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To learn more about what is causing your tinnitus, your doctor may refer you to an audiologist (aw-dee-AH-luh-jist) who can measure your hearing. Although there is no cure for tinnitus, scientists and doctors have discovered several treatments that may give you some relief. When we talk about TRT (Tinnitus Retraining Therpay), this is not simply an abstract learning exercise. Our Clinic provides outside consulting services to senior citizen centers, convalescent hospitals, retirement homes, and hearing conservation programs for the private industry. Florida Medical Clinic is proud to offer the highest quality of hearing healthcare in the Tampa Bay area. Tinnitus is the medical term for the perception of sound in one or both ears or in the head when no external sound is present. Although there have been tremendous advances through research, the exact physiological cause or causes of tinnitus are not known. Noise exposure – Exposure to loud noises can damage and even destroy hair cells, called cilia, in the inner ear. Certain disorders, such as hypo- or hyperthyroidism, Meniere’s disease, Lyme disease, fibromyalgia, and thoracic outlet syndrome, can have tinnitus as a symptom.
Ototoxicity – Some medications are ototoxic, that is, the medications are harmful or damaging to the ear.
Although there presently is no cure, in some cases, tinnitus can be managed by treating the underlying cause or by altering reactions to it. The phrase “prevention is the best medicine” could have been coined specifically for tinnitus. When poor physical health is to blame for tinnitus, correct the underlying medical issue(s) are sometimes all it takes to get rid of the ringing in the ears. While it is not clear exactly why they work, certain antidepressant medications can correct or reduce tinnitus. Benzodiazepines (most famously, Valium and Ativan) have been tried in tinnitus with mixed results.
When tinnitus is a symptom on Meniere’s disease, surgical therapy might be able to correct the dizziness and ear fullness while at the same time eradicating tinnitus. While they have not yet been perfected, there are various types of electrical and mechanical devices that have been used to treat tinnitus. A tinnitus masking device is quite similar to a hearing aid in form but not necessarily in function.
My foundation in faith and family has allowed me to face challenges and grow into an expert in hearing health care. An occasional tinnitus, especially within a very quiet environment, is not at all unusual and is reported by 90 to 95% of the population even in the absence of any ear disease or hearing disorders. The word tinnitus has its etymological root in the Latin tinnire meaning “to jingle.” However, the patient experiencing tinnitus may describe the sound as a ringing, roaring, hissing, whistling, chirping, rustling, clicking, buzzing, or some other similar term or description.
The perceived loudness of tinnitus may be intense enough for some to be highly debilitating. To understand the pathopysiology of tinnitus it is first necessary to understand how the ear itself works. The cochlea is the portion of the inner ear responsible for hearing and it is within the cochlea that the origins of tinnitus arise.
The sensory receptors, known as hair cells because of their appearance under magnification), are shown in Figure 2. Figure 2: Cross-sectional schematic view of the single row of inner hair cells and the three rows of outer hair cells within the organ of Corti in the cochlea of the human ear.
The alterations in the normal random firings of the hair cells are “heard” only because they are a novelty: something new.
Tinnitus sounds different to everyone, so it makes sense that there are four different types: subjective, objective, neurological, and somatic. Neurological tinnitus: Usually caused by a disorder, such as Meniere’s disease, that primarily affects the brain’s auditory functions. Objective tinnitus: A rare form of tinnitus that may be caused by involuntary muscle contractions or vascular deformities. Musical tinnitus: Also called musical hallucinations or auditory imagery, this type is less common.
Low-frequency tinnitus: Perhaps the most confusing type of tinnitus because sufferers aren’t sure whether the sound is being produced internally or externally.
There are countless treatment options, but they vary in effectiveness depending upon the type of tinnitus. Doctors and scientists have discovered that people with different kinds of hearing loss also have tinnitus. Allergies, tumors, and problems in the heart and blood vessels, jaws, and neck can cause tinnitus.
