tinnitus n : a ringing or booming sensation in one or both ears; a symptom of an ear infection or Meniere's disease
- The perception of noise, such as a ringing or beating sound, which has no external source.
perception of nonexistent noise
Tinnitus ( or /ˈtɪnɪtəs/, from the Latin word for "ringing") is the perception of sound in the human ear in the absence of corresponding external sound(s).
Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise, but in some patients it takes the form of a high pitched whining, buzzing, hissing, humming, or whistling sound, or as ticking, clicking, roaring, "crickets" or "tree frogs" or "locusts", tunes, songs, or beeping. It has also been described as a "whooshing" sound, as of wind or waves.
Tinnitus is not itself a disease but a symptom resulting from a range of underlying causes. Tinnitus is the ability to perceive sounds which are always present within the auditory (hearing) system. This is a failure of the compensatory mechanisms that are part of its normal function. This "phantom" sound can create distress in the sufferer. http://www.tinnitus.org Causes include ear infections, foreign objects or wax in the ear, nose allergies that prevent (or induce) fluid drain and cause wax build-up, and injury from loud noises. Tinnitus is also a side-effect of some oral medications, such as aspirin, and may also result from an abnormally low level of serotonin activity.
The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The term "tinnitus" usually refers to more severe cases. Heller and Bergman (1953) conducted a study of 80 tinnitus-free university students placed in an anechoic chamber and found that 93% reported hearing a buzzing, pulsing or whistling sound. Cohort studies have demonstrated that damage to hearing (among other health effects) from unnatural levels of noise exposure is very widespread in industrialized countries. Because tinnitus is often defined as a subjective phenomenon, it is difficult to measure using objective tests, such as by comparison to noise of known frequency and intensity, as in an audiometric test. The condition is often rated clinically on a simple scale from "slight" to "catastrophic" according to the practical difficulties it imposes, such as interference with sleep, quiet activities, or normal daily activities. For research purposes, the more elaborate Tinnitus Handicap Inventory is often used.http://www.medicdirect.co.uk/self_Exam/default.ihtml?step=5&cid=46
Objective tinnitusIn a minority of cases, a clinician can perceive an actual sound (e.g., a bruit) emanating from the patient's ears. This is called objective tinnitus. Objective tinnitus can arise from muscle spasms that cause clicks or crackling around the middle ear. Some people experience a sound that beats in time with the pulse (pulsatile tinnitus). Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear (such as from atherosclerosis or venous hum), but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear. or carotid artery dissection.
Measuring tinnitusThe basis of quantitative measurement of tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient's tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which he or she hears. The tinnitus will always be equal to or less than sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above.) For example: if a patient has a pulsatile paraganglioma in his ear, he will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible, and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.
Objective tinnitus, however, is quite uncommon. Often patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise, that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods.
If a subject is focused on a sample noise, they can often detect it to levels below 5 decibels, which would indicate that their tinnitus would be almost impossible to hear. Conversely, if the same test subject is told to focus only on their tinnitus, they will report hearing the sound even when test noises exceed 70 decibels, making the tinnitus louder than a ringing phone. This quantification method suggests that subjective tinnitus relates only to what the patient is attempting to hear. Patients actively complaining about tinnitus could thus be assumed to be people who have become obsessed with the noise. This is only partially true. The problem is involuntary; generally complaining patients simply cannot override or ignore their tinnitus. The noise is often present in both quiet and noisy environments, and can become quite intrusive to their daily lives.
Subjective tinnitus may not always be correlated with ear malfunction or hearing loss. Even people with near-perfect hearing may still complain of it. Tinnitus may also have a connection to memory problems, anxiety, fatigue or a general state of poor health.
Mechanisms of subjective tinnitusOne of the possible mechanisms relies in the otoacoustic emissions. The inner ear contains thousands of minute hairs which vibrate in response to sound waves and cells which convert neural signals back into acoustical vibrations. The sensing cells are connected with the vibratory cells through a neural feedback loop, whose gain is regulated by the brain. This loop is normally adjusted just below onset of self-oscillation, which gains the ear spectacular sensitivity and selectivity. If something changes, it's easy for the delicate adjustment to cross the barrier of oscillation and tinnitus results. This can actually be measured by a very sensitive microphone outside the ear.
Other possible mechanisms of how things can change in the ear is damage to the receptor cells. Although receptor cells can be regenerated from the adjacent supporting Deiters cells after injury in birds, reptiles, and amphibians, in mammals it is believed that they can be produced only during embryogenesis. Although mammalian Deiters cells reproduce and position themselves appropriately for regeneration, they have not been observed to transdifferentiate into receptor cells except in tissue culture experiments. Therefore, if these hairs become damaged, through prolonged exposure to excessive decibel levels, for instance, then deafness to certain frequencies occurs. In tinnitus, they may falsely relay information at a certain frequency that an externally audible sound is present, when it is not.
