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Tinnitus Frequently Answered Questions v2.7 |
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Last-modified: 23 August 1996
Version: 2.7
Tinnitus Frequently Answered Questions
Last update v2.7, August 30, 1996
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What's New
* A new FAQ maintainer has stepped forward. Stay tuned for a new and
easier to use FAQ, coming soon.
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What Was New In Recent Updates
* In v.2.6-Updated German language Web Page URL. See: What online
resources are available?
* In v.2.5-What online resources are available?
o http://www.ohsu.edu/ohrc-otda/ Oregon Tinnitus Data Archive- A
reference source for those desiring quantitative information
about clinically-significant tinnitus.
o http://www.ucl.ac.uk/~rmjg101/tinnitus1.html "Tinnitus Retraining
Therapy"- ..."tinnitus management in our clinics is a result of
retraining and relearning"....
o http://www.cdc.gov/niosh/noise2a.html NIOSH- Occupational Noise
and Hearing Conservation page. Provides a basis for a recommended
standard to reduce permanent noise damage.
* In v.2.4-What online resources are available?
http://www.teleport.com/~ata The Home Page Site (under construction)
for the "American Tinnitus Association".
* In v.2.4-What organizations can I turn to for more information? A new
Tinnitus Organization in Spain: ASOCIACION DE PERSONAS AFECTADAS POR
TINITUS(Acúfenos)
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About the Tinnitus FAQ
Welcome to the Tinnitus FAQ. At the present time, there are many questions
about tinnitus, but few definitive answers that apply to all sufferers. If
you have any additional insights not covered in this document, please help
your fellow tinnitus sufferers by contacting the FAQ Maintainer, Lee
Leggore, at nomader@eskimo.com.
IMPORTANT DISCLAIMER: This document is not a substitute for advice from a
competent health care provider specializing in tinnitus. Many of the
underlying medical conditions can be serious, if not fatal, and several of
the listed treatments may have dangerous side-effects. Contact one of the
tinnitus organizations listed in this document if you are seeking a
referral to a skilled physician. The Tinnitus FAQ may contain material
contrary to opinions of the tinnitus research community.
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About the Tinnitus FAQ Maintainer
I (Lee Leggore) began maintaining this FAQ in September of 1995. I was born
8/2/51. I have had Tinnitus and Hyperacusis since 1982. In 1985 I became a
member and contact person with, "American Tinnitus Association".
In 1993, I became involved in computer science at, "Tacoma Community
College", where I previosly earned a diploma in Management. Other than,
"Basic First Aid and CPR", I am WITHOUT medical training. Everything in
this FAQ is the contribution of many, many people, who submitted via
private e-mail and indirectly via public postings to alt.support.tinnitus.
While I will always try to answer questions via private e-mail, you will
hopefully reach people with better expertise than I by posting publicly to
the newsgroup: alt.support.tinnitus (Be advised/warned that this newsgroup
has had obscene posting and you may be quite repulsed by them! Please! Do
not respond to them!)
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In addition to being posted monthly to the Usenet newsgroups
alt.support.tinnitus, news.answers, and alt.answers, this FAQ can also be
found at:
* http://www.cccd.edu/faq/tinnitus.html
* http://www.cccd.edu/faq/tinnitus.txt
* ftp://ftp.cccd.edu/pub/faq/tinnitus.html
* ftp://ftp.cccd.edu/pub/faq/tinnitus.txt
* ftp://rtfm.mit.edu/pub/usenet/news.answers/medicine/tinnitus-faq
* And many other Usenet *.answers FAQ archive sites
To retrieve this FAQ in 150+K large, single message entirety via e-mail,
send a message to majordomo@cccd.edu, and in the body of the message use
one of the following commands:
get faq tinnitus.html
get faq tinnitus.txt
To retrieve this FAQ split into multiple smaller messages, send e-mail to
an ftp-by-mail server (there are many) such as ftpmail@census.gov, and in
the body of the message ask for either the plaintext (.txt) or HTML version
of the FAQ as follows (note that ftpmail servers are very popular and
response time may range from several hours to several days):
open ftp.cccd.edu
get /pub/faq/tinnitus.txt
quit
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Topics covered in this FAQ:
1) What is tinnitus?
2) What does tinnitus sound like?
