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07.02.2015

Can tinnitus cause sleep problems, earrings online - PDF Review

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Tinnitus (pronounced ti-ni-tis), or ringing in the ears, is the sensation of hearing ringing, buzzing, hissing, chirping, whistling, or other sounds. Although tinnitus is often associated with hearing loss, it does not cause the loss, nor does a hearing loss cause tinnitus.
Some instances of tinnitus are caused by infections or blockages in the ear, and the tinnitus can disappear once the underlying cause is treated.
Certain drugs -- most notably aspirin, several types of antibiotics, anti-inflammatories, sedatives, and antidepressants, as well as quinine medications; tinnitus is cited as a potential side effect for about 200 prescription and nonprescription drugs. Tinnitus can worsen in some people if they drink alcohol, smoke cigarettes, drink caffeinated beverages, or eat certain foods.
Thus it can see that there are numerous factors that are weakly correlated with tinnitus, and that hearing impairment is the most strongly associated.
Most tinnitus comes from damage to the inner ear, specifically the cochlea (the snail like thing on the right of figure 1, labeled '9').
Patients with Meniere's disease often describe a low pitched tinnitus resembling a hiss or a roar.
Tinnitus can also arise from damage to the nerve between the ear and brain (8th nerve, labeled 6, auditory nerve).
Tinnitus arises more rarely from injury to the brainstem (Lanska et al, 1987), and extremely rarely, to the brain itself (e.g. Tinnitus can be associated with Basilar Artery Migraine (BAM), and also tinnitus can be more bothersome when one is having a migraine (Volcy et al, 2005), like sound and light and smells. In our opinion, people are very quick to blame drugs for their tinnitus, but it is rare that this is borne out. Often people bring in very long lists of medications that have been reported, once or twice, to be associated with tinnitus.
As tinnitus is essentially subjective, malingering of tinnitus as well as psychological causes of tinnitus is certainly possible. In malingering, a person claims to have tinnitus (or more tinnitus), in an attempt to gain some benefit (such as more money in a legal case). Schecklmann et al (2014) suggested that tinnitus is associated with alterations in motor cortex excitability, by pooling several studies, and reported that there are differences in intracortical inhibition, intra-cortical facilitation, and cortical silent period. ABR (ABR) testing may show some subtle abnormalities in otherwise normal persons with tinnitus (Kehrle et al, 2008). We occasionally recommend neuropsychological testing using a simple screening questionnaire -- depression, anxiety, and OCD (obsessive compulsive disorder) are common in persons with tinnitus.
Microvascular compression of the 8th nerve is not a significant cause of tinnitus (Gultekin et al. Other entities that can sometimes be seen on radiological testing and that can cause pulsatile tinnitus, include AVM's, aneurysms, carotid artery dissection, fibromuscular dysplasia, venous hums from the jugular vein (found in half the normal population), vascular tumors such as glomus, ossifying hemangiomas of the facial nerve, osseous dysplasias such as otosclerosis and Paget's, elevated intracranial pressure.
Disrupted sleep is the most significant complaint, and affects between 25-50% of tinnitus patients. The algorithm that we use in our practice to diagnose and treat tinnitus is here (a PDF graphic).
There is a small literature concerning use of intravenous and local anesthesia for tinnitus.
Liu et al (2011) reported use of botox for tinnitus due to tensor tympani myoclonus, by inserting gelfoam with botox through a perforation in the tympanic membrane.
Pramipexole was recently reported effective for tinnitus in a study of 40 patients with age related hearing loss in Hungary. Most of the discussion of devices for tinnitus are discussed, as is proper, under the placebo page. Cochlear implants, which are used for severe bilateral unaidable hearing loss, usually improve tinnitus (Amoodi et al, 2011).
These are devices based on the idea that tinnitus is usually worst when things are very quiet. A discussion of the Neuromonic's masking device can be found by clicking on the link above. Occasionally persons with Meniere's disease have relief or reduction of tinnitus from transtympanic gentamicin. Microvascular compression syndrome, in theory, may cause tinnitus, but we have had very little success when the few patients we have seen with this syndrome have undergone surgery. Tinnitus usually improves in profoundly deaf individuals who undergo cochlear implantion (Olze, 2015).
