Tinnitus is often described as ringing in the ears

The term tinnitus is from the Latin word tinnire which means "to ring". However, the sounds may take many forms, like humming, hissing, whistling, roaring or clicking.

Although tinnitus is common and may not pose a problem for most, some find tinnitus debilitating and many seek medical attention. Frequently, tinnitus is associated with age associated hearing loss and thought to be caused by damage to the inner ear structures and hair cells, especially if the person has been exposed to loud noises. Without associated hearing loss, tinnitus is thought to be located in the brain (central cause). A hearing test (audiogram) can help determine if there is associated hearing loss or if the tinnitus may be centrally located.

A medical exam is important to determine if there are any conditions that may be causing tinnitus. High blood pressure, vascular conditions, thyroid problems and tumors may cause tinnitus along with a number of medications, including common pain relievers. Most often, no definitive cause is found.

A study in Cases Journal. 2009 Sep 15;2:9237, found a genetic susceptibility to aspartame toxicity suggesting cessation of its use may prove helpful for some. It has also been recommended that one should give up caffeinated beverages like coffee, tea, soda and foods like chocolate to see if tinnitus symptoms are relieved.

Masking the noise is a common approach to lessen the tinnitus. Many people are only bothered by tinnitus when it is quiet like before sleeping. Masking involves using the noise from a fan, humidifier, turning between radio stations and using the noise that is produced or using music or other soothing sounds through headphones or earphones.

People with hearing loss may find a hearing aid helps reduce tinnitus. Additionally, masking can be incorporated into the hearing aid itself. By boosting lower frequencies in the hearing aid, those with high frequency hearing loss may find relief from tinnitus.

The Journal of Psychosomatic Research. 2010 Mar;68(3):245-51, found that a self-help book, without therapist assistance, may help in alleviating distress associated with tinnitus and can provide inexpensive treatment that is not bound by time or place. They call this bibliotherapy, which is book therapy. The book they used is Tinnitus: A Self-Management Guide for the Ringing in Your Ears and the link will take you to the American Tinnitus Association bookstore where the book can be purchased.

The journal PLoS ONE. 2009;4(3):e5026, suggests that some tinnitus sufferers may have a hypersensitivity to electromagnetic fields. Reduction of cell phone use may provide relief in some of these people along with cognitive behavioral therapy.

Tinnitus Retraining Therapy (TRT) uses a combination of ear devices that emit low volume sounds and counseling. This type of therapy may be expensive and take a couple of years as the brain is trained to turn tinnitus into background noise.

People who suffer from tinnitus are likely to experience depression, anxiety or sleep disorders. Regardless of cause and effect, these symptoms should be addressed. It has been shown that cognitive behavioral therapy (CBT) can help with tinnitus. This therapy focuses on the emotional response to tinnitus and attempts to break patterns of thinking and behavior that contribute to anxiety and depression. The Cochrane Database of Systematic Reviews 2010 Issue 2 concluded, "We did not find a significant difference in the subjective loudness of tinnitus, or in the associated depression. However we found a significant improvement in the quality of life (decrease of global tinnitus severity) of the participants, thus suggesting that cognitive behavioural therapy has an effect on the qualitative aspects of tinnitus and contributes positively to the management of tinnitus."

Neck problems may be related to tinnitus. Neck strain, whiplash and degenerative changes in the cervical spine may predispose one to, aggravate possibly cause tinnitus. A few days wearing a soft neck brace may confirm the relationship. Proper ergonomics, especially sitting at a computer, is good advice along with neck exercises, stretches and proper breathing techniques to relieve strain on cervical muscles. Chiropractic evaluation may be helpful, especially the upper cervical segments, however, forceful adjusting should be avoided and I often recommend a low force technique called NUCCA and you can find out more about this through the National Upper Cervical Chiropractic Association.

A study in the International Tinnitus Journal. 2000;6(2):130-3. states "Tinnitus very often is caused by instability of the craniocervical junction. It very frequently manifests as a high-pitched whistle that disappears after operative correction and stabilization of the articular geometry. Prolapsed intervertebral disks, discoligamentous injury, and even metastases as low as level C3 can cause tinnitus, which also usually disappears after surgery."

When there is a problem with the neck, it can cause problems for the nerves and muscles situated by the ears. If you also have stress related to neck problems then it can often make tinnitus worse. Arthritis in the neck may cause the blood supply of the inner ear to be constricted and that could cause tinnitus. Some have suggested taking Ginko herb for this.

