Tinnitus Treatment Blog

Archive for the ‘Tinnitus Treatment’ Category

Although CT is the primary choice in the imaging modality for pathologies of the temporal bone, magnetic resonance angiogram or MRI has a noteworthy contribution to the diagnosis in the following ways:

• It shows the pathology of the membranous labyrinth.
• Assessment before a cochlear implantation.
• It shows complex inflammatory and infectious diseases
• It shows the extension and the location of temporal bone tumors.

Moreover, MRI is also the first choice in dealing with retro cochlear tumors or infections that cause neuro-otologic symptoms. It is also necessary in detecting all the kinds of lesions in the brain stem and brain that are related to the hearing pathways. In the recent years, MRI has been used extensively in detecting the causes of pulsatile tinnitus. Cerebral angiography is only preferred in selected cases. In case of objective pulsatile tinnitus, which can be heard on physical examination, MRI and conventional angiography is used widely for detecting the cause of the disease.

Dolichoectasia, which is a fusiform dilatation of an artery, can cause pulsatile tinnitus. MRI and MR angiography are mostly preferred for imaging investigations in the patients of dolichoectasia.

MRI is also often suggested in the younger patients who suffer from unilateral pulsatile tinnitus.

In order to understand the management and clinical spectrum of pulsatile tinnitus better a study was conducted in which the files of around 84 patients were analyzed. Non-invasive techniques such as MRI, CT and angiography were used to investigate the individual patients in a tailored way. The results showed that the patients of pulsatile tinnitus should be compulsorily investigated with non-invasive techniques. If these are negative then selective angiography is required for diagnosis and to guide treatment. MRI and MRA are more much more sensitive than CT.

By and large, the most significant part of evaluation for tinnitus is a detailed history and physical exam conducted by an otologist or ENT. A hearing test is also essential. Special tests such as MRI, blood tests, CT and auditory brainstem response are also needed sometimes.

Since, pulsatile tinnitus implies a vascular abnormality, the preferred imaging study is magnetic resonance imaging or MRI and contrast-enhanced computed tomography or CT of the brain.

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What are the Problems with Tinnitus Retraining Therapy?

Tinnitus or the ringing ears syndrome is a phantom auditory perception that can be quite unbearable. It is a common disorder that affects nearly 17% of the people throughout the world. Several methods have been developed to deal with it.

Tinnitus Retraining Therapy or TRT is a method of treatment of tinnitus that has gained much popularity in the last decade. The conceptual basis of TRT has been described in 1990 as a form of tinnitus treatment that is based on the neurophysiologic model of tinnitus that was developed by Pawel Jastreboff and JWB Hazell. This model suggested that the treatment of tinnitus should focus on the autonomic nervous systems and the limbic system.

It has been claimed that TRT is currently the most effective therapy for tinnitus which obtains a success rate that exceeds 80%. However, there are some loopholes in the TRT such as the following:

• There are many centers around the world that claim to be treating tinnitus according to the method devised by Hazel and Jastreboff. However, the published literature shows that there are significant differences in the way the Hazel and Jastreboff model is applied in the different centers.

• The authors of the case reports that show the effectiveness of TRT claim to have a success rate ranging between 50-80%. However, the evidence that is provided by this research is inconclusive because of the unclear criteria of patient selection, unavailability of controls and the variability of the tinnitus methods that are implemented.

• The interaction between emotional and neuroacoustic processes that has been emphasized by Jastreboff is neither new nor adequately elaborated in terms of the underlying psychological factors.

• If the current state of evidence is taken into account then one can conclude that there is no realistic empirical support that proves TRT to be superior to other treatments due to lack of comparative studies.

So we find that methodological limitations in the research which has been published so far rule out any claims about the effectiveness of TRT at present.

Suggestions have been made to undertake randomized and controlled studies which include no-treatment and placebo conditions.

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What is the effect of hearing aids on tinnitus and Meniere’s disease?

