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Tinnitus

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Template:Short description Template:For Template:Pp Template:Cs1 config Template:Use dmy dates Template:Infobox medical condition (new) Tinnitus is a condition when a person hears a ringing sound or a different variety of sound when no corresponding external sound is present and other people cannot hear it.<ref name=Lev2015>Template:Cite book</ref> Nearly everyone experiences faint "normal tinnitus" in a completely quiet room; but this is of concern only if it is bothersome, interferes with normal hearing, or is associated with other problems.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The word tinnitus comes from the Latin tinnire, "to ring".<ref name="Baguley McFerran Hall 2013" /> In some people, it interferes with concentration, and can be associated with anxiety and depression.<ref name="ResearchReview">Template:Cite journal</ref><ref name="Research1">Template:Cite journal</ref>

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Tinnitus is usually associated with hearing loss and decreased comprehension of speech in noisy environments.<ref name="NIH2014">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is common, affecting about 10–15% of people. Most tolerate it well, and it is a significant problem in only 1–2% of people.<ref name="Lang2013">Template:Cite journal</ref> It can trigger a fight-or-flight response, as the brain may perceive it as dangerous and important.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite book</ref>

Rather than a disease, tinnitus is a symptom that may result from a variety of underlying causes and may be generated at any level of the auditory system as well as outside that system. The most common causes are hearing damage, noise-induced hearing loss, or age-related hearing loss, known as presbycusis.<ref name=NIH2014/> Other causes include ear infections, disease of the heart or blood vessels, Ménière's disease, brain tumors, acoustic neuromas (tumors on the auditory nerves of the ear), migraines, temporomandibular joint disorders, exposure to certain medications, a previous head injury, and earwax. It can suddenly emerge during a period of emotional stress.<ref name=Han2009>Template:Cite journal</ref><ref name="Baguley McFerran Hall 2013"/><ref name=NIH2014/><ref>Template:Cite journal</ref><ref name="Mazurek et al. (2022)">Template:Cite journal</ref> It is more common in those with depression.<ref name="Baguley McFerran Hall 2013"/>

The diagnosis of tinnitus is usually based on a patient's description of the symptoms they are experiencing.<ref name="Baguley McFerran Hall 2013"/> Such a diagnosis is commonly supported by an audiogram, and an otolaryngological and neurological examination.<ref name=Lev2015/><ref name="Baguley McFerran Hall 2013"/> How much tinnitus interferes with a person's life may be quantified with questionnaires.<ref name="Baguley McFerran Hall 2013"/> If certain problems are found, medical imaging, such as magnetic resonance imaging (MRI), may be performed. Other tests are suitable when tinnitus occurs with the same rhythm as the heartbeat.<ref name="Baguley McFerran Hall 2013"/> Rarely, the sound may be heard by someone other than the patient by using a stethoscope, in which case it is known as "objective tinnitus".<ref name="Baguley McFerran Hall 2013"/> Occasionally, spontaneous otoacoustic emissions, sounds produced normally by the inner ear, may result in tinnitus.<ref name=Hen2005/>

Measures to prevent tinnitus include avoiding chronic or extended exposure to loud noise, and limiting exposure to drugs and substances harmful to the ear (ototoxic).<ref name=NIH2014/><ref name="pmid33080070">Template:Cite journal</ref> If there is an underlying cause, treating that cause may lead to improvements.<ref name="Baguley McFerran Hall 2013"/> Otherwise, typically, tinnitus management involves psychoeducation or counseling, such as talk therapy.<ref name=Lang2013/> Sound generators or hearing aids may help.<ref name=NIH2014/> No medication directly targets tinnitus.

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Signs and symptomsEdit

File:Tinnitus Simulation.mp3
Simulation of a tinnitus

Tinnitus is often described as ringing, but it may also sound like clicking, buzzing, hissing, or roaring.<ref name=Han2009/> It may be soft or loud, low- or high-pitched, and may seem to come from either one or both ears, or from the head itself. It may be intermittent or continuous. In some individuals, its intensity may be changed by shoulder, neck, head, tongue, jaw, or eye movements.<ref>Template:Cite journal</ref>

CourseEdit

Due to variations in study designs, data on the course of tinnitus shows few consistent results. Generally, prevalence increases with age in adults, and the ratings of annoyance increase with persistence at follow up.<ref>Template:Cite book</ref><ref name="pmid20124901">Template:Cite journal</ref><ref name="pmid20670725">Template:Cite journal</ref>

