Tinnitus

Tinnitus is the sensation of noise in the ears in the absence of an external noise source. Approximately 15% of the adult population has experienced tinnitus at one time or another, 0.5-2% suffer severely from it. Although children also sometimes experience tinnitus, it quickly passes for them and they do not pay attention to it. Most often, tinnitus begins at the age of 50-60 years.

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Causes of Tinnitus

The causes of tinnitus are more than varied: earwax in the external auditory canal, viral infection, vascular disorders, presbycusis, acoustic trauma, chronic purulent otitis media, condition after removal of the stapes, Meniere's disease, head injuries, intake of ototoxic drugs, neuroma of the auditory nerve, anemia, hypertension, impacted (retained) wisdom tooth, intake of aspirin.

In 20% of people complaining of tinnitus, some hearing loss is also detected. The mechanism of the disease is unknown in most cases. The exception is people with "objective" tinnitus, but such cases are rare. Such patients can hear themselves (and others can hear them) various sounds that occur as a result of involuntary movements of the soft palate, the muscle that tenses the eardrum, or contraction of the stapes muscles. Other causes of "objective" tinnitus may be vascular malformations and atheromatous murmurs in the vessels.

Another group of people with tinnitus perceive it when breathing through the nose, but the noise disappears when breathing through the mouth. In such patients, the eardrum can be seen moving with breathing movements of the chest during otoscopy. The reason for this is most likely that the Eustachian tube is "open", so patients experience relief after applying silver nitrate solution to the area of the Eustachian tube orifices or after submucosal injection of Teflon (these measures allow the Eustachian tube to be narrowed).

History of the disease in such patients. When collecting anamnesis in such patients, it is necessary to clarify a number of questions: where is the lesion that produces the noise localized - in the ear or in the brain centers? What is the nature of the noise? What amplifies and what weakens the noise? Is there otalgia, discharge from the ear? Is there dizziness? Has there been a head injury in the past? Is there a hereditary burden with respect to deafness or tinnitus? What is the sleep? What is the social environment (the noise is aggravated in isolated individuals and individuals who are depressed)? What medications does the patient take?

Examination and examination of the patient. Otoscopy is required to detect middle ear disease, hearing testing (with a tuning fork and audiometry), tympaniography to study the function of the middle ear and the thresholds of the stapedius reflex.

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Treatment of tinnitus

After serious causes of tinnitus have been ruled out, try to convince the patient that the tinnitus does not indicate any brain disorder or any serious illness at all, and that the slight noise he feels should not get worse. Encourage the patient to join a self-help society. Drug therapy is ineffective. Tranquilizers are not indicated, although sleeping pills at night may be helpful. Carbamazepine has not lived up to expectations; betahistine helps only some patients with Meniere's disease. Antidepressants may be helpful in people who have developed depression.

Wearing a special mask, although it does not cure the disease, can bring relief to the patient. At night, softly playing music can suppress the noise in the ears without disturbing the sleep of the spouse. A noise generator is also used, producing a soft indifferent noise; it is worn behind the ear. These auxiliary hearing aids usually help patients with hearing loss. Those patients who are disabled by tinnitus can be helped (in 25% of cases) by cutting the cochlear nerve, but after this deafness develops.