3) How is tinnitus diagnosed?
4) What causes tinnitus?
5) How can I avoid getting tinnitus?
6) What are some ototoxic drugs?
7) What is Meniere's Disease?
8) What is hyperacusis?
9) What drugs, vitamins, and herbs are available for treating tinnitus?
10) What other treatments are available for tinnitus?
11) What is masking?
12) What types of ear plugs or other hearing protection are available?
13) What organizations can I turn to for more information?
14) What books can I turn to for more information?
15) What online resources are available?
16) What can I do when all else fails?
17) Where did the medical advice in the FAQ come from?
18) What clinics or physicians can I turn to for real medical advice?
19) Who are the contributors to this FAQ?
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1) What is tinnitus?
Tinnitus can be described as "ringing" ears and other head noises that are
perceived in the absence of any external noise source. It is estimated that
1 out of every 5 people experience some degree of tinnitus.
Tinnitus is classified into two forms: objective and subjective. Objective
tinnitus, the rarer form, consists of head noises audible to other people
in addition to the sufferer. The noises are usually caused by vascular
anomalies, repetitive muscle contractions, or inner ear structural defects.
Subjective tinnitus is much less understood, with the causes being many and
open to debate. Anything from the ear canal to the brain may be involved.
Hearing loss, hyperacusis, recruitment, and balance problems may or may not
be present in conjunction with tinnitus.
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2) What does tinnitus sound like?
Many sufferers in the online community report that their tinnitus sounds
like the high-pitched background squeal emitted by some computer monitors
or television sets. Others report noises like hissing steam, rushing water,
chirping crickets, bells, breaking glass, or even chainsaws. Some report
that their tinnitus temporarily spikes in volume with sudden head motions
during aerobic exercise, or with each footfall while jogging.
Objective tinnitus sufferers may hear a rhythmic rushing noise caused by
their own pulse. This form is known as pulsatile tinnitus.
In a database of 1544 tinnitus patients, 79% characterized the sound as
"tonal" with an average loudness of 7.5 (on a subjective scale of 1-10).
The other 21% characterized the sound as "noise" with an average loudness
of 5.5. When compared to an externally generated noise source, the average
loudness was 7.5dB above threshold. 68% of patients were able to have their
tinnitus masked by sounds 14dB or less above threshold. The internal
origination of the tinnitus sounds was perceived by 56% of the patients to
be in both ears, 24% from somewhere inside the head, 11% from the left ear,
and 9% from the right ear.
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3) How is tinnitus diagnosed?
The following flowchart from the Cecil Textbook of Medicine, 1992 (19th
ed.), W.B. Saunders, shows the logic for diagnosing the common causes of
tinnitus (note that this chart omits some causes such as TMJ disorders):
ear exam--->(audible sounds)-+-->sync w/respiration--->patent eustachian tube
| |
| +-->sync w/pulse--->aneurysm, vascular tumor,
v | vascular malformation,
(no audible sounds) | venous hum
| |
| +-->continuous--->venous hum, acoustic emissions
v
neurological exam-->(normal)-->audiogram
| |
| +-->normal--->idiopathic tinnitus
| |
| +-->conductive hearing loss
v | |
(brain stem signs) | v
| | impacted cerumen, chronic
| | otitis, otosclerosis
v |
multiple sclerosis, +-->sensorineural hearing loss
tumor, ischemic |
infarction v
BAER test
|
v
+---------+--------------+
| |
v v
abnormal (neural) normal cochlear
| |
v v
acoustic neuroma noise damage
other tumors ototoxic drugs
vascular compression labyrinthitis
Meniere's Disease
perilymph fistula
presbycusis
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4) What causes tinnitus?
In a database of 1687 tinnitus patients, no known cause was identified for
43% of the cases, and noise exposure was the cause for 24% of the cases.
* overexposure to loud noises
Repeated exposure to loud noises such as guns, artillery, aircraft,
lawn mowers, movie theaters, amplified music, heavy construction, etc,
can cause permanent hearing damage. Some people report auditory
fatigue from driving automobiles long distances with the windows down.
Anybody regularly exposed to these conditions should consider wearing
ear plugs or other hearing protection (see below).
