Tinnitus
[2] Other causes include ear infections, disease of the heart or blood vessels, Ménière's disease, brain tumors, acoustic neuromas (tumors on the auditory nerves of the ear), migraines, temporomandibular joint disorders, exposure to certain medications, a previous head injury, and earwax.
[3] Occasionally, spontaneous otoacoustic emissions, sounds produced normally by the inner ear, may result in tinnitus.
In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.
[20][21] Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound.
[22][23] Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus.
[24][27][28][29] The research indicates that conditioning at the initial perception of tinnitus linked it with negative emotions, such as fear and anxiety.
[33] Some evidence suggests that long-term exposure to noise pollution from heavy traffic may increase the risk of developing tinnitus.
[14] Children may be subject to pulsatile or continuous tinnitus, involving anomalies and variants of the vascular parts[51] affecting the middle/inner ear structures.
[59] Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits).
[61] Three reviews in 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which result in a great variety of symptoms and specifically adapted therapies.
[62][63][64][65] The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system.
[38] Treatable conditions may include middle ear infection, acoustic neuroma, concussion, and otosclerosis.
[24] Such questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health, and emotional functioning.
[79][80][81] A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors, and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms.
[82] Current assessment measures aim to identify levels of distress and interference, coping responses, and perceptions of tinnitus to inform treatment and monitor progress.
However, wide variability, inconsistencies, and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.
[83] Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.
[84][need quotation to verify] If 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.
Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing.
[39] 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.
[3] A clinical protocol called Progressive Tinnitus Management has been developed by the United States Department of Veterans Affairs.
[108][109] There is some tentative evidence supporting tinnitus retraining therapy, which aims to reduce tinnitus-related neuronal activity.
Its protocol follows the principle of systematic desensitization and involves a structured rehabilitation program lasting 12 months.
Neuromonics therapy employs customized sound signals delivered through a device worn by the patient, which aims to target the specific frequency range associated with their tinnitus perception.
[125] Botulinum toxin injection has succeeded in some of the rare cases of objective tinnitus from a palatal tremor.
[citation needed] In March 2023, the US Food and Drug Administration (FDA) approved Neuromod's Lenire device as a treatment option for tinnitus.
[116][134] The American Academy of Otolaryngology recommends against taking melatonin or zinc supplements to relieve symptoms of tinnitus, and reported that evidence for the efficacy of many dietary supplements (such as lipoflavonoids, garlic, traditional Chinese/Korean herbal medicine, honeybee larvae, and various other vitamins and minerals, as well as homeopathic preparations) did not exist.
[90] A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.
Children with hearing loss have a high incidence of pediatric tinnitus, even though they do not express the condition or its effect on their lives.
[142] Among those who do complain, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease, or chronic suppurative otitis media.
