- Diseases, Disorders & Conditions
Types of Tinnitus - Why Do I Hear Ringing In My Ears
Medical experts say that tinnitus is merely a perception of sounds which means that it does not exist in reality and therefore does not pose a serious threat to the patient's health.
Tinnitus is the feeling that a tinnitus sufferer gets when he hears sounds in his ears without any identifiable external source. People suffering from tinnitus describe the sounds that they hear as hissing, ringing, whistling, buzzing, or roaring sounds.
WHAT CAUSES THE RINGING IN YOUR EARS?
The most common cause of tinnitus is exposure to very loud sounds such as sounds coming from a lawn mower, a gunfire, from power tools and various machinery.
The ringing in your ears is caused by damage to the stereocilia, those very tiny organelles that act like sensors in the inner ear.
The damage is most likely caused by very loud sounds that the individual has been constantly exposed to such as industrial machines, gun shot sounds, very loud music, various power tools.
Under normal conditions, the stereocilia make moderate movements when they receive sounds in the level of 80 decibels. These movements signal the release of molecules located at the roots of the hair that is responsible for putting the auditory neurons into action in the 8th cranial nerve.
When a person is exposed to very loud sounds, for example at 85 decibels or higher, the stereocilia is forced to bend further than normal. This is when a person starts to hear all sorts of sounds in the ears - ringing, buzzing, hissing - and consider it to be tinnitus. This happens when the hairs found at the cochlea react to the very high-pitched sounds they receive and are in fact the important parts of the ears that are first to be damaged by these very loud sounds.
Damage to the stereocilia can be reversed if the causes of damage are less severe and less frequent.
Types of Tinnitus
Subjective and Objective Tinnitus
The experts on the subject of tinnitus, the otolaryngologists and audiologists agree to the definition of tinnitus as a kind of sound that has no external source and further classify this topic into subjective and objective tinnitus.
Subjective tinnitus is when a patient seems to have heard something but without actually hearing a sound and is usually heard only by the patient himself. Most tinnitus cases are of the subjective type.
The most common diseases that may cause the subjective type of tinnitus are those that involve sensorineural hearing loss disorders, particularly acoustic trauma or noise induced hearing loss, aging or presbycusis, ototoxic drugs and Meniere's disease.
Sensorineural hearing loss occurs when sound makes it to the inner ear but once it's there, the signal is not recognized, or it is misinterpreted because of damage to the tiny fibers in the inner ear, the central hearing nerve of the brain itself.
People with this type of loss often experience a ringing or buzzing sound that occurs intermittently or constantly. For many, this is worse than hearing loss.
For sensorineural losses, treatment can range from using a digital hearing aid, which works extremely well with some patients, to cochlear implants appropriate for people with specific inner ear problems.
Causes of Subjective Tinnitus
Presbycusis is caused by the natural process of aging as the sense of hearing is probably one of the first senses that is affected when a person gets older.
Otosclerosis is a disease that runs in the genes characterized by an unexpected growth of a bone near the middle ear which could lead to a person's loss of hearing.
Ototoxicity is the state of an object or substance that is damaging to the ears particularly to the auditory nerve (cochlea) and the vestibular system. It is one of the more common causes of hearing loss. The medications taken by an otherwise healthy patient may be gradually and silently damaging his cochlea.
Ear-damaging drugs that may cause sensorineural hearing loss and loss of equilibrium are:
- Antibiotics. Certain antibiotics should be avoided as they cause permanent damage to the cells of the cochlea. The antibiotic gentamicin for example is used to treat Meniere's disease and is effective in the treatment of vertigo but results to permanent hearing loss. If you are right now taking this type of antibiotic and are aware of this side effect, you need to discuss this with your doctor.
Another antibiotic, erythromycin, can also damage the ears but it is reversible with proper treatment.
- loop diuretics
- drugs used in chemotherapy especially those containing platinum, and
- non-steroidal anti-inflammatory drugs (NSAIDs) may cause sensorineural hearing loss and loss of equilibrium.
Meniere's disease is a disease that affects the inner ear where the person experiences hearing loss, vertigo and tinnitus. The loss of hearing happens in each ear at separate occasions and eventually becomes permanent.
