Tinnitus is the sound hearing when no external sound is present. Although often described as a ring, it may also sound like a click, hiss or roar. Rarely, voices or unclear music are heard. The sound may be soft or loud, low-pitched or high-pitched and seems to come from one ear or both. Often, this happens gradually. In some people, sound causes depression or anxiety and can interfere with concentration.
Tinnitus is not a disease but a symptom that can result from a number of underlying causes. One of the most common causes is hearing loss caused by noise. Other causes include ear infections, heart or blood vessel disease, MÃÆ' Â © niÃÆ'¨re disease, brain tumor, emotional stress, exposure to certain drugs, previous head injuries, and earwax. More common in those who are depressed.
The diagnosis of tinnitus is usually based on the person's description. A number of questionnaires exist that can help assess how much tinnitus interferes with a person's life. Diagnosis is generally supported by audiogram and neurologic examination. If certain problems are found, medical imaging, such as with MRI, can be done. Another test fits when tinnitus occurs with the same rhythm as the heartbeat. Rarely, a voice can be heard by others using a stethoscope, which in this case is known as objective tinnitus. Spontaneous otoacoustic emission, which is a sound normally produced by the inner ear, can sometimes also cause tinnitus.
Prevention involves avoiding loud noises. If there is an underlying cause, treating it can lead to improvement. If not, usually, management involves talking therapy. Sound generators or hearing aids can help some. In 2013, there is no effective drug. This is common, affecting about 10-15% of people. However, most tolerate it well, and it is a significant problem in just 1-2% of people. The word tinnitus comes from the Latin tinn? Re which means "to ring".
Video Tinnitus
Signs and symptoms
Tinnitus can be felt in one or both ears or in the head. This is a description of the noise inside a person's head without any auditory stimulation. Noise can be explained in many ways. It is usually described as a ringing sound but, in some patients, it takes the form of a high-pitched whine, electric buzz, hissing, humming, tinging or whistling sound or like beating, clicking, roaring, "crickets" or "frog trees" or "grasshoppers (cicadas ) ", a tone, a song, a beep, a hiss, a voice that resembles a human voice or even a steady tone as heard during a hearing test. It has also been described as a "whizzing" sound due to acute muscle spasms, such as wind or waves. Tinnitus may be intermittent or sustained: in the latter case, it can be a cause of great tribulation. In some individuals, the intensity can be altered by the movement of the shoulders, head, tongue, jaw or eye. Most people with tinnitus have some degree of hearing loss.
The perceived sound can range from quiet background noise to audible sounds even through loud external sounds. A special type of tinnitus called pulsatile tinnitus is characterized by hearing sounds from the pulse or muscle contraction of a person, which is usually the result of a sound that has been created by movement of a muscle near one's ear, or blood-related sounds. flow of the neck or face.
Course
Due to variations in the study design, data on tinnitus showed little consistent results. Generally prevalence increases with age in adults, whereas impaired ratings decrease with duration.
Psychological
Persistent tinnitus can cause anxiety and depression. Tinnitus disorder is more closely related to psychological conditions than loudness or frequency range. Psychological problems such as depression, anxiety, sleep disturbances and concentration difficulties often occur in people with severe tinnitus. 45% of people with tinnitus have an anxiety disorder at some point in their lives.
Psychological research has seen the reaction of tinnitus distress (TDR) to explain the severity of tinnitus. These findings suggest that in the early perception of tinnitus, conditioning connects tinnitus with negative emotions, such as fear and anxiety from unpleasant stimuli at the time. It increases activity in the limbic system and autonomic nervous system, thereby increasing awareness and tinnitus disorders.
Maps Tinnitus
Cause
There are two types of tinnitus: subjective tinnitus and objective tinnitus . Tinnitus is usually subjective, meaning no sound can be detected in any other way. Subjective tinnitus is also called tinnitus aurium, "non-auditory" or "non-vibrational" tinnitus. In very rare cases tinnitus can be heard by others using a stethoscope, and rarely - but still rarely - this case can be measured as spontaneous otoacoustic emission (SOAE) in the ear canal. In such cases it is objective tinitus, also called "pseudo-tinnitus tinnitus" or "vibration".
subtitle tinnitus
Subjective tinnitus is the most common type of tinnitus. This can have many possible causes, but the most common is the result of hearing loss. When tinnitus is caused by interference with the inner ear or the auditory nerve, it is called otic (from the Greek word for the ear). These autologous or neurological conditions include those triggered by infection or drugs. A common cause is exposure to noise that damages the hair cells in the inner ear.
