Tinnitus

Introduction

Tinnitus is harmless. However, depending on the severity, those affected may suffer from ear noises such as whistling, ringing or hissing. These impairments can in turn trigger further symptoms. The causes of tinnitus are complex, but the main cause is stress. In most cases, the ringing in the ears disappears on its own.

Around 15 per cent of the Swiss population suffer from acute ringing in the ears. This means that around half a million people are affected by tinnitus in some form, either temporarily or permanently. Around 30,000 of them require treatment. Chronic tinnitus is less common - around four per cent of adults in Switzerland are affected. However, the proportion of young people whose hearing is impaired has also been increasing in recent years. The reason for this is noise exposure during leisure time - for example through the consumption of loud music at concerts, with smartphones or MP3 players.

Symptoms

Tinnitus is not a disease, but a symptom. It usually occurs continuously in the form of whistling, ringing, hissing or buzzing. This symptom, which is often very distressing for patients, can lead to other symptoms. For example, those affected may also suffer from sleep disorders, irritability, concentration problems, headaches or earaches, dizziness, anxiety, depressive moods or depression. These stresses can severely restrict patients' everyday lives. The additional symptoms can lead to increased stress, which in turn can intensify the tinnitus.

Specialists categorise tinnitus into different levels of severity:

Compensated tinnitus (grade I to II): The sufferer is aware of the ringing in the ears but can cope with it. There are no health problems and the quality of life is not further impaired.

• Grade I: no suffering
• Grade II: Tinnitus occurs mainly in silence and is more pronounced under stress and strain.

Decompensated tinnitus (grade III to IV): The tinnitus impairs health and causes a high level of suffering.

• Grade III: Persistent impairment in private and professional life. Disturbances occur in emotional, cognitive and physical areas - for example, concentration problems, muscle tension, sleep problems or social withdrawal.
• Grade IV: Those affected are constantly aware of tinnitus; the noises in their ears are a massive burden on their private and professional lives. Other health problems occur more frequently, leading to incapacity to work.

Course

In around 70 % of all cases, tinnitus disappears - or at least improves - in the course of treatment. The duration of the annoying ringing in the ears varies greatly: in some patients, the noises disappear after a short time, while sometimes the symptoms only subside after months or years. Tinnitus does not always disappear completely. In these cases, sufferers must learn to live with the ringing in their ears: Rest and relaxation are important. Silence should be avoided, however, as the noises in the ear are perceived even more strongly in silence. Patients can learn appropriate measures in specific tinnitus counselling sessions. As a general rule, however, if the ringing in the ears persists for longer than one or two days (wait for spontaneous healing), an ear, nose and throat specialist should be consulted.

Causes

Tinnitus can have numerous causes - but the main cause is stress. The body releases a stress hormone which constricts the blood vessels and thus impairs blood flow. If, for example, the inner ear is no longer sufficiently supplied with blood, this can lead to tinnitus. However, there are also physical causes of tinnitus:

• Noise trauma, for example, due to loud music, engine noises or bangs
• High blood pressure, low blood pressure
• diabetes
• ear inflammation
• sudden hearing loss
• dizziness
• Medication
• Alcohol, nicotine and caffeine in high doses
• Problems with the cervical spine

The first symptom of the benign tumour vestibular schwannoma

Specialists distinguish between two types of tinnitus: so-called subjective tinnitus is only perceived by those affected and can be a concomitant symptom of other illnesses. Objective tinnitus can be diagnosed by doctors using special equipment.

Diagnosis

As ringing in the ears can have many causes, a doctor must rule out the presence of other illnesses by taking a detailed medical history and making a diagnosis. An ear, nose and throat specialist will examine the patient thoroughly and carry out a hearing test. The examination will also identify any accompanying hearing loss or sudden deafness. Additional examinations may be necessary to rule out other illnesses - for example, blood tests to rule out infections with herpes, measles, mumps, Lyme disease or syphilis. Closer examinations of the skull or cervical spine also support the diagnosis of tinnitus.

Treatment

As part of tinnitus treatment, patients are usually given anti-inflammatory and blood circulation-promoting agents in the form of infusions and tablets.

If the symptoms have been present for three months or less, the tinnitus is acute. The ringing in the ears often disappears as quickly as it appeared. If an earwax plug is the cause of the ringing in the ears, a doctor can easily remove it.

If the symptoms persist for more than three months, this is chronic tinnitus. As chronic tinnitus often causes other symptoms such as sleep disorders, irritability, concentration problems, dizziness or depressive moods, psychotherapy can support the treatment if necessary. Those affected learn to control stress better and "overhear" the tinnitus. The tinnitus fades into the background through behavioural therapy - autogenic training or yoga can help here.

Special hearing aids (so-called maskers or noisers) can drown out tinnitus or cover it with other sounds to such an extent that the affected person no longer hears the tinnitus or only hears it to a lesser extent. Patients with tinnitus who also complain of hearing loss are recommended to use a hearing aid (possibly a special tinnitus hearing aid).

Prevention

Tinnitus cannot be prevented with specific measures. However, as noise is increasingly responsible for ringing in the ears, it is advisable to wear earplugs when going to concerts or discos. Hearing protection should also be used for loud manual work. It is generally advisable to avoid stress, abstain from drugs and nicotine and only drink alcohol in moderation.