What is the physiological basis of tinnitus
Tinnitus (Tinnitus aurium, Ringing ears, Noises in the ears, tinnitus)
Tinnitus aurium - the full term derived from Latin - means "the ringing of the ears". Tinnitus is medically defined as an acoustic perception that arises from outside the body without a corresponding acoustic stimulus and has no information content. The latter distinguishes tinnitus from acoustic hallucinations in which those affected hear voices, for example.
- A distinction is made between two types of tinnitus.
- Organic and non-organic causes come into question as triggers.
- Tinnitus manifests itself as noises in the ears such as hissing, humming, ringing, whistling or hissing.
- Depending on the symptoms and the consequences, tinnitus can be divided into four degrees of severity.
- Diagnosis is based on anamnesis and ENT examination.
- Treatment depends on the cause, severity, and sequelae.
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How common is tinnitus and who does it affect?
Tinnitus is undoubtedly a very common phenomenon - even if there are hardly any large epidemiological studies and the numbers are therefore based on estimates or small representative surveys.
According to a survey in German-speaking countries, around a quarter of those surveyed over 10 years old said they had suffered from ringing in the ears or were currently suffering from it. For the majority, the problem had existed for more than three months.
In Austria, experts are currently assuming 800,000 to 1,000,000 people with tinnitus. In at least 100,000 Austrians, the noises in the ears are so pronounced that they severely impair their quality of life.
Tinnitus can occur at any age, including children. However, the majority of people over 50 are still affected, and women more often than men.
However, the noises in the ears have been observed increasingly in adolescents and young adults in recent years. Experts attribute this to increasing noise pollution in leisure time, especially from loud music at concerts, in discos and through headphones.
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Forms of tinnitus
In principle, a distinction is made between two forms. At the objective tinnitus there is a body's own sound source in or near the ear whose sound emissions are perceived. This means that the noises emanating from the blood vessels or muscles actually exist and can therefore also be heard by others, even if mostly only with a stethoscope or other medical equipment.
|Objective tinnitus||the body's own sound source in the ear|
|Subjective tinnitus||no physical sound source|
|Idiopathic tinnitus||Noise in the ears cannot be attributed to a trigger|
But that is much more common subjective tinnitus. Here those affected perceive tones and noises that cannot be traced back to a physical sound source and therefore cannot be heard by other people either. However, this does not mean that the patient is just imagining the humming, humming, whistling, ringing, hissing or knocking.
Rather, subjective tinnitus can be traced back to incorrect information formation or processing in the auditory system, which extends from the ear via the auditory nerve to the auditory centers in the brain. It has meanwhile been proven that the majority of noises in the ear are generated in the brain, even if the primary cause was in the ear (e.g. bang trauma)!
For many of those affected, however, it cannot be definitely determined what the noises in the ears are due to. This is called idiopathic tinnitus designated.
What are the causes of objective, externally audible tinnitus?
Objective tinnitus is triggered by the body's own sound sources located near the inner ear. Objective tinnitus is very rare. Possible causes include:
- Narrowing of the blood vessels - especially the arteries; the perceived noise is then usually pulse-synchronous.
- Cramping or twitching of the muscles in the ear or the palate muscles; this is often expressed as a "click" in the respective ear, usually only affecting one ear.
- Tumors in the middle ear
- Temporomandibular joint problems, for example joint surfaces rubbing against each other when opening and closing the mouth
- hemangiomas (blood sponges) made up of numerous small blood vessels
- Closure defects of the so-called Eustachian tube, which connects the middle ear with the nasopharynx
What are the causes of subjective tinnitus?
A subjective tinnitus is not an independent clinical picture, but the symptom of a disorder of the auditory system. The possible causes are correspondingly diverse. Tinnitus can occur in connection with almost any hearing disorder.
Experts agree that a pathological process in the area of the inner ear is usually the causal mechanism of development, especially at the level of the hair cells, which convert the sound into nerve cell impulses there.
These electrical signals then reach the auditory centers in the cerebral cortex via the auditory nerve, where they are processed - and where acoustic perception is ultimately created.
Complicated brain-physiological learning processes process the sound coming from the ear in the brain in such a way that it remains as a "catchy tune" - even if the pathological cause has been successfully treated. This essentially depends on the level of attention and focus on the noise in the ear.
The excessive focus on tinnitus, which is often observed, is therefore harmful. In this case, experts speak of secondary centralized tinnitus. On the other hand, it is rare that subjective tinnitus occurs primarily in the central nervous system.