When there seems to be no association with an inner ear disorder or auditory nerve, tinnitus is called nonotik (ie not autik). In about 30% of cases of tinnitus, tinnitus is affected by the somatosensory system, for example people can increase or decrease their tinnitus by moving their face, head, or neck. This type is called somatic or craniocervical tinnitus, because only the head or neck movement has an effect.
There is increasing evidence to suggest that some tinnitus is a consequence of neuroplastic changes in central auditory pathways. This change is assumed to be the result of disturbed sensory input, caused by hearing loss. Hearing loss can indeed cause a neuronal homeostatic response in the central hearing system, and therefore leads to tinnitus.
Hearing loss
The most common cause of tinnitus is hearing loss caused by noise. Such loss of hearing may also be present in a hidden form, that is, in people who exhibit normal audiograms.
Hearing loss may have many different causes, but among the tinnitus subjects, the underlying cause is cochlear damage.
Ototoxic drugs can also cause subjective tinnitus, as it may cause hearing loss, or increase damage done by exposure to loud noise. The damage can occur even at doses that are not considered ototoxic. More than 260 drugs have been reported to cause tinnitus as a side effect. In many cases, however, no underlying cause can be identified.
Tinnitus may also occur due to discontinuation of doses of benzodiazepine therapy. Sometimes it can be a protracted symptom of the withdrawal of benzodiazepines and can last for months. Drugs such as bupropion can also cause tinnitus.
Related factors
Factors associated with tinnitus include:
- ear and hearing problems:
- conductive hearing loss
- acoustic surprise
- loud voice or music
- middle ear effusion
- otitis
- otosclerosis
- Eustachian tube dysfunction
- sensorineural hearing loss
- sound overkill or loud
- presbycusis (age-related hearing loss)
- Disease MÃÆ' Â © niÃÆ'¨re
- endolymphatic hydrops
- superior channel dehiscence
- acoustic neuroma
- mercury or lead poisoning
- ototoxic drugs
- conductive hearing loss
- neurological disorders:
- Arnold-Chiari Malformation
- multiple sclerosis
- head injuries
- temporomandibular joint dysfunction
- giant cell arteritis
- metabolic disorders:
- vitamin B deficiency 12
- iron deficiency anemia
- psychiatric disorders
- depression
- anxiety disorder
- other factors:
- vasculitis
- Some psychedelic drugs may produce temporary tinnitus symptoms as side effects
- 5-MeO-DET
- diisopropyltryptamine (DiPT)
- withdrawal of benzodiazepine
- intracranial hyper or hypotension caused by, for example, encephalitis or cerebrospinal fluid leakage
Destination tinnitus
Objective tinnitus can be detected by others and is sometimes caused by an accidental muscle twitch or a muscle group (myoclonus) or by vascular conditions. In some cases, tinnitus is produced by muscle spasms around the middle ear.
Spontaneous otoacoustic emissions (SOAEs), which are high-pitched high tones produced in the inner ear and can be measured in ear canals with sensitive microphones, can also cause tinnitus. About 8% of those with SOAEs and tinnitus have associated SOAE tinnitus, while the percentage of all tinnitus cases caused by SOAEs is estimated at about 4%.
Tinnitus pulsatil
Tinnitus pulsatil may be a symptom of intracranial vascular abnormalities and should be evaluated for irregular blood flow (bruit). Some people experience pulsating sounds in time with their pulse (pulsatile tinnitus, or vascular tinnitus). Pulsatile tinnitus is usually objective, resulting from changes in blood flow, increased blood turbulence near the ear, such as from atherosclerosis or venous hum, but can also arise as a subjective phenomenon of increased awareness of blood flow in the ear. Rarely, pulsatile tinnitus may be a symptom of potentially life-threatening conditions such as carotid artery aneurysm or carotid artery dissection. Tinnitus pulsatil may also indicate vasculitis, or more specifically, giant cell arteritis. Tinnitus pulsatil may also be an indication of idiopathic intracranial hypertension.