* MRI, CAT, and other non-invasive scanning machines
These high-tech machines may take great images, but they are very,
very LOUD. Do not attempt this type of imaging without wearing
approved earplugs; any competent imaging facility should be able to
supply the earplugs. [Note: Mark Bixby reports that he had knee MRIs
done, and even with earplugs and his head outside the bulk of the
machine it was very loud.]
* wax/dirt build-up in the ear canal
If you're experiencing tinnitus, this is one of the first things you
should check for. NEVER try digging or suctioning the ear canal
yourself or allow a physician to do it as SERIOUS damage may result.
Numerous over-the-counter chemical washes are available from your
drugstore which will clean the ear canal in a safe and gentle manner.
* acoustic neuromas
Acoustic neuromas are small, slow growing benign tumors that press
against or invade the auditory nerves. If your tinnitus is only in one
ear, you should see your physician to rule this one out. An MRI will
probably be required for a definitive diagnosis, but one contributor's
ENT felt that an MRI wasn't warranted unless frequent dizziness was
present. Acoustic neuromas are removable by surgery but involve a risk
of hearing loss. Doing nothing should be considered an option by
elderly patients since these tumors grow so slowly.
* ototoxic drugs
Many prescription and over-the-counter drugs may cause tinnitus and/or
hearing loss that may be permanent or may disappear when the dosage is
reduced or eliminated. Before starting treatment with any prescription
drug, tinnitus sufferers should always ask their physician and/or
pharmacist about the potential for ototoxic side effects. See the next
section for more detail. These drugs include:
salicylate analgesics (higher doses of aspirin)
naproxen sodium (Naprosyn, Aleve)
ibuprofen
many other non-steroidal anti-inflammatories
aminoglycoside antibiotics
anti-depressants
loop-inhibiting diuretics
quinine/anti-malarials
oral contraceptives
chemotherapy
* severe ear infections
Many tinnitus cases onset after severe ear infections. But this may
also be related to the use of ototoxic antibiotics (see above).
* high blood cholesterol
High blood cholesterol clogs arteries that supply oxygen to the nerves
of the inner ear. Reducing your cholesterol level may reduce your
tinnitus.
* vascular abnormalities
Arteries may press too closely against the inner ear machinery or
nerves. This is sometimes correctable by delicate surgery.
* Temporo-Mandibular Joint (TMJ) syndrome
This jaw disorder may cause tinnitus and is characterized by many
symptoms, including headaches, earaches, tenderness of the jaw
muscles, dull facial pain, jaw noises, the jaw locking open, and pain
while chewing. For a good online document on TMJ, see:
http://www.uiuc.edu/departments/mckinley/health-info/dis-cond/misc/tmj-diso.html
One contributor has this to say about the TMJ/tinnitus connection:
The Sternocleidomastoideus muscle connects on your sternum
by the collar bone on both sides and goes back to the back
of the ear. It's about 6-10 inches long and when it gets
tight, it can pull on the TMJ area thereby creating a pull
on the muscles and ligaments around the inner ear area.
Almost certainly the final "pull" is the sphenomandibular
ligament which connects the ear drum and TMJ. An osteopath
can work with this. Xanax or other benzo's can provide
tension relief as well. The masseter and temporalis muscles
(those in front of the ear and above the ear can cause the
same TMJ/tinnitus problems. If a person wants to know if
their tinnitus is connected to their TMJ in some way, have
them 1) clench their teeth- does it change the tinnitus? 2)
push in hard on the jaw with your palm. Does the tinnitus
change? (Get louder/softer, pitch or tone change) 3) Push in
on the forehead with your hand hard. Resist with the head.
Any changes? In about half the people I talk to, they find a
TMJ correlation they never even dreamed of...
There is a highly recommended dentist knowledgable about TMJ/tinnitus
cases who has 30 years of experience and has authored/co-authored
several papers on the subject:
Doug Morgan, DDS
308 Foothill Boulevard
Glendale, CA USA 91214
+1 818 248-1283
For more information about TMJ, visit the TMJ Foundation (a California
public nonprofit corporation) WorldWideWeb site at
http://www.tmjfound.com/ , or contact them at:
TMJ Foundation
P.O. Box 28275
San Diego, CA USA 92128-0275
fax +1 619 592-9107
* traumatic head injuries
Some automobile crash victims have reported a sudden onset of
tinnitus.
