Understanding Tinnitus

What is Tinnitus?

Tinnitus perception है sound का बिना किसी external source के। यानी, आपको कुछ सुनाई दे रहा है लेकिन वह आवाज बाहर से नहीं आ रही – आपके कान या brain में generate हो रही है।

Local Terms – लोग कैसे Describe करते हैं:

• “कान में सीटी बज रही है” (most common)
• “कान में साय-साय की आवाज आ रही है”
• “कान में भिनभिनाहट है”
• “कान बज रहा है”
• “कान में घंटी/झंकार है”
• “हवा के जैसे आवाज आती है”

Types of Tinnitus

1. Subjective Tinnitus (सबसे Common – 95%)

• Only patient को सुनाई देता है
• Examiner नहीं सुन सकता
• Due to problems in auditory system (ear या brain)

2. Objective Tinnitus (Rare – 5%)

• Examiner भी सुन सकता है (stethoscope से)
• Actual physical sound generate हो रहा है body में:
  • Blood vessel abnormalities (pulsatile tinnitus)
  • Muscle contractions (middle ear muscles)
  • Eustachian tube issues

Characteristics

Duration:

• Acute: < 3 months
• Chronic: > 3 months (more common, difficult to treat)

Laterality:

• Unilateral: One ear में (worrisome – needs thorough workup)
• Bilateral: Both ears में
• Central: “सिर में आवाज लग रही है”

Pattern:

• Continuous: Constantly present
• Intermittent: आता-जाता रहता है
• Pulsatile: Heartbeat के साथ (suggests vascular cause)

Severity:

• Mild: केवल quiet environment में notice होता है
• Moderate: Daily activities में aware रहते हैं but manageable
• Severe: Sleep, concentration seriously affected
• Catastrophic: Completely disabling

Causes of Tinnitus

1. Ear-Related Causes (Most Common)

A. Cerumen Impaction (Ear Wax Block)

सबसे common treatable cause!

• Mechanism:
  • Wax blocks ear canal completely
  • Touches eardrum
  • Abnormal pressure → tinnitus
• Clue: Sudden onset, associated hearing loss
• Relief: Immediately after wax removal – dramatic!

B. Noise-Induced Hearing Loss (NIHL)

Very Common in हरदोई:

• Sources of Loud Noise:
  • Occupational: Tractor drivers, factory workers, mill workers, carpenters (machine tools)
  • Recreational: Loud music (wedding bands, DJ), firecrackers (Diwali), gunshots (hunting)
  • Environmental: Heavy traffic, loudspeakers (rallies, festivals)
• Mechanism:
  • Loud noise damages hair cells in cochlea
  • These cells don’t regenerate
  • Damaged cells send abnormal signals → tinnitus
• Pattern:
  • After loud exposure – temporary tinnitus (few hours)
  • Repeated exposure → permanent damage → chronic tinnitus

C. Presbycusis (Age-Related Hearing Loss)

• Natural aging process
• High-frequency hair cells degenerate first
• Usually >60 years
• Bilateral, gradual
• Tinnitus often accompanies

D. Otitis Media (Ear Infection)

• Acute: Fluid in middle ear → pressure changes
• Chronic: Ear discharge, drum perforation
• Usually associated hearing loss
• Tinnitus improves with infection treatment

E. Otosclerosis

• Abnormal bone growth around stapes (middle ear bone)
• Conductive hearing loss
• More common in females, young adults
• Progressive

F. Meniere’s Disease

• Inner ear disorder
• Classic Triad:
  • Episodic vertigo (चक्कर)
  • Fluctuating hearing loss
  • Tinnitus
  • Aural fullness (कान में भरा हुआ feel)
• Dr. Prateek Porwal specializes in Meniere’s disease at Prime ENT Center

G. Acoustic Neuroma (Rare but Important)

• Benign tumor on hearing nerve
• Red Flags:
  • Unilateral tinnitus (one ear only)
  • Progressive hearing loss same side
  • Balance problems
• Needs MRI for diagnosis

H. Eustachian Tube Dysfunction

• Tube connecting middle ear to throat
• Doesn’t open properly → pressure imbalance
• Clicking, popping sounds
• Muffled hearing

2. Systemic Causes

A. Anemia (खून की कमी)

यह वही “कमजोरी” है जिसके बारे में लोग सोचते हैं!

