Tinnitus: causes, treatment
Content:
- The mechanism of development of tinnitus
- Causes of tinnitus
- What could be tinnitus?
- Variants of tinnitus
- Diagnosis for tinnitus
- Tinnitus treatment
Tinnitus is the subjective perception of ears of sounds that are objectively absent, that is, there are no external auditory stimuli. Noises of different nature can be in one or both ears, often there is a feeling that it makes noise in the head.
Tinnitus (tinnīre) is a medical term for tingling or tinnitus. A person describes a similar subjective sensation in the form of ringing, buzzing, hum, or other sounds perceived by the ear in the absence of auditory stimuli from outside. Often the occurrence of tinnitus is accompanied by varying degrees of hearing loss. The intensity of the noise in different time intervals can vary from a weak barely noticeable ringing to a strong hum. In elderly people, due to age-related aging of the body, the development of pathologies of the hearing system, joining of vascular diseases, tinnitus usually increases from year to year, making it difficult to perceive real surrounding sounds.
Tinnitus is not an isolated disease, it is only a manifestation of ill-being in the body, requiring careful diagnosis and treatment. Tinnitus means not only ringing in the ears, but also a complex of problems associated with it. Chronic tinnitus is diagnosed in 5–10% of the world's population, most of which are elderly.
The mechanism of development of tinnitus
The inner ear consists of auditory cells with hairs that help transform sound into electrical impulses, which then enter the brain. In normal movement of these hairs correspond to the vibrations of sound. The emergence of chaotic movement contribute to various factors leading to their irritation or damage. As a result, a mixture of various electrical signals is formed, perceived by the brain as constant noise.
Causes of tinnitus
The etiological factors leading to the occurrence of tinnitus are many: the direct pathology of the organs of hearing, the intake of certain drugs, common diseases, aging of the body, etc.
Pathology of the outer ear :
- foreign body in the ear;
- otitis externa;
- sulfur plug.
Middle ear pathologies:
- tumor formation, trauma or other damage to the eardrum, for example, listening to headphones through loud music or prolonged exposure to the ears of sounds from a working tractor or chainsaw;
- exudative otitis media;
- otosclerosis.
Pathology of the inner ear :
- sensorineural hearing loss;
- Meniere's disease;
- auditory nerve tumor;
- complications of SARS, flu;
- neuritis of the auditory nerve;
- ototoxic effect of drugs or other substances:
- antibiotics-aminoglycosides - amikacin, gentamicin, kanamycin;
- macrolides - azithromycin;
- drugs acting on the central nervous system - haloperidol, caffeine, aminophylline;
- nonsteroidal anti-inflammatory drugs - diclofenac, indomethacin;
- loop diuretics - furosemide, uregite and others;
- cardiovascular drugs - digitalis;
- organic solvents - benzene, methyl alcohol.
- labyrinthitis;
- presbyacus - senile hearing loss due to age-related changes in the auditory cells.
Systemic diseases accompanied by tinnitus:
- metabolic diseases - diabetes, thyrotoxicosis, thyroiditis, hypoglycemia;
- malignant and benign tumor processes - acoustic neuroma, tumor of the eardrum or brain stem, meningioma;
- vascular atherosclerosis;
- hypertension;
- osteochondrosis developing in the cervical spine;
- stenosis of the jugular veins or carotid arteries.
Other reasons :
- industrial poisoning ;
- hepatitis;
- fluid entering the ear;
- perilymph fistula;
- stress;
- head injuries.
What could be tinnitus?
Types of noise:
- Objective In addition to the patient, such a noise is heard by the doctor. This type is rare in practice.
- Subjective . Different nature of the noise is heard only by the patient.
- Vibrating . Sounds reproduced by the organ of hearing itself or the structures surrounding it. It is these mechanical noises that the patient and the doctor can hear.
- Non-vibration . Different sounds are heard only by the patient. They arise from the pathological excitation or irritation of the nerve endings of the auditory pathways, the inner ear.
Gradation of non-vibration noise:
- central - noises are felt in the center of the head;
- peripheral - the sound is heard in one of some kind of ear.
- Standing It is observed after surgery for the intersection of the pre-cochlear nerve or in patients with severe atherosclerosis.
- Periodic . Occurs during inflammatory lesions of the ears.
- One sided . Only heard in one ear.
- Bilateral . Heard in both ears.
Variants of tinnitus
According to statistics, about 15–30% of the world's population periodically feel ringing or tinnitus, 20% of them characterize it as loud. Tinnitus is diagnosed with the same frequency in both women and men from 40 to 80 years. However, pronounced noise with hearing loss is more characteristic of men, who by virtue of their profession are more often found among strong industrial and industrial noises.
