Tinnitus: Causes, Relief and Treatment
Tinnitus by definition is “the perception of sound that results exclusively from activity within the nervous system without any corresponding mechanical, vibratory activity within the cochlea, and not related to external stimulation of any kind” (Jastreboff, 1995).
In any given year tinnitus lasting more than five minutes is heard by 10% of the United States. Tinnitus in and of itself is not the issue; it is when the symptoms move from a non-bothersome level to a bothersome level and begin to influence the quality of life. Bothersome tinnitus can affect concentration, sleep patterns, daily enjoyment of life that can lead to some level of anxiety, depression and extreme life changes.
It is important to know that tinnitus is not a disease or a cause of hearing loss; tinnitus is a symptom of changes within the auditory pathways. These changes can originate from the cochlea to auditory cortex in the brain. Because tinnitus is a symptom rather than a cause there is no actual cure for tinnitus but there are proven ways to change the effects of tinnitus from bothersome to non-bothersome.
GUIDELINES FOR ACTION RELATED TO TINNITUS EVALUATION AND MANAGEMENT
Recently the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) developed a summary of guideline action statements related to the diagnosis and treatment of tinnitus. These guidelines were developed by a multidisciplinary team of otolaryngologists, audiologists, other healthcare professionals and consumer advocates. In summary the guidelines recommend seeking a professional or professionals to provide a history and physical exam, prompt Audiologic exam, identification of persistent bothersome vs. non-bothersome tinnitus. Dependent on findings education and counseling, hearing aids and cognitive behavior therapy may be recommended. In addition to those recommendations routine audiometric evaluations to rule out a progressive hearing loss and use of sound therapy may be indicated as well.
Within the guideline there are recommendations against imaging studies without symptoms of unilateral tinnitus, pulsating tinnitus, asymmetric hearing loss or focalized neurological abnormalities. It is further not recommended to seek medical prescription therapy for anti-depressants or anti-convulsive type medical therapy. Dietary or herbal supplements are not recommended and have not been proven to help in any peer reviewed study and are not monitored by the FDA for accuracy of claims beyond anecdotal. One of the newer therapies that have been developed is transcranial magnetic stimulation but is not recommended by the guidelines developed by this multidisciplinary team. Acupuncture had no recommendation for or against.