Not every treatment works for everyone, so you may need to try several to find the ones that help.
Once the tinnitus loses its sinister meaning, however loud it has been, or however unpleasant it may seem, it DOES begin to diminish, and in many cases may not be heard for long periods of time. In the subconscious part of the brain concerned with hearing, beyond the inner ear, (but before conscious perception of sound takes place), subconscious filters,or networks of nerve cells (neuronal networks) are programmed to pick up signals on a 'need to hear' basis. Please use newer version of your browser or visit Internet Explorer 6 countdown page for more information. There are, however, several likely sources, all of which are known to trigger or worsen tinnitus.
When tinnitus is a symptom of another disorder, treating the disorder can help alleviate the tinnitus. This kind of tinnitus can be caused by abnormal blood flow in arteries or veins close to the inner ear, brain tumors or irregularities in brain structure. However it is important to note that these options do not work for everyone and do not work to the same degree for each individual patient. Balancing thyroid hormone, correcting anemia, and controlling cholesterol might be all that is required to reverse tinnitus. While some have argued that tinnitus and depression are linked, it is not so simple to think that depression alone leads to tinnitus. These medicines quiet electrical activity in the brain and can be helpful in quieting some of the signals that cause tinnitus.

If there is a physical problem that is causing tinnitus and it can be reached and corrected surgically, surgery becomes the treatment of choice. In Meniere’s disease there is an excess of endolymph (fluid) in the vestibular system (the inner ear organ that helps us walk upright and maintain balance). Since once of the root causes (or pathways, really) of tinnitus is abnormal electrical activity in the nerves going from the cochlea to the auditory cortex, scientists and doctors have tried to use electrical stimulation to override those signals. Instead of stimulating the cochlea, a device is applied to the outside of the skull and stimulates brain tissue using strong magnetic oscillations. These tinnitus treatments include hearing aids, masking devices, and tinnitus feedback retraining.
While a hearing aid amplifies sounds that enter the ear, a tinnitus masking device creates noise of its own. Ear and head noises are probably the most common complaints presented to hearing healthcare professionals. Tinnitus becomes a problem for some when its intensity so overrides normal environmental sounds that it invades the consciousness. While most who have tinnitus report the presence of their tinnitus to be constant, others have reported it to be intermittent, fluctuant, or pulsating.
The tinnitus itself may cause or be aggravated by difficulty sleeping, fatigue, difficulty relaxing, decreased ability to concentrate, increased levels of stress, depression and irritability.
As can be seen in the accompanying cross section (Figure 1), the ear is comprised of much more than the visible skin and cartilage appendage on either side of our heads. Within this fluid-filled, snail-shaped, bony capsule, the mechanical energy of the vibrating ear bones changes into an electromechanical energy by triggering the microscopic sensory “hair cells.” These hair cells, so named because of their appearance, send neural impulses to the brain for interpretation.
If you can visualize a conch shell from the beach (similar in shape to the cochlea in the human ear which houses the organ responsible for hearing) with hair cells resting on a shelf that stretches throughout the coil of the shell, you can appreciate how many hair cells there are. The nerve receptors at the ends of your fingers are constantly “firing” and sending impulses to the brain.
It is only when they are triggered by the patterns of sound waves that a pattern occurs in the sequence of neural firing so that the brain pays attention to it. There are approximately 3,500 inner-hair cells, and it is these inner hair cells that are responsible for hearing. Electron micrograph of a portion of the spiral curve of the human cochlea revealing a total obliteration of the outer hair cells and their accompanying nerve fibers following occupational noise exposure. Novel sounds are always heard initially, but when they loose their novelty they leave our conscious attention. Subjective symptoms can only be heard by the affected individual are usually caused by exposure to excessive noise.
