Tinnitus

Related: Dizziness, hearing loss, ototoxicity

Tinnitus

What Is Tinnitus?

• Tinnitus is a word used to describe any ringing, or abnormal sound in your ear or head. Some people may hear roaring, hissing, or humming sounds. This may interfere with your ability to rest, or concentrate. You may be unable to sleep at night.
• Tinnitus may be divided into 2 categories: Objective tinnitus and Subjective tinnitus.
• Objective tinnitus is when another person, such as a healthcare provider, may hear a similar noise as you are hearing. This may be caused by heart valve problems, blood vessel abnormalities, or problems with the tubes in your ear (Eustachian tube). This form of tinnitus is more rare.
• Subjective tinnitus, which is far more common, is a result of damaged cells in your inner ear. This is when the person can tell other people what they hear - but the other persons cannot hear it themselves.
• Although the cause of tinnitus may be unknown, certain things can make your symptoms worse. These may include:
• Anxiety
• Injury to your ears, head or neck
• Certain kinds of tumors
• Infections in your ear or sinuses
• Wax or any foreign objects in your ear canal
• Certain diseases, such as Meniere's disease, heart disease (especially blocked arteries), and thyroid disease. Meniere's disease is a disorder where patients experience dizziness, tinnitus, and hearing loss.
• Heavy smoking, problems with your jaw
• Certain medications that cause tinnitus, may include:
• Diuretics or water pills, such as Diamox^®
• Heart and blood pressure medications, such as metoprolol (Lopressor^®)
• Antibiotics, such as gentamycin
• Anti-nausea medications, such as promethazine (phenergan^®).
• Anti-malaria drugs, such as quinine
• High doses of salicylates (aspirin), if taken for long periods of time.
• Ototoxicity is a word to describe damage to the ear due to many causes. It may be due to a long-term exposure to certain drugs, as the drug accumulates in your body. It may also come from giving high doses of the drug at a time, which causes damage certain cells in your inner ear. The hearing loss you could experience as a result of medications may be irreversible.
• If you have experienced ringing in your ears, or tinnitus, it may be on one side or both.

Tinnitus Symptoms:

• Many people have a tinnitus that comes and goes. Some have a ringing or abnormal noise in the ears at all times. It may or may not be associated with hearing loss or dizziness.
• Along with tinnitus, you might feel like the room is spinning around you, or that you are spinning. Some people describe a feeling of dizziness with a ringing in the ears, and feeling a bit "woozy." Severe dizziness, and the fear that you may fall down when you stand up, should be reported to your healthcare provider.
• Nausea and vomiting may also be associated with tinnitus.
• Severe vomiting over a long period of time may cause you to feel dizzy, or cause you to have abnormal sounds in your ear.
• Notify your doctor if you experience any of the symptoms mentioned here.

How Is Tinnitus Diagnosed?

• Your healthcare will usually, at first, take a complete health history from you. They will then examine your neurological system through conducting a physical exam in their office. This may include looking in your eyes, watching you stand or walk, and testing your strength. They will also look inside your inner ear, to see if there is an infection.
• If you have dizziness with your tinnitus, they will also perform a few different tests. Your healthcare provider may turn your head in different positions, usually from a sitting position, to a lying position, and back again, as they try to elicit the same symptoms that you are describing.
• Your healthcare provider may suggest a few special tests to diagnose your condition. These may include:
• A hearing test, to see if you have problems hearing different levels or pitches (frequencies) of sound. Some people cannot hear high or low-pitched sounds.
• X-rays of your head
• Angiography to look at the vessels in your neck
• MRI, or a CAT scan of your head.
• An otolaryngologist or neurologist will usually perform the complete physical examination, and order all the tests. Your healthcare provider may also do this.
• You may also be referred to a Neurologist, who specializes in dizziness disorders, and tinnitus.
• You may also be referred to an audiologist, a professional who diagnoses, treats, and manages individuals with hearing loss or balance problems.
• Your healthcare provider may order some blood work to be drawn.
• If they are able to find the cause of your tinnitus, it is likely that there are some forms of treatment available, especially if it is due to an infection, or a blocked tube.

