Tinnitus

and Carola Felchner, science journalist

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

Brief overview

What is tinnitus? Sudden, more or less loud noises in the ear (e.g. whistling, humming, humming or hissing). They are only perceptible to the person concerned. Tinnitus can be persistent or recurring.
Causes: e.g.Hearing loss, noise or bang trauma, sudden hearing loss, otitis media, otosclerosis, tumors, perforation of the eardrum, Menière's disease, cardiovascular diseases, medication, stress and emotional stress; in idiopathic tinnitus, the cause remains unclear.
Responsible specialist: ear, nose and throat specialist
Examinations: patient discussion, various examinations such as ear microscopy, hearing test, balance test
Treatment: e.g. infusions, physiotherapy, relaxation techniques, tinnitus retraining therapy (TRT), special hearing system (tinnitus mask), if necessary psychological support
Prognosis: tinnitus sometimes lasts for life. Some people get along well with it, others suffer greatly and develop physical and / or psychological problems as a result.

Tinnitus: treatment

Treating tinnitus is not that easy. It is often impossible to determine the cause of the ringing in the ears. In general, the faster a tinnitus is treated, the better the chances that it will go away. It is ideal if the therapy begins in the first 24 to 48 hours after the ringing in the ears occurs.

Acute tinnitus: treatment

This form of tinnitus has existed for a maximum of three months. If it does not improve on its own after a short period of time (e.g. ringing your ears after a loud concert), the doctor will probably start with standard therapy and either give an infusion of anti-inflammatory agents or, alternatively, prescribe anti-inflammatory tablets.

The doctor can also try causal tinnitus therapy. Some examples:

Infusion therapy with blood circulation-enhancing drugs: It is used when the doctor suspects the cause of the tinnitus in the inner ear, but also when the cause is unknown. The aim of the treatment is to provide the ear area with a better supply of blood and oxygen.
Cortisone: The anti-inflammatory drug is used when the doctor suspects inflammation as the cause of the tinnitus. It is usually given in the form of infusions.
Physical-medical or physiotherapeutic treatment: It is useful if misalignments or injuries to the cervical spine are responsible for the noises in the ears.
Orthodontic treatment: It is intended to correct malformations of the teeth or temporomandibular joint problems that trigger noises in the ears.
hyperbaric oxygen therapy: This method can be considered if the other therapies have not brought about any improvement. The affected person stays in a hyperbaric chamber and breathes in oxygen through a mask. The higher pressure should lead more oxygen into the tissue and blood and thus also better supply the inner ear. However, the effectiveness of this form of treatment is controversial.

Chronic tinnitus: treatment

If the ringing in the ears lasts longer than three months, experts speak of chronic tinnitus. The noises are never pleasant - but while some sufferers manage to "come to terms" with the ringing in their ears, others suffer agonies and sometimes get psychological problems.

The doctor must plan the therapy accordingly. First of all, even with chronic tinnitus, he will usually put in an infusion that stimulates blood circulation. In addition, the patients should be shown ways of how they can better deal with the persistent buzzing, ringing or whistling in the ear. Since stress can aggravate tinnitus, various relaxation techniques such as yoga or autogenic training have proven to be helpful. For people who are very insecure, anxious or depressed by the ringing in their ears, intensive psychological support (e.g. cognitive behavioral therapy) may be necessary in order to learn to live with the tinnitus.

Another option is to mask the tinnitus. This means that the perception of the noises in the ear is suppressed by means of special hearing systems (tinnitus maskers). These systems are similar to hearing aids, but produce a continuous noise that distracts from the ringing in the ears or covers it. Tinnitus retraining therapy (TRT) may be carried out in parallel. In doing so, the person concerned learns to suppress the noises in the ears and to filter them out of their consciousness. An expert advises the patient on his illness (counseling). An ear, nose and throat doctor, psychologist and hearing care professional usually work together at TRT.

“Real” hearing aids make sense if the tinnitus is accompanied by a hearing disorder. In many cases, even the most severe inner ear hearing loss can be treated with an inner ear electrode (cochlear implant, CI). It is inserted into the inner ear and can improve hearing and speech understanding through direct electrical stimulation of the auditory nerve. Often times, tinnitus goes away as hearing increases - or at least it decreases.

Tinnitus: What You Can Do By Yourself

Unlike the eyes, a person cannot close his ears. In a sense, the sense of hearing is always on the receiving end - even when we are asleep. Nevertheless, those affected are not at the mercy of tinnitus. Humans can develop strategies to cope better with the noises in their ears.