Avoid exposure to loud noises and sounds, avoid environments that are very quiet (as this makes tinnitus more noticeable). Tinnitus Retraining Therapy (TRT) is a method of treating tinnitus helpful for some (Wang et al, 2003). Hoare DJ, Kowalkowski VL, Kang S, Hall DA.Systematic review and meta-analyses of randomized controlled trials examining tinnitus management. Mahboubi H, Ziai K, Brunworth J, Djalilian HR.Accuracy of tinnitus pitch matching using a web-based protocol. Piccirillo JF, Garcia KS, Nicklaus J, Pierce K, Burton H, Vlassenko AG, Mintun M, Duddy D, Kallogjeri D, Spitznagel EL Jr.Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus Arch Otolaryngol Head Neck Surg. Wineland AM, Burton H, Piccirillo J.Functional Connectivity Networks in Nonbothersome Tinnitus. Although tinnitus is common and may not pose a significant problems for most, many will experience tinnitus as a life altering and upsetting condition. A thorough history and examination by a health care provider is vital, considering possible causes related to cardiovascular, thyroid, tumors and a variety of medications, which include many commonly used pain relievers.
There are many possible causes of tinnitus and this stresses that it is vital to have it evaluated by a health care professional. In a 2013 Journal of Clinical Otorhinolaryngology, Head, and Neck Surgery, there are indications that exposure to very low frequency electric and magnetic fields can damage outer hair cells of the ear, and this is possibly a risk factor for tinnitus. In a 2013 Environmental Health Journal, there was a study noting several cordless phone frequencies bands were related to tinnitus. A 2014 edition of the European Archives of Otorhinolaryngoly found a direct correlation between depression, anxiety and stress with duration of tinnitus in their study.
The 2015 International Journal of Audiology indicates a relationship between severity of tinnitus and anxiety and depression. A 2000 study in the International Tinnitus Journal indicates that tinnitus can result from an unstable situation of the cervico-cranial junction, which is the relationship between the base of the skull and the first cervical vertebra or neck bone. When there is a problem with the neck, it can cause problems for the nerves and muscles situated by the ears.
A 2014 issue of the Pain Physician Journal describes a case study where a subject had been suffering left sided tinnitus for 3 years. The 2013 issue of the Journal of the American Academy of Audiology did a case study on a patient with tinnitus, focusing on normal neck mobility, mobilization of the joints and tissue massage. A 2015 issue of the journal Otolology & Neurotology studied neck dysfunction in chronic tinnitus patients.
For the affective component of tinnitus related to stress, anxiety and depression, patients may find relief with tricyclics, an older class of antidepressants. Tinnitus Retraining Therapy (TRT) uses a combination of ear devices that emit low volume sounds and counseling. People who suffer from tinnitus are likely to experience depression, anxiety or sleep disorders. Since early tinnitus can be distressful, trying to address it at this point can help prevent it from becoming a chronic problem. Often related to neck problems, temporomandibular disorders may affect tinnitus and one should avoid clenching and grinding of teeth and use jaw and neck relaxing exercises. While there are a number of drugs that can cause tinnitus, some of the more common are analgesics like aspirin and NSAIDs (anti-inflammatories like Ibuprofen). A 2010 study in the American Journal of Medicine gives us a clue to the type of analgesic and potential for damaging the ear and causing tinnitus with acetaminophen being the worse, NSAIDs like ibuprofen second and then aspirin. A nice study in a March 2010 issue of Medical Hypotheses Journal, indicated Melatonin has been proposed as a treatment for tinnitus, especially on the basis of its positive effects on sleep and its vasoactive and antioxidant properties.


This was also noted in the 2014 issue of the Southern Medical Journal, where the authors indicated that melatonin may be a good treatment option for those suffering from tinnitus. A 2015 study in the American Journal of Otolaryngology found a relationship between zinc levels and tinnitus. Those who suffer from tinnitus are aware how bothering it can be, however, sophisticated imaging studies indicates that individuals with tinnitus have problems that can located in the brain related to emotional processing, perception and attention.
The results of the study indicates that the antibiotics did not have an effect on bothersomeness of tinnitus, but did have a positive influence on cognitive problems reported by the subjects taking the antibiotics along with the computer based brain training program.
In the 2014 journal of Neural Plasticity, a study indicated tinnitus is not experienced when dreaming.
In fact, some people with tinnitus experience no difficulty hearing, and in a few cases they even become so acutely sensitive to sound (hyperacusis) that they must take steps to muffle or mask external noises. For reasons not yet entirely clear to researchers, stress and fatigue seem to worsen tinnitus.
