Speaking of Health – Tinnitus

By Gilda Morales, ANP, DC

Today’s health column deals with a condition that has frustrated patients and health care providers alike.  Tinnitus, or more commonly known as “ringing in the ears,” is a condition where there is a perceived sensation of sound when there is none.  The patient may experience a sound that is commonly described as a ringing, hissing, buzzing or whooshing, and may affect one ear or both.

There are two main types of tinnitus, subjective, which is the most common, and which is only heard by the patient, and objective tinnitus, which can be heard by the provider upon examination.  The latter is usually described as hearing one’s heart pounding, especially at night and is related to potentially dangerous diseases such as carotid stenosis, malformation of the blood vessels in the head and neck, anemia, hyperthyroidism and some tumors.

There is a prevalence of the condition in males, whites, and those between the ages of 60 and 69, as well as those with high blood pressure and smokers.  The cause has been blamed on a myriad of agents including NSAIDs such as Ibuprofen and Aleve, antimalarial agents, certain antibiotics, Lasix, anti-ulcer medications, anti-convulsing medications, some anti-hypertensives and some anti-psychotropic medications.  TMJ problems, MS or neck injuries have also been implicated as causes of tinnitus, and one of the most common culprits is exposure to loud noises such as loud music through headphones, concerts, shooting firearms, or working around loud machinery.

Tinnitus can also lead to other problems with the ear including hearing loss and psychological conditions such as depression, anxiety and even suicidal ideation coming from the frustration and despair and the inability to have normal social interactions due to the disease.

Some patients report other conditions that have presented with their tinnitus including hearing loss, headache, noise intolerance, vertigo, pain in the TMJ and neck pain.  Some things that can cause a worsening of symptoms include loud noises and head or neck movements.

Although there are no definitive tests to diagnosed tinnitus, the patient should be checked for organic causes such as checking for hypertension as well as imaging to include carotid Doppler of the carotids, MRI of the brain, and the gold standard, cerebral angiography to rule out arteriovenous malformations.

Unfortunately, treatment for tinnitus is very limited but may provide minimal relief in some patients, including special hearing aids that mask the constant, annoying sounds.  Medication that is commonly prescribed include antidepressants, melatonin, anticonvulsants, anti-anxiety meds, such as Xanax, which help reduce the distress that comes with tinnitus, Vitamin B12 supplements, and high caffeine intake appears to be associated with lower incidence of tinnitus in women.  However, there is very little evidence that any of the aforementioned treatments have a significant effect on the devastating effects of such a frustrating condition.