Tinnitus is the perception of sound without any external auditory stimulus. The perceived sound can be described in various tones and characteristics, such as ringing, humming, wind noise, or the sound of a machine operating. Regardless of its nature, all types of sounds are categorized under “ringing” or “tinnitus.”
There are numerous causes that can lead to tinnitus. These range from simple causes like the accumulation of earwax in the external auditory canal to rare but serious causes such as malignant tumors. Therefore, all cases of tinnitus should be taken seriously, and basic examinations and evaluations must be conducted. Although tinnitus can be observed at any age, it is more commonly seen in older individuals.
Tinnitus is fundamentally divided into two groups.
Objective Tinnitus:
This refers to actual sounds originating from the ear region or adjacent organs and tissues, even though they are not clearly audible from the outside. These sounds can be detected during a careful examination. It is usually caused by turbulence in the blood flow within tumors rich in blood vessels or vascular anomalies. Involuntary rhythmic contractions of muscles around the middle ear or Eustachian tube (myoclonus) can also lead to objective tinnitus. This is a relatively rare cause of tinnitus.
Subjective Tinnitus:
This is the major group of tinnitus cases. It involves the perception of sounds without any external or internal source of sound.
The most common causes include:
- Age-related degeneration of the hearing organs in the inner ear (cochlea)
- Hearing losses caused by various factors
- Narrowing and circulatory disorders in the blood vessels leading to the ear
- Exposure to noisy environments (sound trauma)
- Middle ear infections
- Diseases of the external auditory canal
- High levels of cholesterol and other fats
- Hypertension
- Psychological factors (depression, stress)
- Medications used (aspirin, certain antibiotics, etc.)
- Considering that tinnitus is not a standalone disease but a symptom of another pathology, diagnosis should be attempted accordingly. However, in most cases, since the actual cause of tinnitus cannot be identified, treatment focuses on reducing tinnitus or adapting to living with it. For patients presenting with tinnitus, the following should be done:
- Detailed medical history and complete physical examination
- Otoacoustic tests (targeting the middle and inner ear)
- Blood pressure measurement
- Blood tests (blood sugar, cholesterol, liver, thyroid hormone examinations)
- Radiological examinations (normal X-rays, computed tomography, or magnetic resonance imaging based on suspected pathology).
If a disease that could cause tinnitus is identified through these tests, treatment of that disease is attempted. However, even successful treatment of the existing disease may not completely eliminate tinnitus. In cases of benign and malignant tumors and vascular anomalies causing tinnitus, surgery is the first option.
Regardless of the cause, the most frequently used method to reduce tinnitus is medication. For this purpose, medications that increase blood flow to the inner ear or regulate the activity of the hearing cells in the inner ear are used (Tebokan, Vitamin B, Vastarel, Ginkgo Biloba, Corticosteroids).
If tinnitus is severe enough to affect the patient’s daily life, devices known as tinnitus maskers, similar to hearing aids, can be beneficial. These devices aim to reduce the sensitivity of the areas causing tinnitus by providing sounds at the same frequency as the tinnitus through the inner ear. For patients who have difficulty falling asleep due to tinnitus, listening to music before bedtime can be a practical method.
A new method that has been used in tinnitus treatment in recent years is Low-Level Laser Therapy (Tinnitool=soft laser). This approach is based on the principle that certain wavelengths of laser light applied to damaged tissues have significant positive effects on tissue and cell healing and functions. Although this method has achieved quite good results with consecutive treatment sessions using appropriate wavelengths and doses, it should not be considered a definitive treatment that completely cures all types of tinnitus. It is especially preferred in chronic cases where medication is ineffective and is used alongside antiviral treatments in acute cases. In patients without an organic pathology and who do not benefit from medication and laser therapy, tinnitus adaptation therapy (Tinnitus Retraining Therapy) is recommended.
Recently, I had the opportunity to use Tinnitool on a small number of patients. Initially, I find it generally amusing in resistant cases.