But ringing in the ears that does not get better or go away is an ear condition called tinnitus. Distinct causes are microvascular compression syndrome, viral infections of the 8th nerve, and tumors of the 8th nerve.
For example, Tandon (1987) reported that 1% of those taking imiprimine complained of tinnitus. We doubt that this means that motor cortex excitability causes tinnitus, but rather we suspect that these findings reflect features of brain organization that may predispose certain persons to develop tinnitus over someone else. Because papilloedema is so rare, and tinnitus is so common, it is very unusual to find this dangerous condition. This is not surprising considering how disturbing tinnitus may be to ones life (Holmes and Padgham, 2009). This is because of the very high correlation between anxiety and depression with tinnitus-related annoyance and severity (Pinto et al, 2014). At that date there were 4 double-blind placebo controlled trials of antidepressants for tinnitus. A recent trial in older people showed that atorvastatin had no effect on the rate of hearing deterioration but there was a trend toward improvement in tinnitus scores over several years. This is a drug designed for heart disease, that is marketed in Europe for vertigo and tinnitus. If you have tinnitus associated with a hearing loss, a hearing aid is a reasonable thing to try.
For venous tinnitus, possibilities include jugular vein ligation, occlusion of the sigmoid sinus, or closure of a dural fistula. The effects of unilateral cochlear implantation on the tinnitus handicap inventory and the influence on quality of life.
Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus. Comparison of auditory brainstem response results in normal-hearing patients with and without tinnitus.
Maintenance repetitive transcranial magnetic stimulation can inhibit the return of tinnitus.
The actual experience of this sound can vary and have been described as whistling, clicking, humming, hissing and roaring. Factors involved may be loss of hearing, especially high frequency hearing loss, dizziness related to an inner ear disorder, blockage in the ear, hyperacusis – a sensitivity to noise, tumors, inflammation of the ear, sinus problems, headache and vascular disorders, metabolic disorders related to sugar like diabetes, thyroid or lipids, cervical arthritis, hormonal problems, stressful situations, anxiety, depression, medications that are toxic to the ear (ototoxic), stimulants, epilepsy and other disorders.
An earlier 2013 study in the same journal indicated occupational related high strength very low frequency electric and magnetic fields (VLF EMFs) may be related to an increase incidence of tinnitus due to damage ot the outer hair cells for long term exposure.
It was noted in a 2009 issue of the journal PLoS ONE, the authors suggested that some tinnitus sufferers may have a hypersensitivity to electromagnetic fields.
Usual symptoms of electromagnetic field hypersensitivity were noted including tinnitus and were indicated to have a significant impact on health. Strain of neck muscles, sprain of neck ligaments, whiplash injuries, along with degenerative cervical spine changes can make one more susceptible, aggravate, and may actually cause tinnitus. The authors of the study found that cervical spine dysfunction consisting of motion range, pain producing tests, muscle soreness and weakness, along with functional ability questions were significantly higher in the patients with chronic tinnitus. Doctors may also prescribe antiseizure drugs, sleeping pills, muscle relaxants, or benzodiazepenes like diazepam (Valium) or clonazepam (Klonopin).
This type of therapy may be expensive and take a couple of years as the brain is trained to turn tinnitus into background noise. Tinnitus-related sleeping disorders, anxiety, as well as life satisfaction are important factors related to problems with chronic tinnitus distress. If you are interested in participating in any of these clinical trials, you can follow the link at government approved Clinical Trials for Tinnitus from the U.S National Institutes for Health. A 2014 study in the Journal of Prosthetic Dentistry found a correlation between tinnitus and temporomandibular disorders.
A 2014 article in the journal Hearing Research indicates acetaminophen or paracetamol to be a possible cause tinnitus. Many of these are from abuse of the drugs or high dosages, however, if you suffer from tinnitus, your doctor may be able to avoid aggravation by choosing alternative medications.
It has also been recommended that one should give up caffeinated beverages like coffee, tea, soda and foods like chocolate to see if tinnitus symptoms are relieved. It explores melatonin use in relief of tinnitus, explaining its effect on central nervous system resulting in a type of protective mechanism.
They indicated melatonin may protect against ototoxic drugs, noting the antioxidant property, enhanced sleep and possible other action not understood yet. Other studies have been done and indicate Ginko is moderately effective for helping loudness and severity of tinnitus.