• Low hemoglobin → reduced oxygen to cochlea
• Associated Symptoms:
  • Fatigue (थकान)
  • Pallor (चेहरा पीला)
  • Breathlessness
  • Palpitations (Pulsatile tinnitus)
• Common in India – nutritional deficiency
• Improves with treatment (iron, B12 supplements)

B. Hypertension (High BP)

• Pulsatile tinnitus common
• “दिल की धड़कन सुनाई देती है”
• BP control करने से improves

C. Diabetes

• Damages small blood vessels in inner ear
• Neuropathy can affect auditory nerve

D. Thyroid Disorders

• Both hypo और hyperthyroidism
• Associated symptoms guide diagnosis

E. Cervical Spondylosis

• गर्दन की problem
• Affects blood supply to ear
• Common in elderly, computer users

3. Medications (Ototoxic)

Some medicines can cause tinnitus:

• Aspirin: High doses
• NSAIDs: Pain relievers (prolonged use)
• Aminoglycoside Antibiotics: (Streptomycin, Gentamicin)
• Loop Diuretics: (Furosemide)
• Antimalarials: (Quinine, Chloroquine)
• Chemotherapy drugs
• Usually reversible if detected early and stopped

4. Psychological Factors

• Stress & Anxiety: Can worsen existing tinnitus
• Depression: Bidirectional – tinnitus causes depression, depression worsens tinnitus
• Sleep deprivation

5. TMJ (Jaw Joint) Disorders

• Temporomandibular joint very close to ear
• Jaw problems → referred tinnitus
• Clicking jaw, pain while chewing

When to See ENT Doctor – Red Flags 🚨

Urgent Evaluation Needed If:

• ❗ Sudden Onset Unilateral Tinnitus (one ear में अचानक) – rule out tumor, vascular issue
• ❗ Pulsatile Tinnitus (heartbeat के साथ) – vascular abnormality?
• ❗ Associated with:
  • Sudden hearing loss
  • Vertigo (severe चक्कर)
  • Facial weakness/numbness
  • Severe headache
• ❗ Suicidal thoughts (severe tinnitus can be extremely distressing)

Soon – Schedule Appointment:

• Tinnitus > 3 months (chronic)
• Progressive worsening
• Affecting daily life, sleep
• Associated hearing difficulty

Diagnosis & Evaluation at Prime ENT Center

1. Detailed History

Dr. Harshita Singh या Dr. Prateek Porwal पूछेंगे:

• Tinnitus Characteristics:
  • कैसी आवाज है? (Whistle, buzz, hiss, roar?)
  • कब शुरू हुई?
  • One ear या both?
  • Constant या intermittent?
  • Pulsatile?
• Associated Symptoms:
  • Hearing loss?
  • Vertigo (चक्कर)?
  • Ear fullness?
  • Ear pain या discharge?
• Triggers/Relieving Factors:
  • Worse when? (quiet room, stress, lying down?)
  • Better when? (noise environment?)
• Noise Exposure History:
  • Occupational?
  • Recreational?
  • Use ear protection?
• Medical History:
  • Diabetes, hypertension, thyroid?
  • Previous ear surgeries?
  • Head trauma?
• Medications: Current और recent
• Impact on Life:
  • Sleep disturbance?
  • Concentration problems?
  • Emotional impact? (anxiety, depression?)

2. Clinical Examination

Otoscopy (Ear Examination):

• Check external ear canal
  • Wax impaction?
  • Foreign body?
  • Infection?
• Eardrum visualization
  • Perforation?
  • Fluid behind?
  • Retraction?

Tuning Fork Tests:

• Weber test
• Rinne test
• Differentiate: Conductive vs Sensorineural hearing loss

Auscultation (सुनना):

• If pulsatile tinnitus – stethoscope से neck, ear के पास सुनते हैं
• Vascular bruit?

3. Audiological Tests – Very Important!

A. Pure Tone Audiometry (PTA)

Gold Standard for Hearing Assessment

Procedure:

• Soundproof booth में
• Headphones पहनते हैं
• Different frequencies और volumes की tones सुनाई जाती हैं
• Patient button press करता है जब सुनाई दे

Information Provided:

• Hearing threshold (कितना soft sound सुन सकते हैं)
• Type of hearing loss (conductive, sensorineural, mixed)
• Severity
• Which frequencies affected (high, low?)

