What is tinnitus?
Tinnitus is "noise" heard in the ear or ears when there is no noise in the room.  This is a complaint of some 40 million Americans, and it is a common source of frustration to both patients and doctors.  The sensation of tinnitus may differ from patient to patient.  Some common sensations include ringing, whistling, whooshing, roaring, static electricity, or chirping.  Occasionally, patients may experience a pulsing or humming sound. 

What causes tinnitus?
Tinnitus almost always results from damage to, or degeneration of the inner ear or hearing nerve.  This is almost always accompanied by some degree of hearing loss.  However, an occasional tinnitus sufferer will have a normal hearing test.  This likely represents our inability to detect subtle inner ear disorders with standard testing.  While the damaged inner ear generates the neural signal of tinnitus, the brain receives and interprets the message, and it is the brain's perception of tinnitus that causes distress. 

Rarely a patient will suffer terribly from tinnitus, while most barely notice the tinnitus after a period of time.  The difference in these two patients lies not in the ear where the tinnitus signal originates, but in the way the brain interprets it.  Thus, any treatment designed to aid tinnitus sufferers must address the brain's role in this problem.  In fact, we know that tinnitus actually worsened in 50% of patients who had their ear destroyed. 

Do I need any medical investigations if I have tinnitus?
An appropriate evaluation for tinnitus includes the following.  A history and examination designed to evaluate the nature of the tinnitus, the degree of distress the tinnitus is causing, any associated symptoms, and any factors that may aggravate symptoms (such as medications).  An Audiogram (hearing test) to identify any hearing deficits.  Further evaluations (e.g. an MRI) may be necessary in certain cases.  Features which are of concern include tinnitus which is heard in one ear only, and tinnitus which is a pulsating sound. 

My doctor said there is nothing that can be done for tinnitus.
This answer proves to be frustrating to both the patient and to doctors who treat hearing disorders.  While there is no "magic bullet" cure-all for tinnitus, there are certainly good treatments available for this disorder. 

How do I know what treatment is right for me?
There are a variety of legitimate treatments available for tinnitus sufferers.  Beware of claims that one particular treatment offers significant success for the treatment of tinnitus.  Patients should seek help in a center that offers a comprehensive approach to tinnitus treatment and offers patients a variety of treatment options.  Choice of a particular treatment (or treatments) should be based on the level of hearing loss experienced by the patient and the degree of distress that the tinnitus causes the patient. 

What are my treatment options?
Modification of Diet and Medications may be helpful.  Diminishing components of the diet that have stimulant effects (e.g. coffee) may improve tinnitus.  Certain medications are known to cause or worsen tinnitus (e.g. aspirin).  After consultation with your physician, it may be prudent to modify these medications. 

Alterations in environment may be helpful.  All patients with tinnitus note it is worse in the quiet environments.  This may be particularly troublesome when trying to fall asleep.  Patients often find that keeping a radio tuned between stations (to produce a static-type noise) or playing soothing tapes of environmental sounds (e.g. the ocean) distracts the brain from the tinnitus. 

Medications may be prescribed.  Despite certain claims, careful evaluation of the scientific data indicates that medications are only partially successful in treating tinnitus.  Drugs designed to suppress anxiety (such as Xanax, Valium, Ativan) may be of benefit in patients who have significant anxiety or insomnia associated with tinnitus.  Similarly, anti-depressant medications may help in patients with tinnitus and associated depression.  We counsel careful use of these medications and use them only in patients with the appropriate symptoms. 

Hearing Aids and Tinnitus Maskers may be helpful.  In patients with substantial hearing loss, a hearing aid can be one of the most effective devices at diminishing tinnitus.  Tinnitus masking devices, look like a hearing aid but produce a sound that distracts the brain from the tinnitus.  We are very excited about the advances that have been made in this area, and hope that these newer devices will make a significant difference in the treatment of tinnitus. 
 

All patients with tinnitus are encouraged to join the non-profit American Tinnitus Association (PO Box 5, Portland Oregon, 97207-0005, 503-248-9985). This wonderful organization provides tinnitus sufferers with all the latest information concerning this disorder.