It is the perception of sound in the head or in the ear without an external stimulus. The perceived sound can be described as ringing, hum, wind noise or the working sound of a machine. All kinds of sounds regardless of their characteristics ” tinnitus” or “tinnitus”It is named as ”.
Tinnitus is considered a symptom, not a disease.
2- What is the sound of tinnitus? Can others hear these sounds?
They are usually monotonous (monotonous) sounds. The sound may be a deep, low sound (wind sound, hum) or it may be thin, high-pitched (ringing, ringing). Tinnitus, which occurs from time to time and lasts for a very short time, can happen to all of us, but tinnitus, which is constantly heard in quiet environments, can make the patient’s life very difficult.
– It is not usually possible for others to hear this sound, but in some cases, the person approaching the patient’s ear can also hear the sound. This type of tinnitus objective tinnitus is called. This condition mostly develops due to a vascular abnormality or due to the sounds that occur in the middle ear as a result of the contraction of the muscles of the palate and jaw joint region.
II. Subjective ringing:
The lesion is classified according to its location as follows:
1. External ear canal: Foreign body, plug, infections, benign and malignant tumors, atresia (Congenital and traumatic),
2. Eardrum: Perforation, atelectasis,
3. Middle ear: Effusion, fixation and disruption of continuity in the ossicular system, cholesteatoma, tumors (Glomus tumor, neuroma originating from the facial nerve, hemangioma, carcinoma),
4. Cochlea: All events causing sensorineural hearing loss (Meniere’s disease, presbycusis, head trauma and acoustic trauma, ototoxic drugs, labyrinthitis),
5.Retrocochlear: Causes related to internal acoustic canal, cerebellopontine corner region (Acoustic neuroma, cholesteatoma, facial nerve neuroma, meningioma) and central nervous system (Tumors, inflammatory events)
6. Other causes: Vitamin deficiencies, trace element deficiencies (Copper, iron, zinc), metabolic disorders (Hypothyroidism, diabetes mellitus), jaw and dental disorders, neck region problems
3-What are the causes of tinnitus? Can we specify risky groups in the society?
Tinnitus is seen in 35% of the general population in varying degrees, and 2% in severe form.
Tinnitus is most common between the ages of 40 and 80 throughout life.
– It has been reported that the female male ratio is equal or higher than the male ratio (46.5% / 53.3%).
-Bilateral tinnitus in 50-55.8% of patients;
-Tinnitus in one ear is seen more on the left side.
The most important factor affecting the incidence of tinnitus is the level of hearing. As the degree of hearing loss increases, the incidence of tinnitus increases.
It has been determined that exposure to noise increases the formation of tinnitus.
It is more common in smokers.
-stress, depression, excessive tea coffee-tea consumption increases ringing.
4-Does tinnitus always accompany hearing loss?
Hearing of 10% of patients with tinnitus is within normal limits.
When there is tinnitus, hearing loss is usually detected in the tests performed. This could be for 2 reasons
1-Really inner ear is affected or
2-Because there was humming during the test, the person who had the test could not hear the sounds.
Therefore, my suggestion is to repeat the hearing test after the hum is suppressed by the treatment given by your doctor, even if there is a decrease in hearing.
5-How do you determine the treatment protocol for tinnitus?
– First of all, it is necessary to recognize the patients suffering from this disease;
-These patients are generally people who have visited many doctors, are confused because they have read a lot of information on the internet, and think that there is something wrong with them or that they can remain deaf.
– Some are people who take painkillers and think that the pain will go away and the doctor will give me a medicine and it will pass.
-Usually, it is said by most doctors that the hum will not go away; These are the patients who have been given medication for a certain period of time and discontinue the medication because there is no change.
That’s why the patients who apply to me are usually the people who come as a last resort with their helpless psychology.
1- First of all, a good story in these patientsIt should be taken and asked how long the hum has been, what kind of sound it looks like, its regularity during the day, the diseases and the drugs used.
– With the history taken, it should be explained that this disease cannot be diagnosed by looking at only one part, which we call multidisciplinary, and many parts can come into play to detect the factors causing the hum.
-The approach of the doctor to take this medicine for 3-6 months is completely wrong.
It should be believed that this problem will be solved with patience and the treatment and recommendations given by the doctor.