Psychological effectsEdit

Although it is an annoying condition to which most people adapt, persistent tinnitus may cause anxiety and depression in some people.<ref name="pmid12238249">Template:Cite journal</ref><ref name="pmid10407886">Template:Cite journal</ref> Tinnitus annoyance is more strongly associated with the psychological condition of the person than the loudness or frequency range of the perceived sound.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Psychological problems such as depression, anxiety, sleep disturbances, and concentration difficulties are common in those with strongly annoying tinnitus.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235"/><ref>Template:Cite book</ref> 45% of people with tinnitus have an anxiety disorder at some time in their lives.<ref>Template:Cite journal</ref>

Psychological research has focused on the tinnitus distress reaction to account for differences in tinnitus severity.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235">Template:Cite journal</ref><ref>Template:Cite book</ref><ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> The research indicates that conditioning at the initial perception of tinnitus linked it with negative emotions, such as fear and anxiety.<ref name="TRT">Template:Cite book</ref>

TypesEdit

Commonly tinnitus is classified into "subjective and objective tinnitus".<ref name="Baguley McFerran Hall 2013"/> Tinnitus is usually subjective, meaning that the sounds the person hears are not detectable by means currently available to physicians and hearing technicians.<ref name="Baguley McFerran Hall 2013"/> Subjective tinnitus has also been called "tinnitus aurium", "non-auditory", or "non-vibratory" tinnitus. In rare cases, tinnitus can be heard by someone else using a stethoscope. Even more rarely, in some cases it can be measured as a spontaneous otoacoustic emission (SOAE) in the ear canal. This is classified as objective tinnitus,<ref name="Baguley McFerran Hall 2013"/> also called "pseudo-tinnitus" or "vibratory" tinnitus.

Subjective tinnitusEdit

Subjective tinnitus is the most frequent type. It can have many causes, but most commonly it results from hearing loss. When it is caused by disorders of the inner ear or auditory nerve, it can be called "otic" (from the Greek word for ear).<ref name=Levine>Template:Cite journal</ref> These otological or neurological disorders include those triggered by infections, drugs, or trauma.<ref name="WMClark">Template:Cite journal</ref> A cause is traumatic noise exposure that damages hair cells in the inner ear.<ref>Template:Cite journal</ref> Some evidence suggests that long-term exposure to noise pollution from heavy traffic may increase the risk of developing tinnitus.<ref>Template:Cite journal</ref>

When there does not seem to be a connection with a disorder of the inner ear or auditory nerve, tinnitus can be called "non-otic". In 30% of cases, tinnitus is influenced by the somatosensory system; for instance, people can increase or decrease their tinnitus by moving their face, head, jaw, or neck.<ref>Template:Cite journal</ref> This type is called somatic or craniocervical tinnitus, since it is only head or neck movements that have an effect.<ref name=Levine/>

Some tinnitus may be caused by neuroplastic changes in the central auditory pathway. In this theory, the disturbance of sensory input caused by hearing loss results in such changes<ref name="TriAudiogramSlope" /> as a homeostatic response of neurons in the central auditory system, causing tinnitus.<ref name="hiddenHearingLoss">Template:Cite journal</ref> When some frequencies of sound are lost to hearing loss, the auditory system compensates by amplifying those frequencies, eventually producing sound sensations at those frequencies constantly even when there is no corresponding external sound.

Hearing lossEdit

The most common cause of tinnitus is hearing loss. Hearing loss may have many different causes, but among those with tinnitus, the major cause is cochlear injury.<ref name="TriAudiogramSlope">Template:Cite journal</ref>

In many cases no underlying cause is identified.<ref name=NIH2014/><ref name=Yew2014>Template:Cite journal</ref>

Ototoxic drugs also may cause subjective tinnitus, as they may cause hearing loss,<ref name="pmid33080070" /> or increase the damage done by exposure to loud noise.<ref name="pmid32334867">Template:Cite journal</ref> This damage may occur even at doses not considered ototoxic.<ref>Template:Cite book</ref> More than 260 medications have been reported to cause tinnitus as a side effect.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Tinnitus can also occur from the discontinuation of therapeutic doses of benzodiazepines. It can sometimes be a protracted symptom of benzodiazepine withdrawal and may persist for many months.<ref name="clinical_manual_of_emergency_psychiatry">Template:Cite book</ref><ref name="seizures">Template:Cite bookTemplate:Dead link</ref> Medications such as bupropion may also cause tinnitus.<ref name="pmid20628627">Template:Cite journal</ref>