However, an antibiotic, D-Cycloserine, typically employed in the treatment of tuberculosis may have a positive effect on tinnitus. These cognitive difficulties can result in problems with memory, concentration, anxiety among others. They investigated 78 patients at a specialized tinnitus research clinic, of which 97% did not experience tinnitus in their dreams. A great source for information and to find support groups for tinnitus in your area is the American Tinnitus Association (ATA), and I highly recommend it for anyone who sufferers from or cares for someone suffering from tinnitus.
There are methods to control and relieve tinnitus, mainly through medication, therapies and instrumentation. A 2015 study in The Journal of Laryngology & Otology indicates that of all the benzodiazepines used in treating tinnitus, Clonazepam is the one with the best evidence, and is not as likely as some of the others like Diazepam (Valium) to be abused due to its longer half life. In severe cases, however, tinnitus can cause people to have difficulty concentrating and sleeping. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. According to Park and Moon (2004), hearing impairment roughly doubles the odds of having tinnitus, and triples the odds of having annoying tinnitus. Loudness was correlated with values in the thalamus, bilateral hippocampus and left caudate. Somatic tinnitus means that the tinnitus is coming from something other than the inner ear. In a double-blind trial of paroxetine for tinnitus, 3% discontinued due to a perceived worsening of tinnitus (Robinson, 2007). Specialists who care for patients with ear disease, usually know very well which drugs are problems (such as those noted above), and which ones are nearly always safe.
Of course, tumors are a very rare cause of tinnitus, as tinnitus is at least 100 times more common than tumors of the inner ear area.
On the other hand, Hoekstrat et al (2011) suggested that in general these drugs do not work for tinnitus.
This study suggested that Botox might improve tinnitus to a small extent (7 improved with active, 2 improved with placebo).
Be sure that you try the hearing aid before buying one, as tinnitus is not always helped by an aid.


Given that smartphone apps do the same thing as tinnitus maskers, and that most newer hearing aids are blu-tooth capable, we see little reason to pay for a masker-hearing aid when one already owns a cell phone.
Surgery seems worth considering only in extreme situations - -the tinnitus is extremely loud, very distressing, and there is a methodology to decide whether or not the tinnitus can be improved with surgery.
On the other hand, very few individuals with tinnitus are deaf enough to qualify for cochlear implants. However, eliminating very concerning causes like tumors is important to relieve some of the stress. Couple stress with long hours in poor posture hunched over a computer, and you have factors that combine to increase tinnitus symptoms. The authors conclude that early assessment and intervention to reduce depression and anxiety may have a positive influence regarding some troubling aspects of coping with tinnitus. Therefore, serotonin, noted to be involved in depression and other psychological issues, may play a role in tinnitus. It is often compromised in the typical forward head posture, where this area can be compressed. Arthritis in the neck may cause the blood supply of the inner ear to be constricted and that could cause tinnitus.
It was noted that certain motions of the neck done against resistance made the tinnitus worse, so there were indications that the cervical spine was involved.
Although adjustments did not help my tinnitus, it is reasonable to take easy to implement measures such as detailed at Neck Solutions or seek professional help from a Chiropractor as a secondary approach. By boosting lower frequencies in the hearing aid, those with high frequency hearing loss may find relief from tinnitus.
There are antibiotics like gentamycin, erythromycin and vancomycin, which have been known to cause tinnitus.
Melatonin was able to significantly decrease the intensity of tinnitus, especially in men with a history of exposure to noise and having severe symptoms. They hypothesized that during dreaming, a prediction error from interacting with the environment in tinnitus is not present.
The study has benefits for future research into the nervous pathway for tinnitus and disrupting the pathway to alleviate the symptom.
I know that just saying, try to calm down and it will get better over time seems ridiculous if you are just experiencing tinnitus. Difficulty sleeping can be not only be assisted through medications, but can be helped by listening to music, or in my case, listening to lectures to the point where I just fall asleep. Practically, as there is only a tiny proportion of the population with objective tinnitus, this method of categorizing tinnitus is rarely of any help. In other words, the changes in the brain associated with tinnitus seem to be associated with emotional reaction (e.g. In a large study of tinnitus, avoidance of occupational noise was one of two factors most important in preventing tinnitus (Sindhusake et al. Tinnitus from a clear cut inner ear disorder frequently changes loudness or pitch when one simply touches the area around the ear. There are case reports concerning tinnitus as a withdrawal symptom from Venlafaxine and sertraline (Robinson, 2007). Nevertheless, this quality of tinnitus probably justifies a trial of oxcarbamazine (a less toxic version of carbamazepine). TMS seems to be somewhat helpful for depression and migraine, and one would think that a modality that worked for these, would also work to some extent for tinnitus.