* cochlear implant or other skull surgeries
Sometimes poking around inside the skull will accidentally damage the
hearing system. Tinnitus can result, or even profound deafness caused
by severe inner ear infections.
* stress
Stress is not a direct cause of tinnitus, but it will generally make
an already existing case worse.
* diet and other lifestyle choices
Like stress above, a poor diet can worsen an existing case of
tinnitus. Alcohol, tobacco, caffeine, quinine/tonic water, high fat,
high sodium can all make tinnitus worse in some people.
* food allergies
Specific foods may trigger tinnitus. Problem foods include red wine,
grain-based spirits, cheese, and chocolate. One contributor reported
hearing tones after consuming honey. Another contributor notes that
these same foods are on the list known to trigger migraine headaches;
additional migraine foods include soy and anything including soy, MSG,
very ripe bananas, avocados, and citrus fruits.
* foods rich in salicylates
There is a long list of foods that are supposed to be "rich" in
salicylates. See the Shulman book listed below for details. [Ed. note:
I'm not listing the foods here since no data is given on exactly how
rich the foods are, i.e. "13 mangoes = 1000mg aspirin" as a
hypothetical example.]
* glaumous tumors
These tumors can cause pulsatile tinnitus. They are confirmed with a
CAT scan or other imaging, and may be surgically removable by a
delicate procedure.
* mercury amalgam tooth fillings
Researchers June Rogers and Jacyntha Crawley (P.O. Box 413, London SW7
2PT, U.K.) have found a possible connection between mercury tooth
fillings and tinnitus. They publish a booklet on the subject available
for 6 International Reply Coupons, and they also have a questionnaire
that interested people can fill out. Their research suggests following
a vegetarian diet, plus eating 2 raw African green chillies one day,
followed by 1 chilli the next day for temporary relief.
But a prominent American tinnitus specialist says that no such link
has been established.
* marijuana
Marijuana usage may worsen pre-existing cases of tinnitus.
* Lyme Disease
Lyme is a parasitic, tick-borne disease, which in the United States is
most commonly seen in eastern states. In some cases, tinnitus has been
a side-effect of Lyme.
Lyme disease deserves special mention partly because it is so
difficult to diagnose objectively; the commonly available serological
tests have very high rates of false negatives. In the only study (by
McDonald) in the literature which used objective measures
(histopathology) to confirm test results, over 50% of currently
infected patients were negative by ELISA and/or Western Blot. False
positives are infrequent, occurring primarily in pts. exposed to other
nasties such as syphilis or rocky mountain spotted fever. So
serologies can be used to confirm but not to rule out diagnosis.
The Lyme Urine Antigen Test is a useful supplement test to serologies;
it tests for current infection, as opposed to a history of exposure.
It has some problems with low sensitivity; these can be improved by
the following regimen. Give amoxicillin 500mg tid q5d; on days 3,4,5
take and test first-in-the morning urine specimens. The LUAT can be
ordered by your MD from Immugenex, 1-415-424-1191. Other, better tests
(including PCR) are under development, expected to be available for
clinical use within the next few years.
For further online information about Lyme Disease, you may send the
following command in the body of an e-mail message to
listserv@lehigh.edu:
subscribe LymeNet-L yourfirstname yourlastname
A regular newsletter is published here, and patients & physicians may
exchange their stories.
* dental procedures
Certain dental procedures such as difficult tooth extractions and
ultrasonic cleaning can cause hearing damage via bone conduction of
loud sounds directly to the ear. Wearing ear plugs will not guard
against bone conduction.
* intracranial hypertension
Intracranial hypertension can cause pulsatile tinnitus. If you can
stop your tinnitus by slight pressure to the neck on the affected
side, that is an indication. The definite way to find out is if you
get a spinal tap and your Opening Pressure is higher than 200.
* otosclerosis
Otosclerosis is a bony growth around the footplate of the stapes (one
of the 3 middle ear bones). This footplate forms the seal that
separates the middle ear space from the inner ear. When the footplate
moves normally, the sound vibrations are passed from the middle ear
"chain" of bones into the fluid of the inner ear. If the footplate is
fixated, the vibrations cannot pass into the inner ear as well and
hence a resulting hearing loss. Tinnitus may also be involved.