The mechanisms of subjective tinnitus are often obscure. While it is not surprising that direct trauma to the inner ear can cause tinnitus, other apparent causes (e.g., temporomandibular joint disorder (TMJ) and dental disorders) are difficult to explain. Recent research has proposed that there are two distinct categories of subjective tinnitus: otic tinnitus, caused by disorders of the inner ear or the acoustic nerve, and somatic tinnitus, caused by disorders outside the ear and nerve but still within the head or neck. It is further hypothesized that somatic tinnitus may be due to "central crosstalk" within the brain, as certain head and neck nerves enter the brain near regions known to be involved in hearing.
While most discussions of tinnitus tend to stress physical mechanisms, there is strong evidence that the level of an individual's awareness of their tinnitus can be stress-related, and so should be addressed by improving the state of the nervous system generally, using gradual, unobtrusive, long-term treatments. http://www.paralumun.com/healthtinn.htm
Charismatic Tinnitus and Meditation-induced TinnitusTinnitus can be caused by various religious activities, such as meditation and contemplation. Within the context of religion numerous sounds have been reported over the history of religion. These sounds are often called the charism of sound or charismatic sound. Charismatic sound is also called clairaudience. Related to this subject is a condition that has been called meditation-induced tinnitus, which occurs among contemplatives.
There are numerous references in religious literature to charismatic sound. Some of these references are in the Bible, but the Yoga Sutras refer to charismatic sound, as well as the Discourses of the Buddha. Many of these references also come from the various mystics, such as Kabir, Rumi and Teresa of Ávila.
- I saw the glory of the God of Israel coming from the east. His voice was like the roar of rushing waters, and the land was radiant with his glory."
- Then shall the trees of the wood sing out at the presence of the LORD...."
- ''There came from heaven a noise like a violent, rushing wind, and it filled the whole house. There appeared tongues as of fire and it sat above each one of them. And they were filled with the Holy Spirit."
The earliest Buddhist literature has numerous references to something called in Pali "Dibba-sota," which is generally translated as "Divine ear." The "Divine ear" is known in the suttas as a fruit or phala. The fruit or phala are the Buddhist and Hindu equivalent of the Christian charism. One of those references is in the Mahàli Sutta (DN 6), which refers to someone who had achieved liberation through two ways, which is called “ubhato-bhága-vimutta” in Pali.
- ''But suppose, Mahâli, he has attained meditative absorption with the double object in view of seeing and hearing, in any one direction, those heavenly sights and those heavenly sounds. Then since he has attained meditative absorption with the double object in view, he both sees the sights and hears the sounds. And why so? Because of the nature of his meditative absorption.'Mahàli Sutta (DN 6)
The Yoga sutras also refer to charismatic sound and indicate that the sounds are an indicator of success with meditation.
- ''A contemplative’s mastery can extend to the infinite or the infinitesimal. Through becoming saturated in meditative absorption (samadhi) the habits of the mind, perceiver, perceiving and perception, dwindle until transparent as a jewel. Meditative absorption (samâpattiï) that is combined with sounds (åabda), forms (artha) and concepts (jõâna) is a conceptual meditative absorption with (sa) applied attention (vitarka) (savitarka samadhi) (upon objects).” Patanjali’s Yoga Sutras (1.40-1.51)
Some Christian mystics described various charismatic sounds. One of the best descriptions of charismatic sound comes from St. Teresa of Ávila in her book The Interior Castle.
- ''As I write this, by the way, I can’t help but wonder what’s going on inside my own head. Those noises I told you about in the beginning are getting so loud that it’s almost impossible for me to obey the order to write this. It sounds like there are a multitude of rushing rivers inside my head, their waters cascading downward, surrounded by many little birds and other whistling sounds. This is all unfolding not in the ears but the upper part of the head, where they say the higher part of the soul resides. I have spent long periods in these regions. The spirit seems to push its way upward with great power and speed…all of this turmoil doe not hinder my prayer or interfere with what I am trying to say. Instead, my soul is whole within its quietude, its love, its longing, and its clarity of consciousness."
The Sufi Mystics of Islam also described various charismatic sounds. Jalal ad-Din Muhammad Balkhi-Rumi and Kabir are the most significant references to charismatic sounds within Islam.
- ''A million suns come forward with light, When I sit firmly in this world. I hear bells ringing that no one has shaken, Inside "love" there is more joy than we know of, Rain pours down although the sky is clear of clouds, There are whole rivers of light. The universe is shot through in all its parts by a single sort of love." -Mevlana Rumi, Sufi Master
- ''Listen! The sound of big conch seashells. The sound of bells. Kabir says: Friend, listen, this is what I have to say: The guest I love is inside me."
These religious references suggest that at least some of the subjects who report tinnitus as well as the mysterious HUM might just be experiencing clairaudience, charismatic sound, or meditation-induced tinnitus.
PreventionTinnitus and hearing loss can be permanent conditions, thus, precautionary measures are advisable. If a ringing in the ears is audible after exposure to a loud environment, such as a rock concert or a work place, it means that damage has been done. Prolonged exposure to noise levels as low as 70 dB can result in damage to hearing (see noise health effects). For musicians and DJs, special musicians' earplugs can lower the volume of the music without distorting the sound and can prevent tinnitus from developing in later years.