Meniere’s disease is a combination of tinnitus, hearing loss, fullness in the affected ear, and dizziness caused due to the abnormal fluctuation in the fluid levels in the inner ear.

The hearing loss is one of the initial symptoms of Meniere’s disease but it is usually overlooked because it is the tinnitus that is considered to be more irksome.

There is a mistaken belief that hearing aids are of no help for those suffering from Meneire’s disease. However, with the introduction of digital sound processing integrated with the hearing aid technology, there is an increased chance of an enhanced hearing in Meneire’s disease. The modern hearing aids can amplify sounds to match the hearing loss very accurately and they can also reduce loud sounds to a more comfortable level.

When a hearing aid is successfully fitted the patients of Meniere’s disease can obtain the following benefits:

• The every-day sounds become clearer,
• The discomfort of recruitment gets reduced by compressing distressingly loud sounds to a more bearable volume,
• Reduction in the tinnitus perception to a less agonizing level.

The following facts should be kept in mind before choosing a hearing aid for Meniere’s disease:

• First and foremost it should be kept in mind that a hearing aid is a medical gadget and not a fashion accessory.
• The quality of the hearing aid is very important for those with Meniere’s disease.
• A suitable hearing aid should be selected only after the fluctuating hearing loss has been established on the basis of a series of hearing tests.

Tinnitus is an auditory disorder that is often found to be associated with a hearing loss. A study showed that 60% of the tinnitus patients who were surveyed experienced some amount of relief due to hearing aids whereas 22% indicated a major relief by using hearing aids.

The hearing aids apparently provide the following benefits to the tinnitus patients:

• Improvement in attention span
• The helps in focusing better.
• There is less fatigue, stress and tension.
• There is less irritability and anger
• There are lesser chances of social avoidance due to awkwardness.

Thus, we find that the hearing aids play an important role in the treatment of tinnitus and Meniere’s disease.

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The problem of tinnitus or ringing ears can occur after a plane ride due to a disorder known as airplane ear. If the airplane ear lasts for several hours then it may cause tinnitus, vertigo, vomiting or bleeding through the ear.

Airplane ear gets triggered by the rapidly changing air pressure due the changes in the altitude during a flight. The normal vibration of the ear drum requires the same air pressure in the middle ear and the environment. The regulation of the air pressure is the function of the narrow passage known as the Eustachian tube.

During an aircraft’s take-off and landing the air pressure of the environment changes rapidly. The pressure at the higher altitudes is quite less as compared to the pressure at sea level. Hence, when the plane is ascending the air pressure in the middle ear becomes higher then the pressure in the aircraft. The balance in between the air pressure can be normalized if the air gets released through the Eustachian tube. The escape of air through this tube is relatively easier. During the flight the air pressure on either side of the eardrums gets normal again. However, when the plane is landing the air pressure in the aircraft is higher then the air pressure in the middle ear. This difference in the air pressure can be equalized if the air enters into the middle ear via the Eustachian tube. This is difficult as air cannot enter the middle ear rapidly. Hence, due to this difference in the air pressure people are more likely to suffer from airplane ear while landing.

The following self-care tips can help in rectifying the imbalance between the air pressures and in avoiding airplane ear:

1. One should yawn and swallow during a take-off and landing.
2. Filtered ear-plugs should be used.
3. Use the Valsalva maneuver during take-offs and landing. For doing this one should blow gently, as though blowing through one’s nose, with the nostrils pinched and the mouth shut tightly.
4. Chewing a gum is also helpful.

In case one has severe and persisting airplane ear symptoms then consulting a doctor is essential.

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The Eustachian tube is a narrow tube that acts like a bridge or link between the middle ear and the back of the nose. This tube remains closed most of the time except during yawning and swallowing. However, sometimes it remains opened abnormally and this condition is referred to as a patulous Eustachian tube. This condition may lead to pulsatile tinnitus. The patulous Eustachian tube occurs because of a defect in the normally convex anterior-lateral wall. This can be due to a loss of volume with the Ostmann’s fat pad, mucosa, sub mucosa, cartilage, or tensor veli palatini muscle.