Pathophysiology
The mechanism of subjective tinnitus is often unclear. Although it is not surprising that direct trauma to the inner ear can cause tinnitus, other obvious causes (eg, temporomandibular joint dysfunction) are difficult to explain.
This may be due to an increase in nerve activity in the brainstem of hearing, in which the brain processes sound, causing some of the auditory nerve cells to become overzealous. The basis of this theory is that many people with tinnitus also experience hearing loss.
The three reviews of 2016 emphasize the large range and possible combinations of pathologies involved in tinnitus, which in turn produce a variety of symptoms that demand customized therapy.
Diagnosis
Even when tinnitus is a major complaint, audiological evaluation is usually preceded by an ENT examination to diagnose treatable conditions such as middle ear infection, acoustic neuroma, concussion, otosclerosis, etc.
Evaluation of tinnitus will include an auditory test (audiogram), measurement of tinnitus acoustic parameters such as pitch and loudness, and psychological assessment of comorbid conditions such as depression, anxiety, and stress associated with tinnitus severity.
The accepted definition of chronic tinnitus, compared to normal ear-earning experience, is five minutes of ear noise that occurs at least twice a week. However, people with chronic tinnitus often experience more frequent noise than this and can experience it continuously or regularly, as at night when environmental noise is less to cover the sound.
Audiology
Because most people with tinnitus also experience hearing loss, pure hearing tone hearing tests that produce an audiogram can help diagnose the cause, although some people with tinnitus do not experience hearing loss. Audiograms may also facilitate the installation of hearing aids in cases where hearing loss is significant. Tinnitus plates are often in the range of hearing loss.
Psychoacoustics
Tinnitus acoustic qualification will include measurement of some acoustic parameters such as frequency in monotonous tinnitus case or frequency range and bandwidth in case of narrow band tinnitus noise, loudness in dB above the auditory threshold at indicated frequency, mixing point, and minimum masking level. In most cases, pitch tinnitus or frequency range between 5 kHz and 10 kHz, and loudness between 5 and 15 dB above the auditory threshold.
Other relevant parameters of tinnitus are residual inhibition, temporary suppression or loss of tinnitus after a masking period. Residual inhibition rates can show how effective the mask tinnitus is as a treatment modality.
Assessment of hyperacusis, often accompanied by tinnitus, can also be performed. The parameter measured is the Loudness Discomfort Level (LDL) at dB, the subjective level of acute discomfort at a particular frequency over the auditory frequency range. This defines the dynamic range between the auditory threshold at that frequency and the level of loudspeaker discomfort. A compressed dynamic range over a specified frequency range is associated with a submissive hyperacusis. Normal hearing thresholds are generally defined as 0-20 decibels (dB). The normal loudness discomfort level is 85-90 dB, with some authority citing 100 dB. A dynamic range of 55 dB or less is an indication of hyperacusis.
Severity
This condition is often assessed on a scale from "mild" to "disaster" according to the effects it has, such as sleep disorders, quiet activity and normal daily activities. In extreme cases, a man commits suicide after being told that there is no cure.
The assessment of psychological processes associated with tinnitus involves measuring the severity and distress of tinnitus (ie, the nature and extent of tinnitus related problems), measured subjectively with a validated self-report tinnitus questionnaire. This questionnaire measures the level of psychological distress and disability associated with tinnitus, including effects on hearing, lifestyle, health and emotional function. A broader assessment of common functions, such as anxiety levels, depression, stress, life stress and sleeping difficulties, is also important in the assessment of tinnitus because of the higher risk of negative health in this area, which may be affected by or worsen the symptoms of tinnitus for individuals. Overall, current assessment measures aim to identify the degree of interference and individual interference, addressing the response and perception of tinnitus to inform treatment and monitor progress. However, widespread variability, inconsistency and lack of consensus on assessment methodologies are evidenced in the literature, limiting the comparison of treatment effectiveness. Developed to guide the diagnosis or classify severity, most of the tinnitus questionnaires have also proven to be a measure of sensitive treatment outcomes.
Tinnitus pulsatil
If the examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.
Differential diagnosis
Other potential sources of sounds normally associated with tinnitus should be ruled out. For example, two recognized high-pitched sound sources may be common electromagnetic fields in modern cables and various voice signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which the subject has been tested and is found to hear a high-pitched transmission frequency that sounds similar to tinnitus.
