Tinnitus

What is tinnitus?

Everyone sometimes hears a vague noise in their ear that lasts for a few seconds or minutes. This ringing in the ears is quite normal. It is real tinnitus if you hear the ringing in your ears permanently or repeatedly over a longer period of time. The characteristic feature of tinnitus (Latin “tinnire” = ringing, tinkling or ringing) is that this noise is not caused by the environment, but that your body causes it itself and it has no informational value for you. Medicine distinguishes between subjective tinnitus, which you only perceive yourself, and the much rarer objective tinnitus, which your doctor can sometimes also hear.

Depending on how long you have had the ringing in your ears, it may be a:

• Acute tinnitus: has been present for up to three months,
• chronic tinnitus: persists for more than three months.

How you experience the impairment caused by the constant ringing in your ears varies from case to case. Many come to terms with it, others feel very burdened by it.

Tinnitus: frequency, causes and risk factors

A distinction is made between two forms of tinnitus depending on the cause:

• The much more common subjective tinnitus can only be heard by the person affected.
• The much rarer objective (syn. pulsatile) tinnitus is caused by noises coming from muscles or blood flow in blood vessels. These sounds can sometimes be heard by other people (e.g. doctors) (therefore objective).

It is estimated that one in four people have experienced temporary ringing in the ears. About 10-15% of the population suffer from chronic subjective tinnitus that lasts longer than three months, but only a small percentage suffer from tinnitus. More and more young adults are now complaining of permanent ringing in the ears. One possible reason for this is the increasing exposure to noise during leisure time, through loud music via headphones, in clubs and at concerts.

The causes of subjective tinnitus

If only you hear the tinnitus, i.e. it is the subjective form, then it can occur as a side effect of certain illnesses.

Causes in the ear

• Hearing loss: In most cases of subjective tinnitus, hearing loss of varying degrees is found. This also applies to situations in which the person concerned is not even aware of their impaired hearing. In most cases, there is a slow onset of hearing impairment in the high tones in the sense of an incipient age-related hearing loss. As this form of hearing loss affects everyone sooner or later, the majority of those affected are over 50 years old. The hearing impairment means that signals from a certain sound spectrum are no longer transmitted to the auditory cortex of the brain and processed.

In addition to this very general, model-like idea of the development of ringing in the ears, in some cases very specific ear diseases can also trigger tinnitus:

• Noise and blast trauma:After a loud concert, the sensory cells in the ear can be temporarily damaged, resulting in ringing in the ears. If you regularly listen to very loud music, you can not only permanently damage your hearing, but also develop tinnitus. The same applies to blast trauma caused, for example, by a gunshot or firecrackers fired in the immediate vicinity.
  
• Blockage of the ear canal: The ringing in the ears can also be caused by hearing impairment due to an obstruction of the ear canal, such as a plug of earwax or a foreign body.
• Hearing loss: A hearing loss is an acute, one-sided hearing loss, which can also lead to tinnitus.
• Pressure in the ear: Extreme changes in pressure in the ear (e.g. due to diving, air travel or colds) can cause ringing in the ears. The connection between the middle ear and the throat is partially or completely blocked. This creates an unpleasant feeling of pressure in the ear, which you cannot get rid of even by yawning or swallowing. This ventilation disorder of the eustachian tube can lead to tinnitus.
• Tumor of the auditory and vestibular nerves (acoustic neuroma, synonym vestibular schwannoma): The very rare benign tumor on the vestibular nerve and/or auditory nerve and can show tinnitus as the first symptom.
• Inner and middle ear infectionInfections sometimes cause ringing in the ears.
• Perforation of the eardrum: The ringing in the ears can occur, for example, after an injury to the eardrum caused by a tear.
• Meniere’s disease: The disease of the inner ear leads to acute rotary vertigo with hearing loss and ringing in the ears.
• Otosclerosis: This is ossification at the junction between the stapes (third auditory ossicle) and the inner ear. It can also provoke subjective tinnitus.

Cause stress

Tinnitus is caused by central compensation, which begins with overactivity of the auditory cortex. If this leads to a connection between the auditory cortex and other areas of the brain that are responsible for stress, emotion, attention, consciousness, memory or sleep, the activity in the auditory cortex can be perceived as “ear noise”. Ultimately, therefore, it is not hearing loss alone that causes tinnitus, but also the networking with other brain structures that is responsible for tinnitus. This explains why stress, anxiety, excessive demands and mental illness can contribute to the development of ringing in the ears in some people.

Causes in the skeleton

A further influence on the perception of ear sounds is achieved at the level of the brain stem. This is where signals from the neck, cervical spine or temporomandibular joint come into contact with the auditory system. For this reason, changes in the neck, cervical spine or temporomandibular joint can also influence the perception of ear noises.

The causes of objective tinnitus

In some cases, your doctor can also hear the objective tinnitus and measure it with special equipment. It is the cause of only about one percent of all tinnitus cases.