It is also important to check medications for potential ototoxicity. Ototoxicity can be cumulative between medications, or can greatly increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.
Causes of subjective tinnitusTinnitus can have many different causes, but most commonly results from otologic disorders – the same conditions that cause hearing loss. The most common cause is noise-induced hearing loss, resulting from exposure to excessive or loud noises. But tinnitus, along with sudden onset hearing loss, may have no obvious external cause. Ototoxic drugs can cause tinnitus either secondary to hearing loss or without hearing loss, and may increase the damage done by exposure to loud noise, even at doses that are not in themselves ototoxic.
Causes of tinnitus include:
- Otologic problems
- conductive hearing loss
- excessive or loud noise
- presbycusis (age-associated hearing loss)
- Ménière's disease
- acoustic neuroma
- mercury or lead poisoning
- chemotherapy and antiviral drugs:
- loop diuretics:
- Psychedelic drugs:
- neurologic disorders:
TreatmentThere are many treatments for tinnitus that have been claimed, with varying degrees of statistical reliability:
- Drugs and nutrients
- Ginkgo Biloba: Many European doctors and a growing number of doctors in the United States use the herb Ginkgo Biloba
- Lidocaine, injection into the inner ear found to suppress the tinnitus for 20 minutes, according to a Swedish study.
- Benzodiazepines (xanax, ativan, klonopin)
- Avoidance of caffeine, nicotine, salt
- The consumption of alcohol has been found to both increase and decrease the severity of tinnitus. Therefore, alcohol's effect on the severity of tinnitus is dependent on the causes of the individual's affliction and cannot be considered a treament.
- Etidronate or sodium fluoride (otosclerosis)
- Lignocaine or anticonvulsants (usually in patients responsive to white noise masking)
- Melatonin (especially for those with sleep disturbance)
- Vitamin combinations (Lipoflavonoid)
- Electrical stimulation
- Transcranial magnetic stimulation or transcranial direct current stimulation
- Transcutaneous electrical nerve stimulation
- Direct stimulation of auditory cortex by implanted electrodes
- Berthold Langguth, German neurologist would apply an electric or magnetic current for stimulation over the head of the patient to reduce ringing sound. Dirk De Ridder, Belgian neurosurgeon implanted electrodes to the brain of sufferers to normalise overactive neurons. Cambridge scientists also found that lidocaine, an anaesthetic reduces the sound in 2/3 of patients for 5 minutes, but it needs another drug to suppress its dangerous effects.
- Repair of perilymph fistula
- External sound
- The Neuromonics Tinnitus Treatment, introduced first in Australia now in the US. FDA Cleared treatment for tinnitus.
- Low-pitched sound treatment has shown some positive, encouraging results.(UC, Irvine press release)
- Tinnitus masking (white noise, or better 'shaped' or filtered noise
- Tinnitus retraining therapy
- Auditive stimulation therapy (music therapy)
- Compensation for lost frequencies by use of a hearing aid.
- Ultrasonic bone-conduction external acoustic stimulation
- Avoidance of outside noise (exogenous tinnitus)
- Cognitive behavior therapy
- Photobiomodulation (a.k.a. Low Level Laser Therapy); efficacy is debated
Although there are no specific cures for tinnitus, anything that brings the person out of the "fight or flight" stress response helps symptoms recede over a period of time. Calming body-based therapies, counseling and psychotherapy help restore well-being, which in turn allows tinnitus to settle. Chronic tinnitus can be quite stressful psychologically, as it distracts the affected individual from mental tasks and interferes with sleep, particularly when there is no external sound. Additional steps in reducing the impact of tinnitus on adverse health consequences include: a review of medications that may have tinnitus as a side effect; a physical exam to reveal possible underlying health conditions that may aggravate tinnitus; receiving adequate rest each day; and seeking a physician's advice concerning a sleep aid to allow for a better sleep pattern.
Notable individuals with tinnitus
Notable sufferers of tinnitus include:
- ''Tinnitus a Multidisciplinary Approach" Gehard Anderson, David Baguley, Laurence McKenna, Don McFerran.(ISBN 1861564031)Wiley Chichester, 2005
tinnitus in Breton: Droug an divskouarn
tinnitus in Bulgarian: Тинитус
tinnitus in Danish: Tinnitus
tinnitus in German: Tinnitus
tinnitus in Spanish: Acúfeno
tinnitus in Esperanto: Tinito
tinnitus in French: Acouphène
tinnitus in Croatian: Tinitus
tinnitus in Italian: Acufene
tinnitus in Hebrew: טיניטוס
tinnitus in Luxembourgish: Tinnitus
tinnitus in Dutch: Tinnitus
tinnitus in Japanese: 耳鳴り
tinnitus in Norwegian: Tinnitus
tinnitus in Norwegian Nynorsk: Tinnitus
tinnitus in Polish: Szumy uszne
tinnitus in Portuguese: Zumbido
tinnitus in Russian: Тиннитус
tinnitus in Finnish: Tinnitus
tinnitus in Swedish: Tinnitus
tinnitus in Chinese: 耳鸣