain essential trace elements that the body requires to function normally.

If the doctor can pinpoint the exact underlying cause of extremely loud tinnitus then the subsequent treatment can help one get rid of the tinnitus. Unfortunately, sometimes the root cause eludes everybody and the problem becomes more or less persistent. In such cases the internal treatment may become impossible and the only option left will be the management of the symptoms.

If the tinnitus noise is extremely loud then it goes without saying that it may be extremely unbearable too. The technique of masking comes to one’s rescue at such critical moments. This technique employs other sounds to subdue or mask tinnitus noise. This is a safe and useful method and is so effective in certain cases that the people can hardly hear their tinnitus noise.

At night when there is silence in the environment the tinnitus noise becomes too distracting to let a person sleep peacefully. At such moments the pillow or bedside maskers are of great help. These novel devices help one ignore the tinnitus and fall asleep.

Besides using the masking techniques there are a few other suggestions that one may follow to keep the extremely loud tinnitus under control. They are the following:

• Avoid alcohol and smoking as they can worsen tinnitus.
• Regular exposure to loud noise can cause further damage to the auditory system. Hence, one should wear earplugs or earmuffs
• It has been found that stress can trigger tinnitus or else it may aggravate the already existing tinnitus. Hence, stress management becomes imperative to keep tinnitus under control. This can be done by various methods like music therapy, yoga and meditation.

These practical suggestions can help one in taming the extremely loud tinnitus.

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