The medical treatment for a patulous Eustachian tube consists of drugs as well as surgery. However, the surgical treatment is done only if the patients suffer from continual significant otologic symptoms in spite of the medical therapy. Moreover, surgical therapy for a patulous Eustachian tube is contraindicated in pregnant women and patients who have mild symptoms. Only informative reassurance is required by such patients.

The surgical treatment for a narrow lumen caused by an extrinsic compression is as follows:

• Eustachian tube diathermy
• Occlusion of the Eustachian tube
• Myringotomy and insertion of a ventilating tube
• Surgical scar tissue removal in nasopharynx

There may be certain complications in the surgical treatment.  The Eustachian tube diathermy has been linked with complications such as trigeminal nerve damage, intermittent secretory otitis media and middle cranial fossa dural burns. Teflon injections can result in total blockage of the Eustachian tube. The patients who had undergone tensor veli palatini transection developed middle ear effusions.

Eustachian tuboplasty is an advanced and promising type of treatment that is still in the early stages of implementation. Eustachian tuboplasty is also being used to treat a patulous Eustachian tube.

For a patulous Eustachian tube the surgeons augment the Eustachian tubal walls, tapering the passageway, with the help of auto graft cartilage. The surgical process mostly needs general anesthesia and is an outpatient process.

Till date, none of the patients have had any significant complications after undergoing Eustachian tuboplasty for a patulous Eustachian tube. Research data related to the treatment of patulous Eustachian tubes is in the being collected.

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What is the Treatment for Tinnitus Caused by Loud Noise?

Apart from damaging the auditory system loud noise can also lead to tinnitus. The hair cells and the tiny auditory nerve cells in the ears get easily damaged due to exposure to loud noise. Consequently, they start sending random electrical impulses to the brain which are perceived as sound although there is none. This is how tinnitus originates as a result of loud noise.

A medical examination by a doctor followed by further examination by an otolaryngologist and an audiologist is of utmost importance. Depending on the magnitude of the hearing loss different types of treatment will be suggested to control the tinnitus.

The treatment for tinnitus caused by loud noise is as follows:

• Hearing aids make it easier for some patients to hear the sounds they want to hear by amplifying them. The better one hears the sound of other people talking the lesser does a person notice the tinnitus noise.
• Maskers are tiny electronic devices that employ white noise to make tinnitus less apparent. Maskers do not eradicate tinnitus completely but they subdue the tinnitus noise. Maskers have benefited the tinnitus sufferers a lot and some people who use them can barely hear their tinnitus noise. Using bedside maskers or masking pillow helps one to get sound sleep at night. These devices can be placed by the bedside instead of behind your ear.
• Tinnitus retraining therapy is an effective treatment that helps the patients to avoid thinking about the tinnitus noise. It employs the techniques of counseling and masking.
• Stress can worsen tinnitus so relaxation is of utmost importance in controlling tinnitus.
• In order to minimize the damage caused by loud noise or explosion one should avoid listening to any loud sound till several days. This gives the hair cells an opportunity to rest and recover.
• Magnesium supplements, if given soon after the explosion or hearing loss, can reduce the magnitude of the problem.
• Sound absorbing earplugs or earmuffs should be used to avoid further damage to one’s hearing.

These holistic remedial measures can help one in controlling tinnitus caused by loud noise effectively.

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Viral infections of various types can cause a hearing loss in humans. Such viral infections include:

1. Chronic otitis media or glue ear that can cause a subtle hearing loss.

2. Viral labyrinthitis that is characterized by a sudden, unilateral loss of hearing.

3. Viral meningitis can cause hearing loss and tinnitus.

4. Congenital cytomegalovirus (CMV) infection can cause loss of hearing in the children.

5. Idiopathic Sudden Sensorineural Hearing loss or ISSNHL that can be caused by viral cochleitis.

6. Vestibular neuronitis which is a viral infection of the vestibular nerve can also cause a hearing loss.

Alternative treatments for hearing loss caused due to viral infections provide a holistic solution.