Different people have different noise. Some are worried about the monotonous hiss, someone whistling, tapping, ringing, buzzing or humming. Tinnitus is often accompanied by partial hearing loss, headaches (cephalalgia), sleep disturbance. Noise may be accompanied by low-grade fever, auricle discharge, nausea, dizziness, pain, swelling and a feeling of bursting inside the ear. The intensity of the sounds is different: from a weak ring to a strong hum or roar. Often the patient, describing the nature of the noise, says that it resembles the noise of a waterfall or a passing vehicle.
Most people are forced to get used to their pathological condition, but the strong noise in many people leads to insomnia, irritability, inability to concentrate on work or everyday household chores. Some complain that the loud constant hum prevents them from hearing the rest of the surrounding sounds and speech. In fact, this hum is not so loud, but they do not hear well due to the weakening of hearing associated with tinnitus.
Diagnosis for tinnitus
Certain diagnostic difficulties arise due to the multifactorial nature of the pathology, and also due to the fact that the subjective non-vibration ringing is difficult to determine with objective diagnostic methods. In the event of noise, its amplification and increase in the duration or hearing loss, it is necessary to visit an otolaryngologist. To clarify the cause and eliminate it, consultations of other narrow specialists - vascular surgeon, cardiologist, neuropathologist, psychiatrist, endocrinologist are not excluded.
First, the ENT doctor conducts a physical examination. Clarifies the nature, intensity, duration of noise. Finds out whether there are chronic diseases of the endocrine, cardiovascular and nervous systems. Visual otolaryngological examination allows to assess the condition of the auricles, to see the external manifestations of the inflammatory process or injury. Then, based on the alleged cause of the noise, a series of studies is appointed.
Non-invasive instrumental diagnostic methods:
- Tone threshold audiometry - a technique for checking the severity of hearing with the aid of a device - an audiometer. The device emits tones of different frequency and intensity that the patient hears through the headphones, after capturing the sound, he presses a button. Based on the data obtained, an audiogram is compiled, according to which the doctor assesses the level of hearing.
- Weber's test is a study of the acuity of hearing using a tuning fork, which is set in the middle of the forehead or in the parietal area. If the subject hears better the sounds on the side of the patient's ear, the reason for the deafness in the sound conduction (unilateral conductive hearing loss), if on the healthy side, the inner ear is affected (unilateral sensorineural hearing loss).
- X-ray skull. With a head injury.
- Radiography of the spinal column (cervical). When osteochondrosis.
- Dopplerography of cerebral vessels . With atherosclerosis and ischemia.
- Rheoencephalography of brain vessels . In ischemic lesions.
- X-ray (planar) pyramid of the temporal bone . If you suspect a retrocochlear formation.
- Politomografiya: MRI or CT . With the proposed tumor process.
- CT of the skull with contrast . If you suspect a tumor of the inner ear.
Laboratory diagnostic methods:
- Thyroid hormone analysis .
- Clinical analysis of blood .
- "Biochemistry" of blood with the determination of lipid levels .
- Serological studies for syphilis .
Tinnitus treatment
The main thing in treatment is to minimize the effects on the body or, if possible, to completely eliminate the cause that led to tinnitus. The main disease is being treated. In osteochondrosis, non-narcotic analgesics, catadolone, are prescribed to control pain syndrome. Mandatory nonsteroidal anti-inflammatory - meloxicam, nemulid. Muscle relaxants help relieve muscle tension - sirdalut, mydocalm. Sometimes anticonvulsant drugs are shown - carbamazepine, gabapentin.
If a sulfur plug is the etiological factor, then it is successfully eliminated during the washing of the auditory canal with saline or furacilin, given through a syringe from Janet. Combined therapy of cerebral vascular disease consists of nootropes - Cortexin, Cerebramine, Cerebrolysin; drugs that improve the metabolism and blood circulation of the brain - Cavinton, cinnarizine, betaserk, xanthineol nicotinate and others.
The appearance of tinnitus and a slight decrease in hearing, arising from the use of drugs that adversely affect hearing, are the basis for the abolition of these drugs. They are replaced by others that do not cause tinnitus. In most cases, problems disappear after this, it is rarely possible to return the normal acuity of hearing.
In the treatment of tinnitus prescribed tricyclic antidepressants, for example amitriptyline. Drug therapy is complemented by physiotherapy. In relation to etiology, endaural electrophoresis, hardware treatment, laser and magnetic therapy, pneumomassage of the eardrum are prescribed. Effective acupuncture, reflexology or electrical stimulation.
When noise or other types of injuries of the eardrum or age-related changes in the structures of the ear decrease hearing is irreversible. A person has only to adapt to the problem. In such cases, a hearing aid is recommended by a doctor. A hearing aid is being picked up or a cochlear implant is installed with a more pronounced degree of hearing loss.