Tinnitus is not a disease rather an annoying symptom of myriad of conditions, caused by minor changes in the sensitive hearing system (Cochlea and auditory nerve).

Tinnitus (means ringing in Latin) is sound sensation in the ear or head, in the absence of any external source of sound.  Commonest types are hissing, roaring, swishing, rustling, buzzing, humming, or chirping. Tinnitus varies in pitch and loudness and is more annoying in quiet surroundings, particularly at night.  It can be quite disturbing leading to sleep deprivation, depression & decreased work efficiency. Most important aspect of tinnitus is distress, irritation and distraction caused by the noise. Person often feels that such noise is a symptom of brain tumor or stroke. In most cases tinnitus is not harmful.

Patient with tinnitus should undergo thorough ENT evaluation and if required neurological examination. ‘Nothing can be done and you have to live with it’ is to be avoided and patient should be investigated properly to find any treatable condition.

Most common cause for tinnitus is hearing loss because of aging, noise, drugs or chemicals.

Possible theory:

1. Because cochlea is no longer sending normal signals to brain, confused brain create own noise.
2. Made worse by anything that makes hearing worse like infection/wax.  

Causes:
I. Related to ear (otologic)

** Cause may be in the external, middle or inner ear

Subjective causes:

• Impacted wax
• Fluid in the middle ear
• Acute and chronic otitis media
• Otosclerosis
• Menieres disease
• Presbiacusis
• Noise-trauma
• Ototoxic drugs (such as ACE inhibitors, Antibiotics-ciprofloxacin, erythromycin, streptomycin, and vancomycin, Anti depressant-alprazolam, Anti-malarials-chloroquine and quinine, B-blockers, Diuretics-acetazolamide and amiloride, NSAIDs and Aspirin)
   

Objective causes are less frequent:

• Aneurism of carotid artery (it is synchronous with pulse)
• Vascular tumor of middle ear
• Palatal myoclonus
• Tinnitus synchronous with respiration may occur with abnormally patent Eustachian tube (mostly seen after weight loss).
   

II. Not related to ear

Disease of CNS, anemia, arteriosclerosis, hypertension, hypotension, hypoglycemia, epilepsy, migraine

III.  Psychological

Assessment of tinnitus:
Most important is History and Identification of hearing loss and Clinical Examination of ear by otoscope/operating microscope with detail head and neck examination by specialist.

Investigations:

• PT Audiometry
• Brain-stem Evoked Response Audiometry
• CT scan (especially if tinnitus is asymmetrical, 10% of cases it may be a tumor (Acoustic Neuroma).
  Blood Investigations to test Anaemia- CBC, Hypothyroidism- TSH, Diabetes-sugar, Syphilis- FTABS and lipid profile.
  Tinnitus pitch matching and masking.

 
Treatment of the cause should take care of tinnitus but tinnitus may persist even after the disease causing tinnitus has been cured, When a lesion or disease process is not identifiable, then tinnitus management is more difficult.

There is at present no effective surgery or medical therapy for the treatment of tinnitus.

In majority of cases our system adapts to noise over a period of time and is accepted as a part of normal environment. This process can be helped by proper reassurance and counseling. Relaxation and biofeedback help to improve coping with the condition.

Tinnitus maskers are sometimes recommended. These are similar to hearing aids and generate continuous noise. Their use is based on the fact that the patient is more comfortable in a noisy environment than in a quiet surrounding.

Research shows encouraging result on the effectiveness of pharmacological therapy for tinnitus, such as carbamazepine, lidocaine, and intravenous barbiturates, but potentially serious side effects limit their use.

Avoid irritants like smoke, alcohol, caffeine, & loud noise.

Aspirin is one of the reversible causes, stop using it, and most important of all manage your stress as it makes tinnitus worse.