Long-term exposure to noise. The extent of damage caused by long-term exposure to noise ranges from severe damage to total death of hearing cells.
Hearing loss occurs when the hair cells in the ears are over stimulated which leads to the production of reactive oxygen species leading to oxidative stress that eventually cause cell death.
The best protection from extreme noise is wearing of earplugs or ear muffs.
Neoplasm is tissue found surrounding the inner ear that has developed abnormally. This growth is usually but not always accompanied by a mass. A neoplasm is classified into three categories: benign, potentially malignant, or malignant. If a patient has this in his/her ear, it could be considered a cause of hearing loss.
Tinnitus that is caused by neural degeneration is irreversible and cannot be treated by any type of medicines or cannot be remedied by surgery.
Objective tinnitus means sounds are not being conducted or not getting through to the inner ear at all where the interpretation of sound occurs.
These include obstruction of the ear canal by cerumen or earwax, a foreign body, or external otitis. Otitis media, barotrauma, eustachian tube dysfunction, and otosclerosis may also be associated with objective tinnitus.
Temporomandibular joint dysfunction or TMJ, a dental related problem, may also be associated with tinnitus in some patients.
Objective tinnitus typically is pulsatile or follows the beating of the heart, or intermittent. In this case, tinnitus is most noticeable in quiet environments and in the absence of distracting stimuli and becomes worst at bedtime.
FINDINGS FROM STUDIES AND RESEARCH
Experts also say that damage to the auditory system is another major cause of tinnitus.
An article published in the Journal of the American Academy of Audiology in 2000 reported that the ringing in the ears experienced by tinnitus patients occur when the normal activities going on inside the auditory system is disrupted . These findings are the result of electrophysiologic and behavioral studies to further evaluate the changes that take place in the brain, and the changes in the patient's perception.
An article in the British Journal of Health Psychology reported a study conducted to determine the coping mechanisms of those who suffer from tinnitus and described 3 coping styles which are the maladaptive coping style, effective coping style and passive coping style.
Maladaptive coping, also called non-coping style, is a short-term strategy of coping with tinnitus. It only provides temporary relief from the symptoms but it does not attempt to remove or completely eliminate the symptoms.
Acute and Chronic Tinnitus
Tinnitus can be acute or chronic. It is considered in the acute stage when the attacks only lasts for days or weeks due to damage to the ears caused by constant exposure to very loud sounds. It may have also been caused by medication, injury to the head or neck area, ear infection or a very simple ear wax; it can also be due to the fluctuations in a person's blood pressure or to body metabolism.
It is considered in the chronic stage when the attacks are experienced for a period of 6 months and beyond. The causes are the same as with the acute stage tinnitus but this is experienced more by those who are already suffering from some kind of hearing loss.
It is estimated that there are currently 40 million people in the US who suffer from tinnitus and this incidence increases with age. Among the tinnitus sufferers who belong to the age group 45 years and older, 27 percent are males and 15 percent are females.
Among those who suffer from chronic tinnitus, only 25 percent find the symptoms to be a bothersome problem and say this percentage of people are the ones who are more likely to find an effective treatment for this disorder.
State-of-the-art imaging procedures such as MRI or Magnetic Resonance Imaging and PET or positron-emission tomography scan reveal that chronic tinnitus happens when parts of the brain's auditory cortex becomes hyperactive.
Patients who experience severe tinnitus are believed to suffer from MDD or major depressive disorder but those who experience mild ringing in the ears are said to be neither severely depressed nor bothered by the sounds in their ears.
One kind of disruption that occurs in the ears is otitic barotrauma which is usually experienced when a person travels by air. This happens when the middle ear becomes inflamed due to the difference in the air pressure between the middle ear and the atmosphere outside the ear which occurs during take off and landing.
This is characterized by feeling of fullness in the ear, temporary deafness and otalgia and can result to damage to the tympanic membrane and rupture of the membrane of the round window.
Treatment of tinnitus
There are at present three methods in treating tinnitus: physical, psychosomatic and chemical. The chemical method seems to be the most effective as it is user friendly, it takes a little time to use, gives a more accurate result and it does not rely too much on the patient's intellect and active participation.
© 2012 Zee Mercado