Avoid silence: Sounds strange at first. But the quieter the environment, the more you notice the noises in your ears. Especially when falling asleep, it can help to let a fountain splash around, to play nature sounds or soft music. Try what works best for you.
Stay calm: The inner attitude to the ringing in the ears is also decisive. In general, we classify sounds differently. The sound of the sea, for example, is perceived as calming by many people, a leaf blower is more annoying, children's screams are perceived by some as beautiful and by others as annoying, and a fire alarm should be interpreted as an indication of danger. So if a person concerned perceives the tinnitus as threatening, their consciousness will not block out the noises in their ears. Ignoring a danger could ultimately have meant death in evolution. If, on the other hand, the patient succeeds in developing a relaxed attitude towards tinnitus, he can push it out of consciousness.
Reduce stress: Anything that relaxes is also helpful. Because under stress, people are particularly thin-skinned and overly sensitive - also to noise. Perhaps you will be able to restructure your life a little, bring more calm into everyday life and reduce stress. Here, too, a short therapeutic intervention can help to say goodbye to deeply internalized performance thinking. Relaxation methods such as autogenic training, mindfulness exercises, progressive muscle relaxation according to Jacobsen as well as yoga, meditation or tai-chi can also be useful and reduce your own stress level.

How to break the vicious circle of tinnitus

A relaxed attitude towards the noise in the ear and stress relief can help break out of the tinnitus vicious circle.

For patients whose tinnitus is due to a circulatory disorder of the inner ear, there are herbal preparations based on ginkgo biloba. This extract from the leaves of the tree of the same name is said to have a beneficial effect on blood circulation.

Tinnitus: causes and possible diseases

Doctors differentiate between objective and subjective tinnitus:

Objective tinnitus

Objective tinnitus is caused by a measurable sound source near the inner ear. With suitable devices, the noises in the ears of the patient can also be made audible for other people.

The measurable sound source is, for example, flow noises of the blood, which are caused by constrictions of the vessels. In this case, the tinnitus is a throbbing sound in the ear. Other patients describe clicking sounds. They come about through involuntary muscle twitching in the middle ear or roof of the mouth.

An open tube can also be the reason for objective tinnitus. The tube (Eustachian tube) is the tubular connection between the middle ear and the nasopharynx. It is important for equalizing pressure in the middle ear. It opens briefly when swallowing and speaking, only to close again quickly afterwards. In people with an open tube, the Eustachian tube is open permanently or at least for a long time. This can cause ringing in the ears.

Other possible causes of objective tinnitus are heart valve disease, anemia (anemia) or a so-called glomus tumor. This is a benign tumor in the carotid artery area.

Subjective tinnitus

Much more common than objective tinnitus is subjective: it cannot be made audible for other people, but can only be perceived by the person affected. The exact origin of subjective tinnitus has not yet been conclusively clarified. However, it is known that the noises in the ears are caused by incorrect information formation or processing in the hearing system. So far known causes are:

