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17.08.2014

White noise effect on tinnitus, tinnitus treatment melatonin - Review

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Constant stress — whether from a traffic-choked daily commute, unhappy marriage, or heavy workload — can have real physical effects on the body. Constant noise in the head -- such as ringing in the ears -- rarely indicates a serious health problem, but it sure can be annoying.
Tinnitus (pronounced tih-NITE-us or TIN-ih-tus) is sound in the head with no external source. Almost everyone has had tinnitus for a short time after being exposed to extremely loud noise.
While there's no cure for chronic tinnitus, it often becomes less noticeable and more manageable over time. Most people who seek medical help for tinnitus experience it as subjective, constant sound, and most have some degree of hearing loss.
Tinnitus can arise anywhere along the auditory pathway, from the outer ear through the middle and inner ear to the brain's auditory cortex, where it's thought to be encoded (in a sense, imprinted). Most tinnitus is "sensorineural," meaning that it's due to hearing loss at the cochlea or cochlear nerve level. Musculoskeletal factors — jaw clenching, tooth grinding, prior injury, or muscle tension in the neck — sometimes make tinnitus more noticeable, so your clinician may ask you to tighten muscles or move the jaw or neck in certain ways to see if the sound changes. Tinnitus that's continuous, steady, and high-pitched (the most common type) generally indicates a problem in the auditory system and requires hearing tests conducted by an audiologist. Your general health can affect the severity and impact of tinnitus, so this is also a good time to take stock of your diet, physical activity, sleep, and stress level — and take steps to improve them. If you're often exposed to loud noises at work or at home, it's important to reduce the risk of hearing loss (or further hearing loss) by using protectors such as earplugs or earmuff-like or custom-fitted devices. In addition to treating associated problems (such as depression or insomnia), there are several strategies that can help make tinnitus less bothersome. There is no FDA-approved drug treatment for tinnitus, and controlled trials have not found any drug, supplement, or herb to be any more effective than a placebo.
The most effective approaches are behavioral strategies and sound-generating devices, often used in combination. Not all insurance companies cover tinnitus treatments in the same way, so be sure to check your coverage. While insomnia itself is a medical condition, many people are suffering from poor sleep simply because of the environment they're living in. If noise pollution such as barking dogs, garbage trucks, noisy neighbours or your partners snoring keep you awake at night, it may be time to consider investing in a white noise generator. Every week we sell the Marpac White Noise Machines to parents with bubs and small children (I speak from first hand experience with both of my children having been raised from a very young age with the Dohm in their rooms – and can not recommend them more highly.
For many, it's a ringing sound, while for others, it's whistling, buzzing, chirping, hissing, humming, roaring, or even shrieking.