This can be adequately proved by the following natural, home based remedies:

1. Use a blow drier from some distance into the ear to remove any trace of water trapped inside the Eustachian tube.

2. Put a few drops of warm olive oil into each ear.

3. Avoid the smoke from cigarettes as it can choke our Eustachian tubes.

4. Some drops of lobelia extracts should be put into the ears and massaged gently.

Nutritional therapy:

1. Vitamin C intake can strengthen our immune system. This helps the body in combating the viral infections and preventing hear loss.

2. Zinc is found to cure ear infections.

3. Avoid junk and processed foods. Eat healthy.

4. Include calcium in your daily diet.

5. Breast feeding reduces the chances of such infections in infants.

6. Nutritional supplements such as vitamin B- complex vitamins and iron supplements reduce the risk of chronic ear infections that can cause a hearing loss.

7. Vitamin A and C, bioflavonoids and zinc should be used to cure chronic ear infections in kids.

Herbal therapy:

1. Herbs such as echinacea and goldenseal are natural antibiotics that can cure ear infections. They promote a strong immune system and help in controlling viral infections.

2. Chinese herbal therapy is also widely popular in curing ear infections.

3. Put some drops of garlic juice into the ear as it is a powerful and natural antiseptic herb. It kills virus, parasites, bacteria, fungi etc.
Thus we find that there are various alternative therapies that can uproot the viral infections that lead to a hearing loss. They are safe and natural and look into all the aspects of the problem.

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Our diet is closely linked with the tinnitus problem. Generally speaking, the foods that have a positive effect on our health help in the treatment of tinnitus also.

The intake of the following foods should be curbed to cure tinnitus:

•A high salt intake tends to worsen tinnitus. This happens due to a plausible reason. If we take salt in excess our blood vessels get restricted. This increases the blood pressure. Consequently the blood supply towards the ears, eyes and the brain reduces. A lot of people who have a habit of munching chips and other salty snacks usually complain of tinnitus. However, if they control their habit of eating salty snacks then they report of improvement in their tinnitus noise. Most of the packaged foods should be avoided as they have a high intake of salt.

•Saturated and trans-fats can produce multiple adverse effects on both our body as well as tinnitus. The people who suffer from tinnitus require an increased blood flow towards the inner ear for removal of the toxins and for maintaining healthy cells. The saturated fats increase triglycerides and trigger atherosclerosis. Atherosclerosis can reduce the blood supply and a reduced blood supply towards the ears is a major cause of tinnitus.

•Flavor enhancers are a part of the most of the pre-packaged and processed foods. The chief flavor enhancer used in the food industry is Monosodium Glutamate or MSG. Monosodium Glutamate breaks down into Glutamate in our body which is the prime culprit in causing tinnitus in a large number of people.

•A sugar metabolism disorder known as hyperinsulinemia is found in a number of tinnitus patients. This disorder occurs due to ineffective delivery of sugar to the cells. Sugar metabolism has a vital role to play in the normal functioning of the auditory system, which entirely depends on the sugar and oxygen from the blood supply. If this supply of nutrients gets disrupted then there is an imbalance.

Hence if one is seriously interested in controlling the distracting and frustrating tinnitus noise, then a little control over one’s diet can go a long way in curbing tinnitus.

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White noise generators or CDs are a boon to the patients suffering from Tinnitus as the abnormal sounds that they tend to hear, get masked by the white noise. This article may prove useful to all those people who would like to not only get a short term relief by masking the ringing in their ears, but also to wipe it off completely by retraining their brains to stop paying attention to these irritating sounds by the process of auditory habituation.