Deafness: Tinnitus and deafness often go hand in hand. Experts therefore assume that the noises arise in a similar way to phantom pain after an amputation: Since the hearing impairment means that corresponding signals from a certain hearing spectrum are either absent or only weakly perceived, the brain tries to compensate for this deficiency. To do this, it regulates the activity upwards in the corresponding areas - tinnitus develops. This assumption is also supported by the fact that in such cases the frequency of the tinnitus noise is often in the range in which the person concerned hears poorly.
Ear wax or foreign bodies in the ear: If the ear canal is blocked by a wax plug or a foreign body, ringing in the ears can result.
Noise and bang trauma: In a bang trauma, the pressure in the ear is briefly so high that in extreme cases even the eardrum bursts. The trigger can be a shot, a burst tire, a firecracker - in short: anything that suddenly makes a lot of noise. But even after a loud concert, your ears ring because your sensory cells have been damaged. The hearing no longer works properly, and a (usually only brief) subjective tinnitus develops. Anyone who repeatedly exposes their ears to noise exposure (e.g. through loud music through headphones) can also get ringing in their ears.
Sudden hearing loss: Sudden hearing loss is manifested in one-sided hearing problems. Experts also speak of a hearing attack. The cause is probably circulatory disorders in the smallest vessels in the inner ear. Tinnitus occurs in 70 percent of cases after a sudden hearing loss.
Acoustic neuroma: ringing in the ears is sometimes the first symptom of this benign tumor of the auditory or equilibrium nerve. Other possible signs are dizziness and decreased hearing.
Inner ear and middle ear infections: Such inflammatory processes trigger temporary tinnitus in some people.
Otosclerosis: This is understood to mean ossification at the transition between the stapes (third auditory ossicle) and the inner ear. It can also provoke subjective tinnitus.
Eardrum perforation: Such injuries to the eardrum can occur, for example, from infections of the middle ear, from blows to the ear or from sound waves. Direct injuries, for example from cleaning the ears, are less common. Even with an eardrum injury, hearing suffers and noises in the ears occur.
Tubular dysfunction: This is a ventilation disorder of the ear trumpet - the connection between the middle ear and throat is partially or completely blocked. This triggers an uncomfortable feeling of pressure in the ear, which does not improve even if you yawn or swallow - the eustachian tube does not open as usual. In addition, many sufferers report ringing in their ears, such as a cracking sound when swallowing.
Menière's disease: Typical of this disease of the inner ear are acute vertigo attacks, often accompanied by nausea and vomiting. During such attacks, those affected usually also suffer from hearing loss and low-pitched noises in the ears.
Changed pressure conditions in the ear: Significant changes in pressure, such as those that can occur during diving or air travel, can also trigger ringing in the ears.
Arteriosclerosis (arteriosclerosis): If deposits (plaques) form in the blood vessels of the head and spine, this can disrupt the blood flow to the inner ear and cause ringing in the ears. Risk factors for arteriosclerosis, which therefore also favor tinnitus, are high cholesterol levels, high blood pressure and diabetes.
Cardiovascular diseases: In some cases, tinnitus can be attributed to cardiovascular diseases such as cardiac arrhythmias, low blood pressure or high blood pressure.
Metabolic diseases: They can also trigger ringing in the ears (e.g. diabetes, kidney dysfunction).
Disorders in the hormonal balance: Hormonal changes (e.g. due to menopause) are also considered to be a possible cause of tinnitus.
Diseases of the central nervous system: For example, multiple sclerosis, brain tumors and meningitis (meningitis) can be accompanied by ringing in the ears.
Cervical spine dysfunction: Some experts believe that tinnitus in some cases comes from problems with the cervical spine (e.g. vertebral blockage). However, this is controversial.
Tooth and jaw problems: Very rarely, tinnitus is caused by tooth fillings, teeth grinding, misaligned jaws or cramping of the masticatory muscles (craniomandibular dysfunction, CMD).
Alcohol abuse: Excessive consumption of beer, wine etc. can lead to tinnitus as well as many other health problems.
Medication: Some medications can affect the hearing system and make tinnitus more likely. This applies, for example, to certain antibiotics (such as gentamycin), water tablets (diuretics), chemotherapy drugs (cancer drugs), anti-malarial drugs, some psychotropic drugs and higher doses of the pain reliever acetylsalicylic acid (ASA).
Emotional stress: About half of all tinnitus patients report severe stress (current or past). Fears, excessive demands and mental illnesses can also lead to ringing in the ears, even if you do not yet know how this is possible.

Where the tinnitus originates

Tinnitus often occurs as a result of sudden hearing loss, in which the processing of stimuli in the cochlea is impaired.

Often no cause for the noises in the ears can be found. Doctors then speak of idiopathic tinnitus.

Tinnitus: symptoms

Ringing in the ears is very common. According to the German Tinnitus League, every fourth person has had tinnitus at some point, although fortunately mostly only temporarily.

Tinnitus can manifest itself differently in each patient. For example, the noises in the ear can be described as humming, beeping, humming, rattling, whirring, screeching or hissing. The noises in the ears can be consistently intense or rhythmically swell up and down. In the vast majority of cases, only those affected can hear the sounds themselves. Doctors then speak of a subjective tinnitus. It is based on a deception of the hearing organ and, in contrast to objective tinnitus, cannot be determined by means of special examinations.

Doctors divide tinnitus into four degrees of severity, depending on the stress it represents for those affected:

Grade 1: The tinnitus is well compensated and does not bother the person affected.
Grade 2: The tinnitus is largely compensated, but appears in silence and is disturbing under stress and in other stressful situations.
Grade 3: The tinnitus symptoms are a significant burden in the professional and private life of the patient. They cause problems in the cognitive, emotional and physical areas. The patients suffer, for example, from sleep and concentration disorders, muscle tension, headaches and feelings of helplessness and resignation.
Grade 4: The constant stress caused by tinnitus is so massive that the quality of life of those affected is extremely impaired. The patients can no longer do their job, withdraw from social life and suffer from massive psychological disorders such as anxiety or depression.

