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Management of tinnitus (ringing in the ears)

There is no cure and no specific treatment is efficacious for noise/ringing in the ears/head; however person can opt from many options available. In some cases it can be quieted with treatment of underlying cause, thus thorough otologic evaluation and investigation is to be done. In majority of sufferers there is no serious pathology and reassurance is all what is needed.

Most important aspect is patient education regarding nature and prognosis of condition, and general preventive measures.

Medicines-

There is no specific drug designed specifically for tinnitus. There is no active research going on because of high cost and high rate of failure involved in creating a new drug.

Anxiolytics, Carbamazepine, Lidocaine, and intravenous Barbiturates show encouraging results but potentially serious side effects limit usefulness. Relatively low doses may bee effective in tinnitus management.

Patient and clinician together determine right drug considering side effects if it is worth.



Tinnitus Retraining Therapy-

Person can be habituated to sound in the environment, so aim is to train the brain to adapt to sound.

TRT has 2 elements- Direct counseling and sound therapy

Sound therapy: –

Sound therapy is to be combined with other therapies like counseling to improve effectiveness.

Tinnitus is more noticeable and disturbing when environment is quiet. Person with tinnitus thinks that sound is because of or can cause some serious damage to brain or inner ear. This negative emotional response from our subconscious brain (limbic system) travels to conscious brain-cortex, so person reacts.

In sound therapy instead of treating patient surrounding sound is manipulated so that it becomes less noticeable, here are many ways to achieve the goal such as: –

  1. Table top devices-environmental sound machine, water fountain, clocks, fan, radio
  2. CD based system
  3. Hearing aids
  4. Masker
  5. Combination of hearing aid and masker

6.  Cochlear implant/electric stimulation-

Table top devices;

Devices kept on side of bed such as ticking clock, adjusting radio in between two stations, or fan, may divert attention and make tinnitus less noticeable.

Hearing aids;

If a patient has a hearing loss in the frequency range of the tinnitus, hearing aids may be helpful in covering the tinnitus.

Masker;

The use of masking in the treatment of the tinnitus has mixed success, Patient’s perception of the pitch and loudness and the overall intensity of the masking signal should be well understood.

Tinnitus maskers introduce an external pleasant masking sound into affected ear , thereby minimizing or eliminating the perception of the tinnitus.

Cochlear implant;

Cochlear implant may mask tinnitus by ambient sound or may suppress tinnitus by the electrical stimulation sent through the auditory nerve. Some forms of electrical stimulation to the ear can stop tinnitus briefly.
Counseling: –

Effective counseling is most critical aspect of tinnitus management. Tinnitus sufferers are anxious and frightened by the presence of tinnitus and need a careful and clear explanation of the nature of the disorder.

It can be quite disturbing leading to sleep deprivation, depression & decreased work efficiency. Most important aspect of tinnitus is distress, irritation and distraction caused by the noise. Person often feels that such noise is a symptom of brain tumor or stroke. Reassurance should be given by E.N.T. specialist, neurologist and audiologist.

Biofeedback:–

Distress caused by tinnitus is in correlation to degree of attention paid to tinnitus and shifting attention of person to a different signal is bio feedback. It is relaxation technique that teaches to improve coping ability and has 70-90% success rate.

Tinnitus patients have high levels of anxiety, tension, or other symptoms of chronic stress. Biofeedback is quite effective relaxation technique; it teaches person to control certain autonomic body functions such as pulse, muscle tension and skin temperature. Goal is to help person manage stress not by reducing stress but by changing the body reaction to it.

Controversies exist about role of alternate therapies: —

Research results have not conclusively identified these treatments as helpful for tinnitus.

Hypnotherapy

Control of inhalational and food allergy

Bio feedback

Zinc, magnesium and vit-B12

Herbal ginkgo biloba have mixed result

Homeopathic remedies

Acupuncture

Hyperbaric O2

Music- music is soothing to soul, relieves pain and anxiety, and promotes relaxation and positive impulse to limbic system.

But it emphasizes the low frequencies and has little power in high frequency.

Tinnitus patient mostly has less hearing in high frequency and hear better at lower frequency. To correct this mismatch neuromonics are created (creator Dr Paul Davis and Peter Hankey, Australia). Modified music is delivered through high fidelity ear phones that match hearing and tinnitus level.

Research: —

*Research is going on for drugs Acamprosate, Vestipitant+Piroxitine, Neramaxane

*Trans Cranial Magnetic Stimulation-  SHAM stimulation-safe and effective.

*Chronic electrical stimulation of auditory cortex- Rehabilitation by specially trained clinician -daily acoustic neural stimulus customized to audiometric profile is presented to desensitize. Approximately 90% success rate is observed in selected patients with improved life

*Transtympanic perfusion inner ear:

Genta- in menieres disease with intractable vertigo.  Successful and less invasive than surgical procedures such as vestibular nerve section or labirynthectomy.

Dexa- in cochlear meneires may improve hearing, tinnitus, pressure feeling.

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