*** It is not possible to overcome this problem without patience and effort.
2-A very good physical examination should be done.
-Generally, the biggest mistake or deficiency made by us in these patients is here. Either because we just look at the ear with an otoscope and don’t see anything, a lot of unnecessary and expensive tests are requested or they are not done but they are tried and medicine is given. Sometimes, it is not my job to say and look at the mandatory areas, I think.
-After I looked at the ear with an otoscope during the examination, even though it was not my branch, I knew that the patient was left in the middle because of this ailment and was helpless. I am looking at eye movements, which are the organs that absolutely respond to sound, neck movements that make our head turn to the sound side, speech and therefore jaw movements.
-My findings I am trying to determine how many decibels the hum is at which frequency by doing an audiological examination.
– If necessary, I refer the patient to the department that I may be interested in, in order to combine the findings and ask for help and examination from other departments.
6-Who should be in the treatment protocol team in a multidisciplinary approach?
1-Absolute ENT AND AUDIOLOGY
2- If something like a mass or tumor is thought, Neurology and or Neurosurgery
3-Psychiatry if the patient’s psychology has broken or is close to
4-Internal Medicine for other diseases or drugs used
5-I think FTR and PHYSIOTHERAPY programs that I have never been to, but which I think are obligatory
7-What are the applications in the treatment of tinnitus?
In the classical approach; Since the true cause of tinnitus cannot be determined in most cases, treatment is recommended to reduce the target tinnitus, or to get used to living with tinnitus. Rarely, tinnitus suppressive hearing aids, laser therapy, hyperbaric oxygen therapy or, very rarely, surgery are used.
8-Who is the manual therapy program applied to in the treatment of tinnitus?
-Here is the most important point that I determined as a result of my 20 years of ENT specialist experience, which directed me to this treatment and was added to the classical treatment.
In my studies, I detected stiffness, pain or limitation of movement in the ipsilateral neck region in most of the patients with tinnitus.
1-35 % herniation in the C2-C3 region and/or compression of the anterior subarachinoid space
2-5% C3-C4, herniation in the region and/or compression of the anterior subarachinoid space
3-%20 herniation in the C4-C5,C5-C6,C6-C7 region and/or compression of the anterior subarachinoid space
5-20% flattening only in the neck
In almost all of these patients, eye twitches, which we call nystagmus in that ear, were detected in the rapid phase, which we see in vertigo in the ear, which is buzzing in the eye examination. When these findings are put together, it has been suggested that there is a general nutritional problem in the structures that provide both balance and hearing in the inner ear or that the hum is triggered due to muscle spasm of the vestibulo-spinal and/or cochleo-spinal tracts in the neck region.
That’s why I recommend manual therapy applications to relax the muscles of the neck region in the treatment of humming.
– If I find the reason for humming as jaw joint (TMJ) diseases in some patients, I recommend physical therapy again.
9-What is the treatment expectation, points to be considered and the success rate?
It can reach 60-90% with patience, effort and work.
-Increased-decreased intensity or change in the shape of the hum during treatment indicates that it responds to the treatment. Do not panic.
10-Finally, what can you suggest to patients here?
1-Avoid exposure to loud noise
2- Have your blood pressure checked constantly. If it is high, contact your doctor to have it under control.
3-Restrict salt intake (excess salt is harmful to the cardiovascular system and inner ear). Avoid salty foods and don’t add salt to your food.
4.-Stay away from coffee, cola and cigarettes, which have a stimulating effect on the nervous system.
5-Daily physical exercises regulate your blood flow.
6-Get enough rest and avoid getting too tired.
7-Do not worry about the presence of tinnitus. Tinnitus does not make you deaf or lose your mind. Accept these sounds as a disturbing but insignificant fact and learn to ignore them as much as possible. This kind of control can be achieved by self-advocacy.
8- Minimize your nervousness and tension.
9- Pay attention to the neck posture, make movements to relax your neck while doing your work, do not stay in the wind while your neck is sweaty.
10- Not focusing on tinnitus by diverting attention to other points
11th –Not staying in a quiet environment, having a device that makes the sound of music or the sound of the ocean or makes a sound such as a fan will suppress the hum.
12- In most patients, placing the palms of both hands on the nape area, where the hair ends, with the palms grabbing the ears, and placing your index fingers on your long fingers (like the opposite sign, should we cuss?)