Things You Can Do:

• It is important to notify your healthcare provider if you notice any change in the pattern of tinnitus you are experiencing. Also, notify your healthcare provider if you have any loss of vision, hearing, or if your symptoms become more severe, and do not improve.
• If you have hearing loss with your tinnitus, you may require hearing aids.
• Avoid loud noises.
• It is important to drink 2-3 liters of fluid per day to prevent dehydration. This may worsen your symptoms. Things to drink may include fruit juices, water, non-caffeinated sodas and coffee, and non-alcoholic beverages. Alcohol and caffeine may cause dehydration, so these should be avoided. Always carry a "sipper" cup with you, filled with your favorite drinks.
• Stress, anxiety and tiredness may cause your tinnitus to become worse. If stress and anxiety causes your tinnitus to become worse, relaxations techniques may help. You may also be prescribed an anti-anxiety drug.
• Using a quiet radio, television, or any low levels of sound when you are trying to rest may help you to ignore the tinnitus, and make it easier to sleep or relax.
• If your tinnitus is related to jaw abnormalities, you may be referred to a specialist for possible surgery to correct the problem.
• If your tinnitus is a result of drugs or medicines that you have received in the past, it is important to avoid these in the future, if possible. Be sure that you tell all of your health care providers about all of the medicines you are taking, including over-the-counter medications, vitamins, and herbal remedies. It is important to avoid the use of drugs that may cause further damage the cells in your ear.
• Change positions slowly if your tinnitus is accompanied by dizziness. Allow your body a chance to adapt to the position change. For some individuals, lying down until the dizzy episode passes may be the best.
• With moderate dizziness, walk slowly and often. Walk with assistance if the dizziness is severe.
• If you have vertigo, your doctor may teach you exercises, called "vestibular exercises" to try to get rid of your dizziness. These exercises involve you sitting down, and changing into different positions. This may cause you to be dizzier at first, while you are performing these exercises, but should help to correct the vertigo. For these exercises, a trained therapist will teach you. You should expect improvement in 2-6 months.
• If you have Meniere's disease, your doctor or healthcare provider may tell you to limit the amount of salt you eat in a day, and prescribe anti-nausea or anti-vertigo medications, along with a medication to help your body rid itself of salt and fluids. The goal is to decrease the pressure of your inner ear, and to control the dizziness, and tinnitus.
• Depending on the cause of tinnitus, it may last a few days to a few months. It also may never fully resolve. It is important to follow all the instructions your healthcare provides.
• Make sure to keep all appointments.
• Do not share your medications with anyone.

Drugs That May Be Prescribed By Your Doctor:

• There are many drugs that can be used to treat dizziness and tinnitus. These may include:
• Antidepressants, such as nortriptyline at bedtime, are often effective in decreasing your symptoms.
• Meclizine (Antivert^®), dimenhydrinate (Dramamine^®), or the scopolamine patch (Transderm-Scop^®) may also be prescribed. These medications may help to decrease the feelings of unsteadiness or imbalance that you may be feeling.
• Prochlorperazine (Compazine^®), and promethazine (Phenergan^®), may work by preventing the feelings of dizziness, or by preventing nausea and vomiting that may cause dizziness.
• These are just some of the most commonly used drugs. Your healthcare provider may prescribe others.

When to Contact Your Doctor or Health Care Provider:

• If you develop any sudden severe ear pain.
• If you have a temperature greater than 100.5 F (38 C).
• If you have nausea that interferes with your ability to eat, or experience vomiting more than 4-5 times in a 24 hour period.
• If you have a sudden loss of vision, or if you lose your hearing.
• If you fall down, or lose consciousness as a result of your dizziness or tinnitus.
• Severe, uncontrolled nausea and vomiting, unrelieved by anti-nausea medications.
• If your symptoms worsen within 3 days of treatment.
• As always, notify your doctor or healthcare provider if you are concerned about any of the symptoms you are experiencing.

Note: We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Additional resources for hearing problems:

Better Hearing Institute

515 King Street, Suite 420

Alexandria, VA 22314

800-EAR-WELL(327-9355)

http://www.betterhearing.org

The National Association of the Deaf

814 Thayer Ave.

Silver Spring, MD 20910-4500

Voice: 301-587-1788

TTY: 301-587-1789

http://www.nad.org

Self Help for Hard of Hearing People

7910 Woodmont Ave., Suite 1200

Bethesda, MD 20814

Voice: 301-657-2248

TTY: 301-657-2249

http://www.shhh.org