Sunday, January 15, 2006

tinnitus (ringing in ears)

Tinnitus is an auditory sensation subjectively noted by the older person as a ringing or roaring in the ears. It may vary in intensity and may be continuous or intermittent.
Tinnitus is associated with hearing loss arising from disorders of the sound conduction system, the cochlea (temporal bone forming one division of inner ear), or neural pathways of the cochlear nerve. Tinnitus is caused by a variety of factors, including impacted ear wax, ear infection, usage of certain drugs, or systemic diseases such as hypertension and central nervous system disease. The sounds range from low frequencies (like a ventilating fan or seashell sound) to a rushing sound common in Meniere's disease to high-pitched noise (like whistles or insect sounds).
Conductive hearing loss produces a low-pitched steady sound that becomes pulsating if inflammation is present. High-tone hearing loss produces high-pitched continuous or intermittent tinnitus and is an important early sign of drug toxicity (aspirin, digitalis, quinine, etc.). Tumors of the inner ear can be indicated by low pitched tinnitus without hearing loss.
Other than relieving a conductive hearing loss, there is no specific medical or surgical therapy for tinnitus. If it is secondary to a hearing loss, it often will become less of a problem with the passage of time. However, it may reoccur at times of fatigue, stress, or respiratory infection. Reassurance is important in these instances.
People with tinnitus are most bothered at night, when external noises are low. The use of a bedside radio may sufficiently overshadow the tinnitus so the patient can fall asleep. Occasionally, mild sedatives are prescribed for insomnia, but barbituates and tranquilizers are rarely indicated since in most instances patients are able to adapt to the presence of tinnitus and ignore it. Recently, relaxation training has had some excellent results.
Ballenger, J. J. Diseases of the Nose, Throat. Ear. Head and Neck. 13th ed. Philadelphia: Lea & Febiger, 1985.


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