Ringing in the ears • What can be done against tinnitus?

Tinnitus, in medical terms tinnitus aurium, is a collective term for noises in the ear that usually occur without an external sound source. It is derived from the Latin word "tinnire", which means "to sound". In Germany around 25 percent of people have heard ringing in the ears, 13 percent over a longer period of time. According to the German Tinnitus League (DTL), around 1.5 million people in Germany suffer from moderate to unbearable tinnitus. The acute form of tinnitus is more common, but according to information from the DTL, acute tinnitus changes into a chronic form in around 340,000 people every year.

At a glance:

Severity levels of tinnitus

Usually the tinnitus is only perceived by the person affected (subjective tinnitus). Only 0.01 percent of all those affected have objective tinnitus in which the noises can also be heard by a doctor. One speaks of acute tinnitus if the tinnitus has only existed for a maximum of three months. Between three and twelve months, tinnitus is called subacute. If the noises in the ears stay longer than a year, it is chronic tinnitus. In addition, the disease can be classified according to whether there is also hearing loss or not.

Tinnitus is divided into four degrees of severity:

• Grade I.: does not disturb
• Grade II: occurs mainly in silence, it is annoying under stress and psychological stress
• Grade III: constantly disturbs. Emotional and physical damage as well as cognitive disorders also occur. Perception, memory, and learning can be affected. The psyche suffers.
• Grade IV: constantly disturbs, massively impairs the quality of life and leads to occupational disability

Grade I and II are referred to as compensated tinnitus, which means that the noises do not lead to mental disorders. If psychological impairments are the result, one speaks of decompensated tinnitus (grade III and IV).

Symptoms: this is how tinnitus manifests itself

Tinnitus takes different forms. A persistent chirping in the ear is often not noticeable at first. The ringing in the ears can express itself in any pitch and intensity: humming, humming, hissing, roaring, hammering, hissing and much more. In addition, some people experience severe dizziness, nausea and vomiting, hearing loss, sudden hearing loss, pressure in the ear and headache.

The ringing in the ears can occur suddenly and like a seizure, but it can also be creeping. It can be one-sided, stronger in one ear, or affect both ears. The intensity with which the noises occur can generally vary from "barely noticeable" to "extremely loud".

Some sufferers perceive the tinnitus independently of the heart rhythm, while others perceive the tinnitus synchronously, which usually indicates blood vessel-related causes. Clicking or smacking noises often arise when the connection between the ear and throat is opened and are often the result of sticky mucous membranes. So the symptoms of tinnitus sometimes already give clues to the possible cause.

There are many causes of tinnitus

With regard to the causes of tinnitus, the distinction between objective and subjective tinnitus is important – even if the objective tinnitus is relatively rare. In objective tinnitus, the body's own sound sources that are located near the inner ear are perceived. In the case of subjective tinnitus, on the other hand, there is incorrect information processing in the hearing system.

Causes of Subjective Tinnitus

The most diverse causes come into question here, ranging from emotional stress to serious illnesses such as a tumor:

• height Noise pollution

• psychological pressure, stress, grief, fear

• Sudden hearing loss

• orthopedic problems in the temporomandibular joints or the cervical spine

• Inflammation of the outer ear (otitis externa)

• Otitis media

• Inflammation of the inner ear (otitis interna, labyrinthitis)

• Disease of the bone that surrounds the inner ear (otosclerosis)

• Spinning vertigo (Meniere's disease)

• Brain tumor

• Tumor in the ear (acoustic neuroma)

• Cardiovascular diseases like high blood pressure

• Metabolic diseases such as kidney disease or diabetes

• Autoimmune diseases such as rheumatoid arthritis or ulcerative colitis

• Old age hearing loss

• viral or bacterial infections such as Herpes zoster (shingles), Lyme disease or mumps

• certain drugs, including acetylsalicylic acid or Beta blockers

• Luxury and intoxicants such as nicotine, alcohol, cannabis, morphine, heroin

• Earwax and earplug

Causes of Objective Tinnitus

Objective tinnitus, which occurs relatively rarely, has an actual cause as its cause Sound source in the ear or near the ear on the head and neck:

• direct connections between arteries and veins through which blood flows at high speed (arteriovenous fistulas)

• Constrictions of the Carotid arteries with high blood flow rates (carotid stenosis)

• Muscle twitching (myoclonia) of the soft palate or middle ear muscles

• mostly benign tumors in the vein wall (glomus tumors)

• Bulges of arteries within the head (arterial intracranial aneurysm)

• Anemia

• Opening the connection from the ear to the throat (tube opening; process that is important, for example, for pressure equalization underwater)

Finding the cause of tinnitus is not always easy, even for the doctor, because the triggers for the ringing in the ears are so different and widely spread.

Diagnosis: how is tinnitus diagnosed?

If noises in the ears last longer than 24 hours, a doctor should definitely be examined. In the event of ringing in the ears, the ENT doctor is responsible. First, the complaints are discussed in detail (anamnesis). It is important to know how long the tinnitus has existed, whether it can be masked by ambient noise and whether it is harder to hear because of the constant noises in the ear. In addition, questions are asked about underlying diseases such as diabetes or high blood pressure.

This is followed by a physical examination, during which the neck vessels and the ear region are listened to with the stethoscope in order to determine whether an objective tinnitus is present, for example due to a narrowing of the carotid arteries.

Audiogram provides information

The most important test for tinnitus is audiometry, which uses various methods to test certain properties of the hearing. The affected person is played different tones at different volumes.

• Tone audiogram: The hearing thresholds are first determined with the aid of the tone audiogram. It is determined how well individual frequency ranges can be perceived. After the tone audiogram has been created, the pitch and volume of the tinnitus can be determined by playing different comparison tones.