Treatment is by surgery, as one poster to alt.support.tinnitus
explains:
When should surgery be performed? Well IMHO, it all depends
upon the amount of loss (or progression of the condition)
and the amount of difficulty that the patient experiences.
If the amount of loss caused by the otosclerosis is 40 dB or
more, then surgery may be an option that you may want to
think about. But remember that surgeries can be complicated
and can always end up with no real improvement.
Stapedectomy involves removal of the stapes, along with the
fixated footplate, and insertion of a prosthetic stapes into
the window that contains the oval window.
One "nice" thing about people with conductive hearing loss
(i.e. otosclerosis) is that they are excellent candidates
for hearing aids. They often do not experience the
overwelming loudness that people with sensorineural hearing
loss often report, and speech is not distorted.
If your condition involves a 40 dB loss *DIRECTLY* due to
otoscelerosis, you may want to thnik about surgery, but if
it is less than that, you may want to try a hearing aid, and
think about surgery in the future (if the condition develops
further).
* aspartame
Some people allege (quite controversially) that the artificial sugar
substitute aspartame is linked to tinnitus, vertigo, and many other
serious problems (I agree). To retrieve further information about the
allegations against aspartame, send e-mail to freeinfo@servint.com and
include the lowercase command "info mp" in the body (not the Subject:)
of the message.
* Arnold Chiari Malformation (ACM)
An *unscientific* response of 30 ACM patients revealed that 14 had
ringing in the ears (significant) and 9 had a whooshing sound in their
ears (also significant). The survey of patients was conducted by
Darlene Long-Thompson, RN, MHSc.
Essentially there is (in ACM) extra cerebellum crowding the outlet of
the brainstem/spinal cord from the skull on its way to the spinal
canal. This crowding will commonly lead to headaches, neck pain, funny
feelings in the arms and/or legs, stiffness, and less often will cause
difficulties with swallowing, or gagging . There are those that
believe it can cause tinnitus. Often the symptoms are made worse with
straining.
Untreated, the chronic crowding of the brainstem and spinal cord can
lead to very serious consequences including paralysis. There are many
ways to treat Chiari malformations, but all require surgery.
When the diagnosis is suspected the study of choice is an MRI scan.
These malformations are very difficult to see on CT scans and
impossible to see on plain x-rays.
If you are intending to have an MRI for another reason, e.g., Acustic
Neuroma, the MRI technicians should be alerted to the possibility of
ACM (if you are showing any symptoms listed above) since the "MRIing"
will have to concentrate on the brain stem/cerebellum area to detect
the problem.
Most of the preceding (ACM) information provided courtesy of: Bernard
H. Meyer
Arnold Chiari Malformation involves the herniation of the cerebellum
and/or brainstem through the foramen magnum. This can cause problems
in the areas of cerebellar compression and dysfunction, cranial and
spinal nerve (including trigeminal and acoustic nerve) compression and
inflammation, CSF blockages and increased intracranial pressure
(constant or intermittent), and brainstem compression and
inflammation. ANY of these components can cause symptomology
associated with tinnitus...(Think of the ringing in the ears or
buzzing sound associated with light headedness or fainting...many ACM
sufferers experience this either due to acoustic nerve involvement or
to fluid and pressure dynamics).
Because hard data on ACM is difficult to find (and often
contradictory) it is difficult to find a source that says specifically
any one symptom is related to ACM...but the symptoms are often
categorized as...cerebellar syndrome, brainstem deficits, CSF
obstruction, and cranial nerve deficits. Due to the close proximity of
the acoustic nerve to the hindbrain region it would be one of the
primary cranial nerves involved in the compression/inflammation
syndrom.[sic]
Two of my references on this are as follows...
Tinnitus and Neurosurgical Disease
Journal: Journal of Laryngology & Otology
Authors: WA Shucart
M. Tenner
Citation: (4): 166-8
ISSN0144-2945
Tinnitus from Intracranial Hypertension
Journal: Neurology
Authors: KJ Meador
TR Swift
Citation: 34(9): 1258-61
ISSN 0028-3878
Preceding (ACM) information provided courtesy of: Darlene
Long-Thompson, RN, MHSc.
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5) How can I avoid getting tinnitus?
