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Paging Dr. Frischer - Tinnitus
WRITTEN BY :   Dr. Alan Frischer

What in the world is that ringing in the ears, and why doesn’t anyone else hear it? It’s possible that you have tinnitus; a condition, not a disease, that can result from a number of causes. 10% to 15% of us suffer from it, and that percentage rises as we age.
Tinnitus is described as a ringing noise, a high pitched whining, electric buzzing, hissing, humming, tingling, clicking, roaring, beeping, sizzling or whooshing sound. It can seem to come from one or both ears, or sound like it comes from inside the head. It may be intermittent or continuous. It can range from a quiet background sound to a noise that drowns out loud external sounds, and this intensity may change with movement of the head, shoulders, tongue, jaw or even eyes. Typically, those with tinnitus also have some degree of hearing loss.
How is tinnitus diagnosed? There are no simple tests. The diagnosis is made after ruling out other possibilites. For example, a recognized source of very high-pitched sounds is electromagnetic fields that are common in modern wiring and various signal transmissions. Some of us can hear these high-pitched transmission frequencies, and that can mimic tinnitus.
There are two types of tinnitus: objective and subjective. In objective tinnitus, a sound from the ears can actually be heard by others. This sound results from muscle spasms that cause clicks or crackling in the middle ear. It is sometimes in beat with the pulses of the heart within the ear’s blood vessels.
Subjective tinnitus, by far the more common, can have many possible causes. It may not be easy to isolate the root problem, and to further complicate matters, tinnitus and sudden hearing loss may have no obvious cause whatsoever! Here are the areas that you and your doctor may consider:
*Otologic disorders (usually the same causes as hearing loss) including ear infections, acoustic shock, ear wax, Meniere’s disease, and even – but rarely – a tumor.
*Chemicals including mercury or lead poisoning.
*Medications like NSAIDs (aspirin, ibuprofen, and naproxen), some antibiotics, some diuretics, and antidepressants.
*Chemotherapy.
*Neurologic conditions, including multiple sclerosis, head injury, skull fracture, and whiplash.
*Blood flow (vascular) problems, such as carotid atherosclerosis and high blood pressure.
*Metabolic diseases like thyroid disease, hyperlipidemia, vitamin B 12 deficiency, and iron deficiency anemia.
*Psychiatric disorders including depression and anxiety.
*A hodgepodge of other disorders such as fibromyalgia, TMJ syndrome, lyme disease, and even simple nasal congestion.
Treatment depends on whether any underlying, treatable condition is found. For example, if the cause is simple ear wax, removing it will relieve the symptoms. If a medication is causing the problem, then you and your doctor may discuss stopping or changing that medication. If no correctable cause is found, treatments that may help include:
*Noise suppression: Masking devices, similar to hearing aids, are worn in the ear and produce a continuous, low-level white noise (such as simulated sounds like falling rain or ocean waves). This individually programmed tonal music masks the specific frequencies of the tinnitus. Over time, this can help the sufferer to become accustomed to the condition and not to focus on it.
*Hearing aids: Improving hearing has been shown to take the focus off tinnitus.
*Medications: Some antidepressant and antianxiety medications have been shown to lessen the severity of symptoms, probably as a result of alleviating underlying anxiety and depression.
*Lifestyle adjustments: Avoiding irritants such as loud noise by covering it up using quiet fans, soft music or low volume radio can help. Since stress is known to make tinnitus worse, some use stress management, relaxation therapy, biofeedback, or exercise.
*Nicotine may worsen the condition by reducing blood flow to the structures of the inner ear. Alcohol has been variously reported to increase, decrease or have no effect on tinnitus, depending on the source!
This condition can be miserable; perhaps even more so because its severity and suffering can’t be measured objectively. Throughout history, when there are no ideal remedies for our health problems, alternative approaches inevitably appear. For tinnitus, this is no exception; there are many untested and unproven remedies advertised. Be very careful, and consult with your doctor.
Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.

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Published: July 12, 2012 – Volume 11 – Issue 13



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