If tinnitus is reduced by intratympanic lidocaine injection, it seems reasonable to us that surgical treatment may also be effective (for unilateral tinnitus). Symptoms of this hypersensitivity or long term exposure have been anxiety, tension, bone and joint pain, headaches, dizziness and vertigo, forgetfulness, fatigue, insomnia and sleep disturbances, tearing or eye lacrimation, tinnitus and hearing loss. Proper posture and an ergonomic set up for work while sitting at a computer can help with neck problems, along with and healthy and oxygenating breathing techniques help to alleviate stress and strain on cervical muscles. It should not take long to notice a difference in tinnitus after adjusting the cervical spine. This therapy focuses on the emotional response to tinnitus and attempts to break patterns of thinking and behavior that contribute to anxiety and depression. Beyond the initial panic, which was very troubling; seemingly out of nowhere, I developed tinnitus which was quite severe. The most common cause of tinnitus is hearing loss that occurs with aging, but it can also be caused by living or working around loud noises.
It seems to us that it should be possible to separate out tinnitus into inner ear vs everything else using some of the large array of audiologic testing available today.
The exact prevalence of TMJ associated tinnitus is not established, but presumably it is rather high too.
In our clinical practice, we have occasionally encountered patients reporting worsening of tinnitus with an antidepressant, generally in the SSRI family.
When this doesn't happen, the treatments that work the best for tinnitus are those that alter ones emotional state -- antidepressants and antianxiety drugs, and ones that allow you to get a full night's sleep.
Robinson reported that tinnitus in depressed patients appears more responsive to antidepressants than in non-depressed patients. Because it is easily available in the US, and has a rather benign side effect profile, we think that it is a good candidate for medication trials. Seeing a Chiropractor for an examination can help determine if there are neck issues responsive to adjustment or manipulations, particularly the area of the upper cervical spine and I like a low force technique directed in this area called NUCCA, You can learn more and find a Doctor at National Upper Cervical Chiropractic Association.
Tinnitus is known to resolve with surgical correction or stabilization in this area from correcting forward head posture.
The Cochrane Database of Systematic Reviews 2010 Issue 2 concluded, “We did not find a significant difference in the subjective loudness of tinnitus, or in the associated depression.
The tinnitus is usually one sided and on the same side as the jaw problem, which may be effected by jaw movements. There is a test you can take to determine the effects that tinnitus has on the quality of your life called the Tinnitus Handicap Inventory. However, the more you know, the less the anxiety; but an evaluation by a professional is very important to rule out any serious causes. We have encountered patients who have excellent responses to cervical epidural steroids, and in persons who have both severe tinnitus and significant cervical nerve root compression, we think this is worth trying as treatment.
Having TMJ increases the odds that you have tinnitus too, by about a factor of 1.6 (Park and Moon, 2014).
Mechanisms for impovement were suggested to be direct effects of increased serotonin on auditory pathways, or indirect effects of tinnitus on depression or anxiety. As a tinnitus sufferer for some years, I can say that it does seem that this sensitivity can affect tinnitus symptoms, however; when a smart meter was installed, I noticed no difference in tinnitus related symptoms over the years.
A disc herniation, injuries to the disc and ligaments or even metastatic diseases down to the third cervical area may cause tinnitus, which may also respond to surgical repair. It is also a means to monitor the progression of tinnitus and the effects of therapy measures.
Hearing loss treatments depend on the cause and include hearing aids, sound-amplifying devices, and antibiotics if the cause is an infection. He was able to calm me down, determine I had high frequency hearing loss, the most likely cause, and made sure my ears were healthy. MRI studies related to audition or dizziness must be interpreted with great caution as the magnetic field of the MRI stimulates the inner ear, and because MRI scanners are noisy.
There are a variety of causes of hearing loss besides congenital hearing loss, including ear infections, genetic disorders, illnesses that trigger hearing loss, head injuries, medications, and more. This has gone a long way to helping me deal with my tinnitus and I have noticed a decrease in intensity and anxiety, in general, over the years.



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