In the journal HNO. 2006 Feb;54(2):125-31. Functional disturbances of the cervical spine in tinnitus, "Results of the statistical analysis show that patients with tinnitus have characteristic and specific patterns of abnormalities in the joints and paravertebral muscles. The dominant finding is an overall impairment of cervical spine mobility, to which various factors contribute. These include disturbed function of segmental joints of the head and the cervicothoracic junction as well as muscular imbalances of the shoulder and neck muscles."

Thus, tinnitus may be related to or have an association with neck problems. Although adjustments did not help my tinnitus, it is reasonable to take easy to implement measures such as detailed at Neck Solutions or seek professional help as a secondary approach. The first approach should be medical. In practice, I have not seen a patient consult for tinnitus, nor have I had a response to any co-existing tinnitus condition.

Often related to neck problems, temporomandibular disorders may affect tinnitus and one should avoid clenching and grinding of teeth and use jaw and neck relaxing exercises. A dental appointment can assess the need for proper bite and/or a bite plate fitting to wear at night.

For the affective component of tinnitus related to stress, anxiety and depression, patients may find relief with tricyclics, an older class of antidepressants. Doctors may also prescribe antiseizure drugs, sleeping pills, muscle relaxants, or benzodiazepenes like diazepam (Valium) or clonazepam (Klonopin).

A recent article in Medical Hypotheses Journal. 2010 Mar 6. [Epub ahead of print], indicates Melatonin has been proposed as a treatment for tinnitus, especially on the basis of its positive effects on sleep and its vasoactive and antioxidant properties. It explores melatonin use in relief of tinnitus, explaining its effect on central nervous system resulting in a protective mechanism against an exaggerated sympathetic drive; its capacity to induce a more steady hemodynamic condition, through a multifactorial and multi-organ activity, resulting in a more regular labyrinthine perfusion; a possible action on the skeletal muscle tending to a reduction of the muscular tone, which could relieve tinnitus of muscular origin deriving from tensor tympani tonic contractions; its possible reported antidepressive effect, which could indirectly act on tinnitus; a direct regulation of inner ear immunity as proposed in literature when melatonin was reported to be present in the inner ear. They state, "... these observations seem to indicate melatonin as a tool deserving a greater attention than other antioxidants in the attempt of relieving tinnitus, justifying its application from a more precise rationale based on a series of physio-pathological aspects.

Lately, a new therapy called transcranial magnetic stimulation (TMS), which sends an electrical current into the brain has shown some promise along with electrical cortical stimulation (ECS), however, further clinical trial studies are needed. If you are interested in participating in any of these clinical trials, you can follow the link at government approved Clinical Trials for Tinnitus from the U.S National Institutes for Health.

A great source for information and to find support groups for tinnitus in your area is the American Tinnitus Association (ATA), and I highly recommend it for anyone who sufferers from or cares for someone suffering from tinnitus. You are not alone, tinnitus reduces quality of life for 250 million people worldwide. There is a test you can take to determine the effects that tinnitus has on the quality of your life called the Tinnitus Handicap Inventory. It is also a means to monitor the progression of tinnitus and the effects of therapy measures.

To summarize; there is no cure for tinnitus, however, you don't "have to live with it". There are methods to control and relieve tinnitus, mainly through medication and instrumentation, and new methods are being studied. In my case, I have been suffering from tinnitus for a couple of years. Beyond the initial panic, I have been able to control it through medication and the intensity has reduced over time along with the duration. My tinnitus has been evaluated to be related to high frequency hearing loss, however, there are different causes and you need to be professionally evaluated.

The importance for professional evaluation is stressed by the list of causative, co-existing and/or pre-existing factors; hearing loss, vertigo, ear blockage, sensitivity to noise (hyperacusis), ear nose and throat complaints of otalgia, inflammatory ear or nose sinus disease, cranial nerve complaints associated with vision, smell, headache, cognition, speech expression, memory, motor function and gait, metabolic disorders of sugar, thyroid and lipids, cardiovascular disorders of hypertension and athersclerosis, skeletal-muscular disorders eg, cervical osteoarthritis, menses and hormonal therapy, stress, anxiety, depression, medications, stimulants and family history focusing on disorders of hearing loss, diabetes, epilepsy or other illnesses.