It usually indicates a change of blood flow to the vessels near the ear or an increase in awareness of the blood flow to the ear. Often, the tones correspond to the two lowest octaves on a piano and are described as a humming, murmuring, rumbling, or deep droning. No single approach works for everyone, and there is no FDA-approved drug treatment, supplement, or herb proven to be any more effective than a placebo. More than 50 percent of those who experience tinnitus have an inner-ear hearing impairment, meaning that a connection between tinnitus and hearing loss is likely. According to estimates by the American Tinnitus Association, at least 12 million Americans have tinnitus. If you have tinnitus and you take medicine, ask your doctor or pharmacist whether your medicine could be involved. He or she can check to see if it is related to blood pressure, kidney function, diet, or allergies. Wearing a hearing aid makes it easier for some people to hear the sounds they need to hear by making them louder. If your doctor prescribes medicine to treat your tinnitus, he or she can tell you whether the medicine has any side effects. In some cases firmly held beliefs are hard to alter, particularly where there is a conviction that tinnitus is only related to ear damage which cannot be fixed.
Think again of the way we invariably detect the sound of our own name, or a distant car horn, or a new baby stirring in sleep, whereas we may be unaware of the sound of rain pounding on the roof or surf beating on a sea shore. If you believe you may be affected by tinnitus, please call (818) 341 5407 for a no obligation consultation.
That’s why we make every effort to listen to your frustrations and concerns. We strive to build long-term relationships with our patients based on honesty, integrity, and respect. Tinnitus can be intermittent or constant-with single or multiple tones-and its perceived volume can range from subtle to shattering. Your Elkhart Audiologist, Sharon Hirstein, understands that tinnitus can negatively impact your life, family and work.
Sure having tinnitus can be depressing, but only certain types of antidepressants work on tinnitus, specifically tricyclic antidepressants. Sometimes these arteriovenous malformations, as they are called, are present at birth but more often they develop later in life. In fact, the earliest reports of electrical stimulation of the ears for the treatment of tinnitus date back over a hundred years. The technology has been used to improve drug delivery and reduce auditory hallucinations, but may also be effective in treating tinnitus. Since hearing and tinnitus are intimately related, it makes sense that treating deafness also helps treat tinnitus. Seventeen percent of the general population has tinnitus to a noticeable degree with as many as 30% of those over age 65 years reporting the presence of tinnitus.
Tinnitus may be perceived as a high or low-pitched tone, a band of noise, or as a combination of these sounds.
The degree to which these factors are present often far exceeds expectations based on the loudness levels of tinnitus as traditionally measured. A brief overview would begin with the outer ear, which extends from the auricle (what we call the “ear”) down the ear canal to the tympanic membrane, or eardrum. These bones are used in transmitting the sound energy from the vibrating eardrum to the cochlea. What you see in Figure 2 is a representation of a slice of the long rows of hair cells revealing three rows next to each other called the outer hair cells (because they are positioned toward the outside of the snail-shaped cochlea) and a single row of inner hair cells.
These random firings are filtered out as meaningless so that the brain pays them no attention.

It is an alteration in the random neural activity of the hair cells in the absence of sound that the brain interprets as tinnitus. If we label the sound of the tinnitus as something negative (for example, a sign of impending deafness, a sound that may worsen and over-power us, an abnormality that signifies a significant pathology such as a tumor, etc.), then emotional reactions are attached to the sound. Simply defined, it is a phantom ringing, whooshing, or buzzing noise in your ear that only you can hear. This type of tinnitus can appear and disappear suddenly, and may last 3–12 months at a time. This is the only form of tinnitus that can be heard by an outside observer, and the only type that has the potential for a permanent fix.