Prevention
Too long exposure to loud or noise levels can cause tinnitus. Earplugs or other actions can help with prevention.
Some drugs have an autotoxic effect, and can have cumulative effects that can increase the damage caused by noise. If ototoxic drugs should be given, careful attention by the physician for details of the prescription, such as dose and dose intervals, can reduce the damage that occurs.
Management
If there is an underlying cause, treating it can lead to improvement. Otherwise, the main treatment for tinnitus is speech therapy and sound therapy; there is no effective medicine.
Psychological
The best treatment supported for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) that can be delivered over the internet or directly. This reduces the amount of stress those who feel tinnitus. This benefit does not seem to depend on any effect on an individual's depression or anxiety. Acceptance and therapy commitments (ACT) also show promise in the treatment of tinnitus. Relaxation techniques can also be useful. A clinical protocol called Progressive Tinnitus Management for the treatment of tinnitus has been developed by the United States Department of Veterans Affairs.
Drugs
In 2014 there is no effective cure for idiopathic tinnitus. There is not enough evidence to determine whether antidepressants or acamprosate are useful. Although there is temporary evidence for benzodiazepines, it is not sufficient to support use. Anticonvulsants have not been found helpful. Injections of steroids into the middle ear also appear to be ineffective.
Botulinum toxin injection has been tried with some success in some cases of rare objective tinnitus due to palatal tremor.
More
The use of sound therapy with either a hearing aid or tinnitus mask helps the brain ignore the frequency of specific tinnitus. Although this method is less supported by evidence, there are no negative effects. There is some tentative evidence that supports re-tinnitus therapy. There is little evidence to support the use of transcranial magnetic stimulation. Thus it is not recommended.
Alternative medicine
Ginkgo biloba does not seem to be effective. The American Academy of Otolaryngology recommends not taking melatonin or zinc supplements to relieve symptoms of tinnitus. In addition, Cochrane Review 2016 concluded that the evidence is insufficient to support the use of zinc supplements to reduce symptoms associated with tinnitus.
Prognosis
Although there is no cure, most people with tinnitus get used to it from time to time; for the minority, it remains a significant issue.
Epidemiology
Adult
Tinnitus affects 10-15% of people. About a third of North Americans more than 55 have tinnitus. Tinnitus affects one-third of adults at some point in their lives, whereas ten to fifteen percent are quite disturbed to seek medical evaluation.
Children
Tinnitus is generally regarded as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of tinnitus, although they do not reveal the conditions or effects on their lives. Children generally do not report spontaneous tinnitus and their complaints may not be taken seriously. Among children who complain of tinnitus, there is an increased likelihood of autologous or neurologic pathology such as migraine, juvenile Meniere disease or chronic suppurative otitis media. The reported prevalence varies from 12% to 36% in children with normal hearing threshold and up to 66% in children with hearing loss and about 3-10% of children have been reported to be disturbed by tinnitus.
See also
References
External links
- Tinnitus di Curlie (berdasarkan DMOZ)
- Baguley, David; Andersson, Gerhard; McFerran, Don; McKenna, Laurence (Maret 2013) [2004]. Tinnitus: Pendekatan Multidisiplin (edisi ke-2). Indianapolis, IN: Wiley-Blackwell. ISBN 978-1405199896. LCCNÂ 2012032714. OCLCÂ 712915603.
- Langguth, B; Hajak, G; Kleinjung, T; Cacace, A; MÃÆ'¸ller, AR, eds. (Desember 2007). Tinnitus: patofisiologi dan pengobatan . Kemajuan dalam penelitian otak. 166 (edisi 1). Amsterdam; Boston: Elsevier. ISBN 978-0444531674. LCCNÂ 2012471552. OCLCÂ 648331153. Diarsipkan dari aslinya pada 2007 . Diperoleh 5 November 2012 .
- MÃÆ'¸ller, Aage R; Langguth, Berthold; Ridder, Dirk; et al., eds. (2011). Buku teks Tinnitus . New York, NY: Springer. doi: 10.1007/978-1-60761-145-5. ISBN 978-1607611448. LCCNÂ 2010934377. OCLCÂ 695388693, 771366370, 724696022. Diarsipkan dari yang asli pada 2011 . Diperoleh 5 November 2012 . (perlu berlangganan)
Source of the article : Wikipedia
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