Tinnitus is a variety of sound that is heard when no corresponding external sound is present. Nearly everyone experiences faint "normal tinnitus" in a completely quiet room; but it is of concern only if it is bothersome, interferes with normal hearing, or is associated with other problems. The word tinnitus comes from the Latin tinnire, "to ring". In some people, it interferes with concentration, and can be associated with anxiety and depression.
Tinnitus is usually associated with hearing loss and decreased comprehension of speech in noisy environments. It is common, affecting about 10–15% of people. Most tolerate it well, and it is a significant problem in only 1–2% of people. It can trigger a fight-or-flight response, as the brain may perceive it as dangerous and important.
Rather than a disease, tinnitus is a symptom that may result from a variety of underlying causes and may be generated at any level of the auditory system as well as outside that system. The most common causes are hearing damage, noise-induced hearing loss, or age-related hearing loss, known as presbycusis. Other causes include ear infections, disease of the heart or blood vessels, Ménière's disease, brain tumors, acoustic neuromas (tumors on the auditory nerves of the ear), migraines, temporomandibular joint disorders, exposure to certain medications, a previous head injury, and earwax. It can suddenly emerge during a period of emotional stress. It is more common in those with depression.
The diagnosis of tinnitus is usually based on a patient's description of the symptoms they are experiencing. Such a diagnosis is commonly supported by an audiogram, and an otolaryngological and neurological examination. How much tinnitus interferes with a person's life may be quantified with questionnaires. If certain problems are found, medical imaging, such as magnetic resonance imaging (MRI), may be performed. Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat. Rarely, the sound may be heard by someone other than the patient by using a stethoscope, in which case it is known as "objective tinnitus." Occasionally, spontaneous otoacoustic emissions, sounds produced normally by the inner ear, may result in tinnitus.
Measures to prevent tinnitus include avoiding chronic or extended exposure to loud noise, and limiting exposure to ototoxic drugs and substances. If there is an underlying cause, treating that cause may lead to improvements. Otherwise, typically, tinnitus management involves psychoeducation or counseling, such as talk therapy. Sound generators or hearing aids may help. No medication directly targets tinnitus.
Signs and symptoms
Tinnitus is often described as ringing, but it may also sound like clicking, buzzing, hissing, or roaring. It may be soft or loud, low- or high-pitched, and may seem to come from either one or both ears, or from the head itself. It may be intermittent or continuous. In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.
Course
Due to variations in study designs, data on the course of tinnitus shows few consistent results. Generally, prevalence increases with age in adults, and the ratings of annoyance decreases with .
Psychological effects
Although it is an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people. Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound. Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus. 45% of people with tinnitus have an anxiety disorder at some time in their lives.
Psychological research has focused on the tinnitus distress reaction to account for differences in tinnitus severity. The research indicates that conditioning at the initial perception of tinnitus linked it with negative emotions, such as fear and anxiety.
Types
Commonly tinnitus is classified into "subjective and objective tinnitus". Tinnitus is usually subjective, meaning that the sounds the person hears are not detectable by means currently available to physicians and hearing technicians. Subjective tinnitus has also been called "tinnitus aurium", "non-auditory", or "non-vibratory" tinnitus. In rare cases, tinnitus can be heard by someone else using a stethoscope. Even more rarely, in some cases it can be measured as a spontaneous otoacoustic emission (SOAE) in the ear canal. This is classified as objective tinnitus, also called "pseudo-tinnitus" or "vibratory" tinnitus.