Associated factorsEdit

Factors associated with tinnitus include:<ref>Template:Cite journal</ref>

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Objective tinnitusEdit

A specific type of tinnitus, objective tinnitus, is characterized by hearing the sounds of one's own muscle contractions or pulse, typically a result of sounds that have been created by the movement of jaw muscles or sounds related to blood flow in the neck or face.<ref name="entnet-hearing">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> It is sometimes caused by an involuntary twitching of a muscle or a group of muscles (myoclonus) or by a vascular condition. In some cases, tinnitus is generated by muscle spasms around the middle ear.<ref name="entnet-hearing"/>

Spontaneous otoacoustic emissions (SOAEs)—faint high-frequency tones that are produced in the inner ear and can be measured in the ear canal with a sensitive microphone—may also cause tinnitus.<ref name=Hen2005/> About 8% of those with SOAEs and tinnitus have SOAE-linked tinnitus,Template:Request quotation while the percentage of all cases of tinnitus caused by SOAEs is estimated at 4%.<ref name=Hen2005>Template:Cite journal</ref>

Pediatric tinnitusEdit

Children may be subject to pulsatile or continuous tinnitus, involving anomalies and variants of the vascular parts<ref>Template:Cite journal</ref> affecting the middle/inner ear structures. CT scans may be used to check the integrity of the structures, and MR scans can evaluate nerves and potential masses or malformations. Early diagnosis can prevent long-term impairments to development.<ref>Template:Cite journal</ref>

Pulsatile tinnitusEdit

Some people experience a sound that beats in time with their pulse, known as pulsatile tinnitus or vascular tinnitus.<ref name="Pulsatile tinnitus August 2017">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Pulsatile tinnitus is usually objective in nature, resulting from altered blood flow or increased blood turbulence near the ear, such as from atherosclerosis or venous hum,<ref>Template:Cite journal</ref> but it can also arise as a subjective phenomenon from an increased awareness of blood flow in the ear.<ref name="Pulsatile tinnitus August 2017"/>

The differential diagnosis for pulsatile tinnitus is wide and includes vascular etiologies, tumors, disorders of the middle ear or inner ear, and other intracranial pathologies.<ref>Template:Cite journal</ref> Vascular causes of pulsatile tinnitus include venous causes (e.g., high riding or dehiscent jugular bulb, sigmoid sinus diverticulum), arterial causes (e.g., cervical atherosclerosis, potentially life-threatening conditions such as carotid artery aneurysm<ref>Template:Cite journal</ref> or carotid artery dissection), or dural arteriovenous fistula or arteriovenous malformations.<ref name="Carotid Artery Dissection">Template:Cite journal</ref>

Pulsatile tinnitus may also indicate vasculitis, or more specifically, giant cell arteritis. Pulsatile tinnitus may also be caused by tumors such as paragangliomas (e.g., glomus tympanicum, glomus jugulare) or hemangiomas (e.g., facial nerve or cavernous). Middle ear causes of pulsatile tinnitus include patulous eustachian tube, otosclerosis, or middle ear myoclonus (e.g., stapedial or tensor tympani myoclonus). The most common inner ear cause of pulsatile tinnitus is superior semicircular canal dehiscence.<ref>Template:Cite journal</ref> Pulsatile tinnitus may also indicate idiopathic intracranial hypertension.<ref>Template:Cite journal</ref> Pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for irregular noises of blood flow (bruits).<ref>Template:Cite encyclopedia</ref>

PathophysiologyEdit

Tinnitus may be caused by increased neural activity in the auditory brainstem, where the brain processes sounds, causing some auditory nerve cells to become overexcited. The basis of this theory is that many with tinnitus also have hearing loss.<ref name="Nicolas-Puel">Template:Cite journal</ref>

Three reviews in 2016 emphasized the large range and possible combinations of pathologies involved in tinnitus, which result in a great variety of symptoms and specifically adapted therapies.<ref name="pmid26977153">Template:Cite journal</ref><ref name="pmid27871729">Template:Cite journal</ref><ref name="pmid26868680">Template:Cite journal</ref><ref>Template:Cite journal</ref>

DiagnosisEdit

The diagnostic approach is based on a history of the condition and an examination of the head, neck, and neurological system.<ref name=Yew2014/> Typically an audiogram is done, and occasionally medical imaging or electronystagmography.<ref name=Yew2014/> Treatable conditions may include middle ear infection, acoustic neuroma, concussion, and otosclerosis.<ref>Template:Cite journal</ref>

