What are tinnitus?

Tinnitus (or tinnitus in the English-speaking literature), are auditory sensations perceived by some people, which do not have an external origin produced by a sound wave.

The sensation is usually described as a “ringing”, “buzzing” or “rumbling” that can affect one or both ears, or be located “inside the head”. The characteristics of tinnitus are very variable from one patient to another, both in intensity, tone and periodicity (continuous or intermittent).

The degree of affectation that tinnitus produces in the people who suffer from it is also very variable, since it can go almost unnoticed or even produce an important alteration in the quality of life.

Are tinnitus frequent?

Tinnitus is a very common disorder that can affect people of all ages; however, it is more frequent in the elderly and can affect up to 30% of this population.

Fortunately, tinnitus that is considered problematic because it interferes with the normal performance of the patient’s daily activities constitutes only 2-3% of all cases.

Usually, tinnitus is associated with hearing loss due to various causes, although there are sporadic cases of tinnitus with completely normal hearing. It should be taken into consideration that tinnitus is considered a symptom rather than a disease in itself.

Why do tinnitus occur?

As we have pointed out above, tinnitus is usually related to an alteration of the inner ear that manifests with hearing loss; however, from here on, the mechanism by which those cases of “problematic tinnitus” occur has to do with various modifications that occur in the networks of neurons of the auditory pathway, the auditory cerebral cortex, and in higher centers that control stress, attention and fear.

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This causes tinnitus to complicate and produce an affectation in the emotional, cognitive, social and family sphere of the person who suffers it, with a variable intensity and with particular conditioning factors in each case.

How are they treated?

The therapeutic approach to tinnitus should be comprehensive and it is advisable to seek the advice of an otorhinolaryngologist or otoneurologist with experience in this field, who will coordinate and advise on the therapeutic options.

To date, there is no scientific work that has demonstrated significant effectiveness of a particular drug for the treatment of tinnitus. However, in some cases, certain drugs can be used and prescribed on an individual basis, depending on the circumstances of each patient. For this reason, the individualized evaluation of the case is fundamental, from the determination of the origin to the establishment of the conditions for the chronification of tinnitus.

On the other hand, there are therapeutic lines that have shown improvement of the problem in the medium-long term, such as tinnitus retraining therapy, treatment with sounds or cognitive-behavioral therapy. The need for these types of interventions will depend on each particular case, although the number of patients who require them is limited.

What is the role of the ENT or otoneurologist in these cases?

The role of a specialist with experience in the management of patients affected by tinnitus is, firstly, to rule out reversible otological pathology that could potentially cause tinnitus (a wax plug, ear infection, etc.), as well as, on the other hand, to determine whether there is a relevant pathology that causes it, such as a sudden hearing loss, a tinnitus of vascular origin or an intracranial compression of the auditory nerve, especially in cases of unilateral tinnitus. For this reason, it is necessary to carry out an exhaustive clinical evaluation and a diagnostic process by means of various auditory tests, in order to subsequently decide whether or not further complementary tests are necessary.

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Once important diseases have been ruled out and the cause of tinnitus has been determined, in addition to its acoustic characteristics and intensity, the next step is to establish the degree of affectation that tinnitus produces in the patient’s life, establishing which are the particular characteristics of the case and which vital spheres are most affected.

From all this information, we will proceed to explain, guide, advise and establish a plan with particular measures in each case, which will allow the person with tinnitus to recover normality in his life, regardless of whether it disappears completely, decreases in intensity or simply can be left in the background, as happens with many other stimuli around us.

All these measures are effective in a significant percentage of cases. However, complementary treatment with tinnitus retraining therapy and/or cognitive-behavioral support therapy is sometimes considered.