• Impedance measurement: It is used to examine the function of the middle ear. It measures how much resistance the middle ear opposes to the reception of sound waves. The results can be used to identify possible changes in the middle ear.

• Determination of the discomfort threshold: Here the volume from which one perceives sounds as unpleasant is determined. For this purpose, tones with increasing volume are played until the tolerance threshold is reached.

• Speech audiometry: If hearing loss occurs at the same time as the ringing in the ears, speech audiometry can be used to determine hearing ability. Rows of polysyllabic numbers and test words are played with increasing volume.

If these examinations have produced little results, further examinations are recommended. If there are indications of possible physical causes, a computed tomography (CT) scan can show whether the cause of the tinnitus is in the head or whether orthopedic problems in the jaw are causing the noises in the ears.

Therapy of tinnitus

The therapy of tinnitus depends on the cause and form. It is important that the treatment starts as soon as possible after the onset of the ringing in the ears. This increases the chances that the therapy will work well and that the noises in the ears will completely disappear. An infusion that stimulates blood circulation can be used for both acute and chronic tinnitus. Cortisone can be given if the cause is inflammation. If the hearing loss occurs at the same time, the tinnitus can be treated with a hearing aid.

Treatment of Chronic Tinnitus

In the case of chronic tinnitus that lasts longer than a year, the focus is on advising and caring for those affected. Especially with psychologically impairing noises in the ear, it makes sense for those affected to learn how to deal with tinnitus well. Because permanent tinnitus can lead to fears, sleep disorders, fixation on the noises in the ears, depression or even suicidal thoughts. Psychotherapy should definitely be initiated for these or similar psychological complaints.

There are different approaches to treating chronic tinnitus:

• Relaxation procedure such as autogenic training can be helpful in accepting the noises in the ear and living with tinnitus more easily.

• A best practice is that Tinnitus Retraining Therapy (TRT). Those affected are comprehensively informed about the medical connections between the noises in the ears (Tinnitus Counseling) and learn methods that make it easier to deal with tinnitus. These include behavioral measures and acoustic stimulation as part of the Hearing therapy: A device similar to the hearing aid (tinnitus masker) can be used. It emits sounds that are less unpleasant than the tinnitus noises. As part of retraining therapy (retraining means retraining), those affected should use the masker for up to eight hours a day for several months to train the brain so that it perceives the tinnitus as less uncomfortable. The background: With chronic tinnitus, silence makes the ringing in the ears stronger. Those affected report that constant sound in the form of splashing water or a television set to a low level reduce their level of suffering.

• App for the treatment of tinnitus that can be prescribed by a doctor: it combines relaxation techniques, TRT, behavioral therapy and masking.

• Ginkgo biloba leaf preparations are said to have a blood circulation-promoting effect and in this way improve the symptoms of tinnitus, which is caused by circulatory disorders in the inner ear.

Behavioral therapy, stress management or instructions on how to deal with fear correctly are then used. The feeling of being able to let go of an experienced therapist and to put the problem of tinnitus into words is already a great help for many sufferers. A self-help group can also prove helpful. Exchanging experiences with other sufferers and the feeling of not being alone with the tinnitus can help to cope better with the strain caused by the ringing in the ears.

Treatment of acute objective tinnitus

The therapy of acute objective tinnitus also depends on the triggers. Vascular-related causes can be treated microsurgically by the artificial closure of certain vessels (embolization) and by the implantation of stents. Stents are implants that support the tissue of some organs, specifically prevent the growth of certain cells or can also release drugs. In the case of muscle twitching (myoclonia), for example, the tendon of the middle ear muscle can be severed. Soft palate twitches are usually treated with medication.

Tips for dealing with tinnitus

Various measures can make it easier to deal with tinnitus:

• reduce stress: Relaxation techniques such as progressive muscle relaxation according to Jacobsen can help to be able to withstand the tinnitus better and not to be further stressed by the ringing in the ears.

• Develop serenity: Consciously accepting and accepting tinnitus can help to reduce the stress caused by tinnitus and to escape the vicious circle.

• Avoid absolute silence: Since the tinnitus is usually strongest in absolute calmness, it can be helpful in quiet situations such as falling asleep to hear natural sounds such as rain pattering in the background.

Course: tinnitus often disappears completely

An exact prognosis for the course of a tinnitus is difficult. The course depends on the form and how quickly the therapy starts. Ideally, the noises in the ears will disappear after a few days. This applies to the majority of those affected.

Course of chronic tinnitus

The most common problems that arise in the course of chronic tinnitus are sleep disorders such as difficulty falling asleep and staying asleep. Concentration disorders are also part of the psychological effects of ringing in the ears. Tinnitus can lead to depression and in the worst case scenario it can even lead to suicidal thoughts. It is imperative that all therapy options are exhausted here.

Tinnitus: best to prevent

Stress and noise pollution are the two main triggers for tinnitus. In this area, preventive measures can be sensible.

Employees, for example, have a right to noise protection measures in the workplace. In your free time, too, it is important to avoid constant exposure to noise. The volume from headphones should not exceed a normal level. At concerts, it is also advisable not to stand directly next to or under the loudspeakers in order to prevent possible consequences.

The second preventive measure against tinnitus is called: reducing permanent stress. Relaxation techniques such as yoga or autogenic training help here, for example. In general, a healthy lifestyle helps reduce the risk of tinnitus. This includes losing weight, eating a balanced diet and only consuming coffee and alcohol in moderation. You should refrain from smoking if at all possible: Tobacco consumption is the number one vascular toxin, favors deposits and makes the blood vessels inflexible.

Overview of relaxation techniques