Musical tinnitus tends to occur in people who have had hearing loss and tinnitus for some time, though people with normal hearing or increased sensitivity to sound can also have musical hallucinations. Behavioral strategies and sound-generating devices often offer the best treatment results — this is partially why distracting the individual’s attention from these sounds can prevent a chronic manifestation. Though wearing hearing aids helps ease tinnitus (they amplify the sounds outside, making the “inside” sounds less frequent), they are not the only method: careful diagnosis by a professional with years of experience creating solutions for tinnitus sufferers is essential. Of these, at least 1 million experience it so severely that it interferes with their daily activities. Your doctor can also determine whether your tinnitus is related to any medicine you are taking. The better you hear other people talking or the music you like, the less you notice your tinnitus. Retraining the subconscious auditory system to accept tinnitus as something that occurs naturally, does not spell a lifetime of torture and despair, and is not a threat or a warning signal, can take months and occasionally even years. Retraining therapy involves reprogramming or resetting these networks which are selectively picking up 'music of the brain' in the auditory system. Before taking any medication, make sure that your prescribing physician is aware of your tinnitus, and discuss alternative medications that may be available. The best way to prevent tinnitus are to avoid those things that assault the ears namely prolonged exposure to loud noise, short exposures to extremely loud noise, and drugs that can hurt the ears. A full medical checkup is a good place to start because a great number of potential causes will be checked and addressed if needed. If depression was the sole cause, one would expect that better depression medicines like selective serotonin reuptake inhibitors (SSRIs) would also be the better tinnitus medicines. Also, this class of drugs can be habit-forming, which is why they are used with caution and weighed against their usefulness.
An acoustic neuroma is a benign growth around the nerve that carries electrical signals from the inner ear to the brain.
While directly stimulating the auditory system has been reported to help 4 out of 5 patients, the tinnitus returns soon after the stimulation has stopped. Early research indicates that transcranial magnetic stimulation may reduce the symptom of tinnitus for up to six months at a time. Improving hearing with a hearing aid does not always correct tinnitus, but it can be quite helpful to a number of patients with both hearing loss and tinnitus (about half). The outer hair cells are much more plentiful than the inner hair cells, numbering about 12,000. Once this happens, we become increasingly aware of this sound that otherwise would have been filtered from our consciousness. Ideally, retraining should be guided by professionals with experience in this field, forming part of a multi-disciplinary team.
With strong reactions, the filters are constantly monitoring tinnitus, but without a reaction, habituation occurs, as it does to every meaningless sound that is constantly present.
The area is certainly murky, scientifically, but antidepressant medications may be a tool to treat tinnitus in certain patients. Newer strategies for treating abnormal blood vessels include burning them or injecting them with sclerosing agents which causes the vessel to shrink and to die.
Meniere’s surgery is not 100% effective at treating the primary disease or tinnitus, but it may be an option for some people.
It is not practical to use current methods of stimulation constantly—there would be no time for living life. It is the patterned neural impulses that gain attention within the brain and that are assigned meaning. These cells, to the extent possible, will enhance the weak sounds that are received to make them more audible and they will attenuate the loud sounds to make them more comfortable.
Therefore, the primary difference between people who just notice their tinnitus, and those who suffer because of it, is the negative emotional attachments they may bring to its existence. Firstly the disappearance of the reaction means that sufferers no longer feel bad, or distracted, and normal life activities can be resumed a€“ sleep, recreation and work, as before.
Regular checkups can catch hormonal and metabolic problems in the early stages before they result in tinnitus. If the blood vessel that is causing the problem is an important one (like the jugular vein) destroying it is not a viable option. The outer hair cells are more susceptible to damage from viral infections, exposure to intense sounds, and medications that can be toxic to the ear.
It is still there, of course; and is still heard if you think about it, as you probably are now.
Similar tissue growths at various places in and around the ear can cause tinnitus and can be cured surgically. While these devices are primarily used to give the sense of hearing to the deaf, they do so by directly stimulating the cochlea. While it would be considered a rather bold clinical move, cochlear implants may be used to treat tinnitus in the future.
However, this damage can alter the random neural activity that is normally interpreted by the brain as a code of silence. Now, the random firings, occurring in the absence of an actual sound, are “heard” by the brain.
Rather, tinnitus is an alteration in the normal random firings of the nerve receptors of the ear.

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11.02.2014 admin

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