Objective tinnitus is mainly caused by:

• Flow noises of blood vessels (arteries and veins) due to anatomical variations of the course, constrictions, constrictions (pulsating noise) synchronized with the heartbeat)
• Clicking or cracking noises in the ear due to cramping of the internal muscles in the middle ear or palate muscles
• Breath-dependent ringing in the ears due to inadequate closure of the eustachian tube in the nasopharynx, allowing air to enter the middle ear
• Crunching noises because bone or cartilage surfaces rub against each other when closing or opening the mouth

Tinnitus: What symptoms occur

Tinnitus can manifest itself in very different ways. Those affected describe the noises in their ears as humming, beeping, buzzing, rattling, whirring, screeching or hissing. The sounds can be consistently intense or rise and fall rhythmically. Strictly speaking, tinnitus is not a disease, but rather a symptom that can have different causes.

Some of those affected find the constant ringing in their ears threatening and very stressful, even if it is not actually dangerous. In some cases, other symptoms and health problems occur as a result of tinnitus, including sleep disorders, headaches, tense neck and jaw muscles, dizziness, anxiety and depression. Tinnitus accompanied by these additional symptoms can be very life-limiting – up to and including incapacity to work. This often leads to a vicious circle, as the accompanying symptoms can cause further stress and exacerbate the tinnitus.

Severity of the tinnitus

Tinnitus is divided into different degrees of severity. Questionnaires are also used for detailed classification:

• Grade 1: The tinnitus is well compensated: you are aware of the ringing in your ears but do not suffer from it.
• Grade 2: You notice the ringing in your ears when it is quiet. These intensify under stress. You have largely compensated for the tinnitus.
• Grade 3: The tinnitus symptoms are a considerable burden in your professional and private life. They can cause cognitive, emotional and physical problems. Sleep and concentration problems, muscle tension, headaches and feelings of helplessness and resignation can be the result.
• Grade 4: You are constantly aware of the tinnitus and perceive it as a constant burden that massively impairs your private and professional life. They are no longer able to pursue their profession, withdraw from social life and suffer from severe mental disorders such as anxiety or depression.

Tinnitus: Diagnosis by us

Many noises in the ears, such as tinnitus after a bang trauma or a loud concert, disappear by themselves after a few days. However, if you can still hear a noise in your ear after several days, you should visit our clinic for ear, nose, throat and facial surgery.

Your description of the ringing in your ears forms the basis of the diagnosis and provides us with information for assessing the severity.

We carry out various physical examinations to find out the cause in more detail and to confirm the diagnosis, for example:

• Examination of the throat, nose and ears
• Hearing tests for sounds (tone audiogram)

Depending on the findings of the above examinations and discussion, the following examinations may follow:

• Analysis of the tinnitus noise: Using an audiometer, we work with you to determine the frequency at which the ear noises are strongest and their volume.
• High tone audiometry: Hearing test for sounds above 8kHz, which are not normally recorded in a standard tonal audiogram.
• Speech audiometry: Hearing test for understanding numbers and words, which can provide important information for speech comprehension when deciding whether to fit hearing aids.
• Tympanogram: We check the mobility of the eardrum with a small probe that is placed in the ear entrance and closes it.
• Stapedius reflex: The stapedius reflex can be tested at the same time as a tympanogram. It serves as natural protection against excessive sound pressure.
• Test for otoacoustic emissions: The test checks the functionality of the cochlea or the outer hair cells located there. It may indicate damage to the inner ear.
• Clarification of the brain and blood vessels, for example:
  • Clarification of pulse-synchronous tinnitus
  • Doppler sonography of the head and neck vessels (ultrasound)
    
  • Computed tomography (CT)
  • Magnetic resonance imaging (MRI)

Tinnitus: prevention, early detection, prognosis

Prevention is the best therapy. As noise and stress are considered risk factors, it is advisable to avoid both in excessive form. Wear hearing protection when attending concerts and clubs or during shooting practice. Avoid listening to loud music through headphones frequently or for hours on end. If you are exposed to noise at work, you should always wear professional hearing protection. As tinnitus often occurs in the company of stress, it is advisable to consciously and relaxedly deal with persistent stress in everyday life. Learn relaxation techniques.

Course and prognosis

In most cases, the tinnitus improves over time so that it does not impair the quality of life or disappears completely. In some cases, however, the ringing in the ears can cause significant stress. Some sufferers need support, such as cognitive behavioral therapy, physiotherapy treatment or support with sleep regulation, so that the ringing in the ears no longer leads to a reduction in quality of life.

Self-help groups

Tinnitus: treatment for acute or chronic form

The first step of the therapy aims to determine the cause of the ringing in the ears and to eliminate it, which can stop the tinnitus. Unfortunately, it is often not possible to find the cause. In the case of subjective tinnitus, i.e. ringing in the ears that only you perceive, the therapy depends not only on the cause, but above all on how long you have been hearing it and how much your quality of life is affected by the ringing in your ears.

There are also treatment options for chronic tinnitus with severe stress. Their main aim is to help you better understand and accept your tinnitus. In this way, you will learn to give it a less stressful meaning and get used to it better. Treatment is then generally interdisciplinary in collaboration with the Clinic for Consultative Psychiatry and Psychosomatics as part of cognitive behavioral therapy. As a result, many sufferers are able to perceive the tinnitus less and less. This gives the impression that the tinnitus has disappeared – even though the ringing in the ears persists.