Avoid the causes listed above. Really. The number one cause of tinnitus is
exposure to excessively loud noise. Either avoid these noisy situations, or
wear hearing protection as described below. Rock concerts, movie theaters,
nightclubs, construction sites, guns, power tools, stereo headphones and
musical instruments are just some of the things that can be hazardous to
your ears. Damage can result from either a single exposure or cumulative
trauma. There are "tough" ears, and there are "weak" ears; what may be safe
or dangerous for one individual may not be the same for you. If you ever
experience temporary ringing after a sound exposure, YOU ARE AT A SEVERE
RISK FOR TINNITUS AND/OR HEARING LOSS.
If you already have tinnitus, educate your family, friends, and neighbors
so that they can keep their ears healthy.
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6) What are some ototoxic drugs?
All tinnitus sufferers should ask their physician and/or pharmacist about
the potential for ototoxic side effects BEFORE starting a new prescription.
In her book _When the Hearing Gets Hard_ (Insight Books 1993, ISBN
0-306-44505-0), author Elaine Suss names several potentially ototoxic
substances. She lists them in three categories: (1) substances that most
physicians consider ototoxic; (2) substances that many physicians consider
potentially ototoxic; and (3) substances that may be ototoxic in rare
cases. The ototoxic effects of the substances in the third list are
considered to be reversible--the effects diminish when you stop taking the
drug. Ms. Suss does not list dosages.
The first group includes a few antibiotics and several diuretics. Not being
a physician, I don't recognize them all, though Capreomycin, Gentamicin ,
Kanamycin, Neomycin, Streptomycin, Tobramycin sulphate, Vancomycin, and
Viomycin are obviously antibiotics. Ms. Suss mentions that Streptomycin is
used only for certain cases of tuberculosis.
The first group also includes aspirin--ototoxic at higher doses and whose
effects are usually reversible--and other salicylates such as Oil of
Wintergreen (Ben Gay). The other substances in the first group are:
Amikacin, Amphotericin B (Fungizone), Bumetanide (Bumex), Carboplatin
(Paraplatin), Chloroquine (Aralen), Cisplatin (Platinol), Ethacrynic acid
(Edecrin), Furosemide (Lasix), and Hydroxychloroquine (Plaquenil).
The second group includes the analgesic Ibuprofen (Advil) and the tricyclic
anti-depressant Imipramine (Tofranil), along with Chloramphenicol
(Chloromycetin), lead, and quinine sulphate.
The third group includes alcohol, toluene, and trichloroethylene, as well
as Chlordiazepoxide (Librium), Chlorhexidene (Phisohex, Hexachlorophene),
Ampicillin, Iodoform, Clemastin fumarate (Tavist), Chlomipramine
hydrochloride (Anafranil), and Chorpheniramine Maleate (Chlor-trimeton and
several others).
Ms. Suss points out that the _Physicians Desk Reference_ (PDR) did not list
ototoxic drugs until the 1989 and later editions. She refers to a separate
document, _Drug Interactions and Side Effects Index_, which is keyed to the
PDR. She then points out that the Index is incomplete: several problem
drugs are not listed there.
Although the lists of ototoxic drugs are useful, I cannot recommend this
book to tinnitus sufferers in general because it is devoted almost entirely
to the problems of the hearing impaired and methods for ameliorating them.
The book mentions tinnitus primarily as a precursor to hearing loss. (I do
not believe that is the general case.)
The book _Tinnitus: Diagnosis/Treatment_ (Lea & Febiger, 1991, ISBN
0-8121-1121-4) adds that ototoxic symptoms may arise days or even weeks
after the termination of aminoglycoside antibiotics. Some of these
aminoglycosides not listed above are Netilmycin and Erythromycin. Other
trouble antibiotics include Colistimethate, Doxycycline and Minocycline.
The following is a list of drugs that have demonstrated Tinnitus side
effects as indicated in the 1995 "Physicians Desk Reference" and
distributed by the American Tinnitus Association:
Accutane [less than 1%] Mazicon [less than 1%]
Acromycin V Meclomen [greater than 1%]
Actifed with Codiene Cough Syrup Methergine [rare]
Adalat CC [less than 1%] Methotrexate [less common]
Alferon N [one patient] Mexitil [1.9% to 2.4%]
Altace [less than 1%] Midamor [less than or equel to 1%]
Ambien [infrequent] Minipress [less than 1%]
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