B. Tympanometry

• Middle ear function test
• Eardrum mobility measure करता है
• Detects: Fluid, Eustachian tube dysfunction, ossicular chain problems

C. Otoacoustic Emissions (OAE)

• Cochlear (inner ear) function test
• Objective – patient cooperation नहीं चाहिए
• Hair cell function assess करता है

D. Tinnitus Match & Loudness Measurement

• Specialized audiometry test
• Tinnitus की pitch और loudness को objectively measure करते हैं
• Treatment के बाद comparison के लिए useful

4. Imaging (If Indicated)

When Needed:

• Unilateral tinnitus
• Asymmetric hearing loss
• Pulsatile tinnitus
• Neurological symptoms

Modalities:

• MRI Brain with IAC (Internal Auditory Canal): Best for acoustic neuroma
• CT Temporal Bone: Bony pathology, cholesteatoma
• MRI/MRA (Angiography): Vascular causes of pulsatile tinnitus

5. Blood Tests

• CBC: Anemia?
• Thyroid Function Tests: TSH, T3, T4
• Blood Sugar: FBS, HbA1c (diabetes)
• Lipid Profile: Vascular risk
• Vitamin B12, Folate: Deficiencies

Treatment at Prime ENT Center

Important Understanding:

There is no “magic pill” that cures all tinnitus। Treatment approach depends on cause। कुछ causes completely treatable हैं (wax, infection), कुछ manageable हैं (hearing aids, sound therapy), और कुछ के लिए हम coping strategies सिखाते हैं।

1. Treat Underlying Cause – First Priority

If Ear Wax:

• Wax removal (syringing, suction, microsuction)
• Immediate relief usually

If Ear Infection:

• Antibiotics (oral या ear drops)
• Clears infection → tinnitus improves

If Anemia:

• Iron supplements
• B12 injections (if deficient)
• Diet modification
• Tinnitus gradually improves as hemoglobin increases

If Hypertension:

• BP control (medicines, lifestyle)
• Pulsatile tinnitus reduces

If Ototoxic Medicine:

• Stop या change medication (consult prescribing doctor)
• May reverse if caught early

If Acoustic Neuroma:

• Referral to neurosurgeon
• Surgery या radiation

2. Sound Therapy

Principle: Mask the tinnitus sound

A. Environmental Sound Enrichment:

• Background noise use करें:
  • Fan चलाएं
  • Soft music
  • Nature sounds (rain, waves)
• Especially helpful at night (sleep के लिए)
• Tinnitus कम prominent feel होता है

B. Hearing Aids:

• If associated hearing loss
• Amplifies external sounds
• Tinnitus relatively कम सुनाई देता है
• Very effective! 60-70% improvement

C. Tinnitus Maskers:

• Special devices – ear में wear करते हैं
• Produce white noise या specific sound
• Masks tinnitus

D. Combination Devices:

• Hearing aid + masker in one
• Best option if both hearing loss and tinnitus

3. Tinnitus Retraining Therapy (TRT)

Gold Standard for Chronic Tinnitus Management

Concept:

• Brain को tinnitus signal को ignore करना सिखाते हैं
• “Habituation” – जैसे हम background AC sound को ignore कर देते हैं

Components:

• Counseling: Tinnitus के बारे में education, fear removal
• Sound Therapy: Specific low-level sound exposure
• Duration: 12-18 months
• Success rate: 80% improvement

4. Cognitive Behavioral Therapy (CBT)

• Psychological approach
• Change negative thought patterns about tinnitus
• Coping strategies
• Reduces distress, improves quality of life
• Very effective for severe cases with anxiety/depression

5. Medications – Limited Role

No specific “tinnitus medicine” exists। However:

• Antidepressants/Anti-anxiety:
  • If significant psychological distress
  • Doesn’t cure tinnitus but helps cope
• Steroids:
  • For sudden sensorineural hearing loss with tinnitus
  • Early treatment essential
• Vasodilators, Ginko Biloba:
  • Controversial, limited evidence
  • May try for 2-3 months

6. Lifestyle Modifications

• Avoid:
  • Loud noise: Use ear protection in noisy environments
  • Caffeine: Can worsen tinnitus in some
  • Alcohol: May exacerbate
  • Salt: If Meniere’s disease
  • Smoking: Affects blood circulation
• Practice:
  • Stress management (yoga, meditation)
  • Regular exercise
  • Good sleep hygiene
  • Stay active – don’t isolate

Myths vs Facts

❌ Myth 1: कान में सीटी = कमजोरी

✅ Fact: Tinnitus के बहुत सारे causes हैं। Anemia one possible cause है but not the only one। Proper evaluation जरूरी है।

❌ Myth 2: Tinnitus का कोई इलाज नहीं

✅ Fact: बहुत से cases में underlying cause treatable है। Chronic cases में effective management strategies हैं।

❌ Myth 3: यह सिर्फ बुढ़ापे की problem है

✅ Fact: किसी भी age में हो सकता है। Young adults में noise exposure से बहुत common।

❌ Myth 4: अपने आप ठीक हो जाएगा

✅ Fact: Acute tinnitus may resolve, लेकिन >3 months chronic = medical evaluation जरूरी है।