Tinnitus is the perception of sounds that does not have an external source. It is often perceived as “ringing”, “buzzing” or “hissing” in nature and can vary in loudness. Sometimes it is “pulsatile” in nature, similar to the heart-beat sounds. It does not include the hearing of voices which is often a psychiatric condition. All of us may occasionally experience a few seconds of tinnitus which is physiological and therefore, considered normal. Persistent tinnitus on the other hand, affects up to 10-15% of the population. It is mostly innocuous but occasionally can be due to serious underlying conditions. It is often but not necessarily associated with hearing loss.
Tinnitus is merely a manifestation of a disturbance of the auditory system. Any disorder relating to the external, middle or inner ear can result in tinnitus. These may include impacted ear wax, middle ear infections and damage to inner ear hair cells. Pulsatile tinnitus may occasionally be a manifestation of a vascular tumour in the ear. However, many patients suffer from persistent tinnitus without obvious ear abnormalities. Some may have somatic tinnitus due to other head and neck disorders.
Tinnitus can be extremely disturbing, affecting sleep, work and quality of life in general. It is often made worse by body stress which includes work stress, lack of sleep and anxiety. It is certainly not true that “nothing can be done for tinnitus and patients have to live with it”.
Patients are carefully assessed from the history and physical examination. A detailed hearing test is often part of the evaluation process. If necessary, further investigations such as imaging studies are carried out.
Identifiable causes of tinnitus are appropriately treated which can lead to resolution of tinnitus. Counselling including discussions on the pathogenesis and possible causes is an essential part of the overall management of tinnitus. Suitable medications may be prescribed for some patients. Hearing aids not only improve hearing but may help in relieving tinnitus in patients with associated hearing loss. Some patients may benefit from modulated-sounds therapy (Neuromonics Tinnitus Treatment). This program works on the auditory and neural pathways relating to tinnitus which can potentially lead to improvement or even resolution of tinnitus.
Senior Consultant Ear, Nose & Throat Surgeon
Sub-specialty in Otology & Neuro-otology
MBBS (S’pore), PhD (S’pore)
FRCSG, FRCSEd, DLORCSEng, FAMS (ORL)
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