Tinnitus is characterized by ringing in the ears which causes a lot of disturbance and irritation to its patients. A convenient way to protect one self from the side effects of these constant or intermittent annoying sounds is to mask them by some other more pleasing sound.

White noise plays an important role in masking the ringing in the ear. It consists of the entire spectrum of the frequencies which are audible to a human ear and works as good masking agent.

By gently stimulating the nerve cells, it programs them in such a way that the Tinnitus sounds are not noticed by the mind. At times when the patients try to sleep at night, the environment is usually peaceful. The silence makes them much more aware of the disturbing sounds arising due to Tinnitus, which otherwise get concealed due to the din during daytime.

At such times, the white noise Tinnitus generators come handy because they minimize the contrast between the Tinnitus sounds and the pin drop silence.

White noise Tinnitus CDs prove to be more effective then home remedies such as a noisy fan or air conditioner which can cause distress due to the unpleasant sounds they produce. The sound of the white noise Tinnitus CDs can be controlled to suit one’s mood.

White noise machines produce pure white noise which helps the patients of Tinnitus to ignore the abnormal sounds they hear which prevents them from focusing or concentrating on any work.

The pure white noise is a soothing sound such as the ocean waves or rainfall. Those persons who suffer from Tinnitus may have a problem in leading a normal life. The less inexpensive white noise Tinnitus CDs come to their rescue, in which the bass and the treble can be changed by the listeners to conceal the high or low background sounds at any place.

Not only do the white noise MP3 recordings and CDs give instant relief to the Tinnitus patients but over a period of time, they also bring about auditory habituation in which the brain does not react in negative way to the unpleasant Tinnitus sounds. It gets retrained to ignore the Tinnitus noise.

Tinnitus retraining therapy or white noise therapy is a recent advancement in the medical field. By exposing the patients to the white noise produced by a generator, till a particular period of time, the brain is forced to listen to the actual sound and ignore the Tinnitus sounds they tend to hear.

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Generally speaking a surgical management of tinnitus has been successful in some cases but it does not provide a valid and consistent form of treatment for subjective tinnitus.

Surgical failures can also occur because the tinnitus may set up a secondary central focus inside the brain. In such cases, the alternate source of the tinnitus, which is located deep within the brain, cannot be treated surgically.

A study showed that the surgical removal of acoustic tumors with an excision of the auditory nerve in 414 patients resulted in the improvement in the tinnitus only in 40% patients.

In another study, out of 68 patients undergoing translabyrinthine eighth nerve section, 80% of them had tinnitus preoperatively. There was an improvement only in 45% whereas 55% reported the condition to be the same or worsen.

Stapedectomy is a surgical treatment of tinnitus that can improve the hearing in most of the cases but it can cure only 50% of the symptoms of tinnitus. On the contrary, most of the patients with cochlear implants report an improvement in the tinnitus by the use of implant and stimulator.

The cochlear implants have proven to be more suitable for the patients who suffer from severe tinnitus.

Some patients had undergone middle cranial fossa section of the vestibular nerve for the treatment of vertigo. Most of them reported the tinnitus to be the same as before but a considerable number felt that it had worsened.

Some cases of tinnitus in which the option of a surgery is considered are as follows:

• Tinnitus caused due to a tumor.
• If the diagnosis is otosclerosis or fistula.
• In case of venous tinnitus the options of occlusion of the sigmoid sinus, jugular vein ligation or closure of a dural fistula may be considered.
• In certain cases the patients of Menire’s disease may get some relief in their tinnitus by a transtympanic gentamicin.

8th nerve sections are done to treat tinnitus in the rarest of cases because although they may be successful in about 50% but there is a risk of losing one’s hearing in almost all the cases.

Hence, we find that surgery is considered only in extreme situations where the tinnitus noise is extremely loud and there is a methodology to decide if tinnitus can be improved by surgery.

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