In the case of hearing loss, there is another mechanism that causes tinnitus: the neurons in the brain assigned to the ear have become “unemployed” due to a lack of activation from the hard-of-hearing inner ear. Now they try to compensate for missing frequencies or produce their own tones through uninhibited spontaneous activity - and thus themselves become a tinnitus generator.
Possible triggers and factors that favor the development of subjective tinnitus include:
existing inner ear hearing loss
- due to noise pollution or a bang trauma
- Sudden hearing loss
- Menière's disease, a clinical picture with acute dizziness and hearing loss
- acute and chronic otitis media
- Eardrum defects
- Otosclerosis, which can cause the stapes to become more immobile in the middle ear and damage to the inner ear.
- Dysfunction of the Eustachian tube between the middle ear and the nasopharynx
- Constrictions and closures of the external auditory canal - also harmless ear wax
- Foreign body in front of the eardrum
- certain drugs, including some antibiotics, antidepressants, pain relievers, and some chemotherapy drugs used in cancer therapy
- Tumors of the auditory and equilibrium nerves - ringing in the ears is often the first symptom here
- Diseases outside of the hearing system such as high blood pressure, circulatory disorders (arteriosclerosis) in the head and neck vessels, anemia, thyroid disorders
- Temporomandibular joint problems and teeth grinding directly due to the mechanical noise but also indirectly due to the tension of the neck muscles and the tension of the entire chewing apparatus.
- Tension in the neck muscles ("cervical syndrome") and functional restrictions in the cervical spine
- Stress and psychological distress are considered to be one of the main causes of subjective tinnitus and also help to maintain and amplify the noises in the ear.
- Chronic noise pollution
- Mental hurts and injuries
++ More on the topic: The consequences of stress on the body ++
How is tinnitus expressed?
The symptoms of tinnitus can vary greatly from person to person. The spectrum of perceived noise phenomena is very broad - whizzing, humming, ringing, whistling, knocking, hissing, beeping, hissing, cracking, all of this is possible.
The noises in the ears can occur on one side as well as on both sides, they can become louder and quieter and change their pitch. With some patients they are there all the time, with others with interruptions, so they come back after "rest breaks".
Tinnitus can have a number of consequences. These so-called secondary symptoms include:
- Problems falling and staying asleep
- Difficulty concentrating
- Headache (with massively increased noise and noise sensitivity)
- Dizziness and lightheadedness
- Hypersensitivity of the hearing (hyperacusis) is often combined with tinnitus, but can also occur alone
- Disturbances of the auditory impression, e.g. a hall
- social withdrawal
- Depressive mood up to a manifest depression
Severity levels of tinnitus
Depending on which of these sequelae occur and how much the tinnitus affects the quality of life of the person affected, the classification is made as a whole4 degrees of severity:
- Grade 1: The tinnitus is well compensated, there is no psychological stress.
- Grade 2: Tinnitus mainly occurs when you are silent and only has a disturbing effect when you are under stress and psychological-physical stress.
Severity grades 1 and 2 are also known as "compensated tinnitus". Those affected perceive the noises in the ears, but they can handle it so well that no secondary symptoms occur. Your quality of life is not impaired or only in rare exceptional situations.
Decompensated tinnitus, on the other hand, has noticeable effects on all areas of the patient's life, leads to psychological and physical sequelae and creates a high level of suffering. A distinction is made between severity levels 3 and 4:
- Grade 3: Tinnitus is associated with disturbances in the emotional, cognitive and physical area and leads to permanent impairment in professional and private life.
- Grade 4: The tinnitus leads to complete decompensation in the private sphere and to occupational disability.
The majority of tinnitus patients are grades 1 and 2.
How is tinnitus diagnosed?
A medical history is the basis of the tinnitus diagnosis. The medical history is collected, questions about the noises in the ears and about triggers and sequelae are asked.
This is followed by a hearing test and a full ear, nose and throat examination.
++ More on the topic: Diagnosing tinnitus ++
Treatment of tinnitus
Tinnitus therapy depends on the causes, severity and possible secondary symptoms. It is also crucial whether it is acute or chronic tinnitus.
Possible treatment methods are:
- Tinnitus Retraining Therapy (TRT)
- Relaxation exercises
- anti-inflammatory drugs
- blood circulation-enhancing drugs
++ More on the topic: Treatment of tinnitus ++
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Ulrich Kraft, doctor and medical journalist
Dr. med. Eberhard Biesinger, specialist in ENT diseases, ENT Center Traunstein, Germany (04/2012), Dr. Johannes Schobel, specialist in ENT diseases, Tinnitus Center St. Pölten
Mag. (FH) Silvia Hecher, MSc (2012), Dr. med. Stefanie Sperlich (2015)
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