When hair cells are damaged — by loud noise or ototoxic drugs, for example — the circuits in the brain don't receive the signals they're expecting.
Things that cause hearing loss (and tinnitus) include loud noise, medications that damage the nerves in the ear (ototoxic drugs), impacted earwax, middle ear problems (such as infections and vascular tumors), and aging. One of the most common causes of tinnitus is damage to the hair cells in the cochlea (see "Auditory pathways and tinnitus").
Pulsatile tinnitus calls for a thorough evaluation by an otolaryngologist (commonly called an ear, nose, and throat specialist, or ENT) or neurotologist, especially if the noise is frequent or constant. You may also be able to reduce the impact of tinnitus by treating depression, anxiety, insomnia, and pain with medications or psychotherapy.
CBT uses techniques such as cognitive restructuring and relaxation to change the way patients think about and respond to tinnitus. Masking devices, worn like hearing aids, generate low-level white noise (a high-pitched hiss, for example) that can reduce the perception of tinnitus and sometimes also produce residual inhibition — less noticeable tinnitus for a short time after the masker is turned off.
Other treatments that have been studied for tinnitus include transcutaneous electrical stimulation of parts of the inner ear by way of electrodes placed on the skin or acupuncture needles, and stimulation of the brain using a powerful magnetic field (a technique called repetitive transcranial magnetic stimulation, or rTMS).
It works by restoring a sound equilibrium,  which means that it will help reduce them amount of noise around you that grabs your attention, and steals your sleep! Some medications (especially aspirin and other nonsteroidal anti-inflammatory drugs taken in high doses) can cause tinnitus that goes away when the drug is discontinued. This stimulates abnormal activity in the neurons, which results in the illusion of sound, or tinnitus. Tinnitus can also be a symptom of Mnire's disease, a disorder of the balance mechanism in the inner ear. She or he will also ask you to describe the noise you're hearing (including its pitch and sound quality, and whether it's constant or periodic, steady or pulsatile) and the times and places in which you hear it.
If you have age-related hearing loss, a hearing aid can often make tinnitus less noticeable by amplifying outside sounds. The aim is to habituate the auditory system to the tinnitus signals, making them less noticeable or less bothersome.
Today, the term TRT is being used to describe modified versions of this therapy, and the variations make accurate assessment of its effectiveness difficult. A specialized device isn't always necessary for masking; often, playing music or having a radio, fan, or white-noise machine on in the background is enough. Transcutaneous electrical stimulation has been shown to be no more effective than a placebo. Noises that commonly prevent you from falling asleep, or that cause you to wake up in the night are masked by a calming background shhhhhhh. Many people can hear their heartbeat — a phenomenon called pulsatile tinnitus — especially as they grow older, because blood flow tends to be more turbulent in arteries whose walls have stiffened with age.


If the auditory pathways or circuits in the brain don't receive the signals they're expecting from the cochlea, the brain in effect "turns up the gain" on those pathways in an effort to detect the signal — in much the same way that you turn up the volume on a car radio when you're trying to find a station's signal. Your clinician will review your medical history, your current and past exposure to noise, and any medications or supplements you're taking.
The main components of TRT are individual counseling (to explain the auditory system, how tinnitus develops, and how TRT can help) and sound therapy.
Individual studies have reported improvements in as many as 80% of patients with high-pitched tinnitus. Although there's not enough evidence from randomized trials to draw any conclusions about the effectiveness of masking, hearing experts often recommend a trial of simple masking strategies (such as setting a radio at low volume between stations) before they turn to more expensive options. Electrodes attached to the skin feed information about physiological processes such as pulse, skin temperature, and muscle tension into a computer, which displays the output on a monitor. In two small trials, rTMS compared with a sham procedure helped improve the perception of tinnitus in a few patients. I panicked because I thought I'd gone deaf," he says.Mild tinnitus affects about 10 per cent of the population and in older people can be caused by natural hearing loss.
Pulsatile tinnitus may be more noticeable at night, when you're lying in bed, because more blood is reaching your head, and there are fewer external sounds to mask the tinnitus.
The resulting electrical noise takes the form of tinnitus — a sound that is high-pitched if hearing loss is in the high-frequency range and low-pitched if it's in the low-frequency range. Tinnitus can be a side effect of many medications, especially when taken at higher doses (see "Some drugs that can cause or worsen tinnitus").
A device is inserted in the ear to generate low-level noise and environmental sounds that match the pitch, volume, and quality of the patient's tinnitus. In a Cochrane review of the one randomized trial that followed Jastreboff's protocol and met the organization's standards, TRT was much more effective in reducing tinnitus severity and disability than a technique called masking (see below). Ear infections, glue ear or a build up of earwax and conditions such as otosclerosis or Meniere's disease can also be responsible for it.In younger people tinnitus can be triggered by exposure to loud noises that damage the inner ear.
Many people worry that tinnitus is a sign that they are going deaf or have another serious medical problem, but it rarely is.
If you notice any new pulsatile tinnitus, you should consult a clinician, because in rare cases it is a sign of a tumor or blood vessel damage. This kind of tinnitus resembles phantom limb pain in an amputee — the brain is producing abnormal nerve signals to compensate for missing input.



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