Tinnitus: Investigations

In many cases, tinnitus will go away on its own, for example if it occurs after attending a loud concert. Then give your ears a break from listening to the sound and forego listening to music or other acoustic barrages. If the noises in the ears occur for the first time in stressful situations, it usually helps to reduce the stress level and relax.

However, if the noise in the ear has not disappeared after one to three days, you should consult a doctor. The right contact person for tinnitus is the ear, nose and throat doctor:

He will first collect the patient's medical history in conversation with him (anamnesis). Possible questions are:

Since when did the tinnitus exist?
Was it sudden or creeping?
Were there any possible triggers such as noise or stress?
Can you describe the noises in your ears in more detail?
Is the tone / noise in the ear steady or pulsating? Does it change during the day or depending on the position of the head?
How bad are you with tinnitus?
Do you have any previous illnesses (diabetes, heart disease, high blood pressure, etc.)?

A wide variety of examinations can follow the anamnesis:

Ear microscopy: With the help of an ear microscope, the doctor can examine the outer ear and eardrum. It can be determined whether a wax plug is the cause of the disturbing noise or whether the eardrum is injured.
Hearing test: As part of a so-called audiometry, the doctor checks the hearing performance of the inner ear. If the body tries to compensate for a hearing loss, this can cause ringing in the ears.
Balance test (vestibularis diagnostics): Since the balance organ is located in the inner ear (cochlear), a disturbed sense of balance is an indication that the cause of the tinnitus lies in this region. How well the organ of equilibrium is functioning can be determined relatively easily - for example, by trying to stand on one leg with closed eyes for as long as possible.
Tympanogram: This can be used to determine the mobility of the eardrum.
Reflection of the nasopharyngeal space (nasopharyngoscopy): The examination shows whether the area around the ear has been abnormally changed.
Brain stem audiometry (BERA): This is a special hearing test that checks the function of the auditory nerve.
Tinnitus Matching: During this examination, the doctor determines the volume and frequency of the tinnitus tone.
Tinnitus masking: This method shows whether and with which frequencies the tinnitus can be covered (masked). To do this, the doctor plays various tones to the patient through headphones until the patient can no longer perceive the tinnitus. Experts refer to the frequency in question as the masking level.
Further tinnitus examinations: In addition to disorders of the hearing system, other physical problems can also trigger tinnitus (such as hardening of the arteries, high blood pressure, misaligned teeth or jaws, problems with the cervical spine, etc.). Depending on the suspicion, the doctor can therefore carry out appropriate examinations to clarify, for example blood pressure measurements, blood tests, ultrasound examinations of the neck vessels, magnetic resonance imaging, orthopedic examinations and examinations of the chewing apparatus.

Tinnitus: effects

For some people, tinnitus remains a lifelong companion. The level of suffering is very different - while some people are barely or not at all bothered by the hum in their ears (compensated tinnitus), it causes great stress for others and significantly reduces their quality of life. In extreme cases, those affected develop anxiety or depression. In severe cases, there is also social isolation and disability.

So-called somatoform disorders can also be a consequence of tinnitus. This is understood to mean physical complaints that have no clear physical cause. This can be, for example, tiredness, exhaustion, cardiovascular problems, gastrointestinal complaints or sexual disorders. In addition, tinnitus is often accompanied by other complaints such as tension in the neck and neck area as well as the jaw and masticatory muscles, nocturnal teeth grinding (bruxism), headache, earache, drowsiness, dizziness, difficulty falling asleep and staying asleep.

On an emotional level, ringing in the ears can lead to concentration problems, negative thoughts, a feeling of loss of control and helplessness, to resignation, fear of the future and a loss of self-esteem. People with tinnitus also often suffer from impaired hearing processing and perception such as oversensitivity to noise (hyperacusis) and distorted hearing (dyacusis). Some people also report that speaking at a normal volume is perceived as being too soft and speaking loudly as screaming (recruitment).

Additional information

Books:

Tinnitus: Cognitive-behavioral treatment manual by Birgit Kröner-Herwig, Burkard Jäger and Gerhard Goebel, BELTZ, 2010
Tinnitus: Suffering and Chances by Helmut Schaaf and Gerhard Hesse, PROFIL Mchn, 2008