Evaluation of tinnitus can include a hearing test (audiogram), measurement of acoustic parameters of the tinnitus like pitch and loudness, and psychological assessment of comorbid conditions like depression, anxiety, and stress that are associated with severity of the tinnitus.Template:Citation needed

One definition of tinnitus, in contrast to normal ear noise experience, is that tinnitus lasts five minutes at least twice a week.<ref>Template:Cite journal</ref> However, people with tinnitus often experience the noise more frequently than this. Tinnitus can be present constantly or intermittently. Some people with constant tinnitus might not be aware of it all the time, but only, for example, during the night when there is less environmental noise to mask it. Chronic tinnitus can be defined as tinnitus with a duration of six months or more.<ref>Template:Cite journal</ref>

AudiologyEdit

Since most people with tinnitus also have hearing loss, a pure tone hearing test resulting in an audiogram may help diagnose a cause. An audiogram may also facilitate fitting of a hearing aid in those cases where hearing loss is significant. The pitch of tinnitus is often in the range of the hearing loss.

PsychoacousticsEdit

Acoustic qualification of tinnitus includes measurement of several acoustic parameters like frequency in cases of monotone tinnitus or Template:Clarify, loudness in dB above hearing threshold at the indicated frequency, Template:Clarify, and minimum masking level.<ref>Template:Cite journal</ref> In most cases, tinnitus pitch or frequency range is between 5 kHz and 10 kHz,<ref name="pmid26583098">Template:Cite journal</ref> and loudness between 5 and 15 dB above the hearing threshold.<ref name="pmid24349414">Template:Cite journal</ref>

Another relevant parameter of tinnitus is residual inhibition: the temporary suppression or disappearance of tinnitus following a period of masking. The degree of residual inhibition may indicate how effective tinnitus maskers would be as treatment.<ref name="pmid17956813">Template:Cite book</ref><ref name="pmid18712566">Template:Cite journal</ref>

An assessment of hyperacusis, a frequent accompaniment of tinnitus,<ref name="pmid24012803">Template:Cite journal</ref> may also be made.<ref name="pmid25104073">Template:Cite journal</ref> Hyperacusis is related to negative reactions to sound and can take many forms. One parameter that can be measured is Loudness Discomfort Level (LDL) in dB, the subjective level of acute discomfort at specified frequencies over the frequency range of hearing. This defines a dynamic range between the hearing threshold at that frequency and the loudness discomfort level. A compressed dynamic range over a particular frequency range can be associated with hyperacusis. Normal hearing threshold is generally defined as 0–20 decibels (dB). Normal loudness discomfort levels are 85–90+ dB, with some authorities citing 100 dB. A dynamic range of 55 dB or less is indicative of hyperacusis.<ref name="pmid15807048">Template:Cite journal</ref><ref name="pmid25478787">Template:Cite journal</ref>

SeverityEdit

Tinnitus is often rated on a scale from "slight" to "severe" according to the effects it has, such as interference with sleep, quiet activities, and normal daily activities.<ref name="pmid11678946">Template:Cite journal</ref>

Assessment of psychological processes related to tinnitus involves measurement of tinnitus severity and distress, as measured subjectively by validated self-report tinnitus questionnaires.<ref name="Henry JA, Dennis KC, Schechter MA 2005 1204–1235"/> Such questionnaires measure the degree of psychological distress and handicap associated with tinnitus, including effects on hearing, lifestyle, health, and emotional functioning.<ref name="pmid17956816">Template:Cite book</ref><ref name="pmid17956815">Template:Cite book</ref><ref name="pmid22156949">Template:Cite journal</ref> A broader assessment of general functioning, such as levels of anxiety, depression, stress, life stressors, and sleep difficulties, is also important in the assessment of tinnitus due to higher risk of negative well-being across these areas, which may be affected by or exacerbate the tinnitus symptoms.<ref>Template:Cite book</ref>

Current assessment measures aim to identify levels of distress and interference, coping responses, and perceptions of tinnitus to inform treatment and monitor progress. However, wide variability, inconsistencies, and lack of consensus regarding assessment methodology are evidenced in the literature, limiting comparison of treatment effectiveness.<ref>Template:Cite journal</ref> Developed to guide diagnosis or classify severity, most tinnitus questionnaires have been shown to be treatment-sensitive outcome measures.<ref name=":0">Template:Cite journal</ref>Template:Request quotation

Pulsatile tinnitusEdit

If examination reveals a bruit (sound due to turbulent blood flow), imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.<ref name="pmid28203490">Template:Cite journal</ref><ref name="pmid23885280">Template:Cite journal</ref><ref name="pmid22552697">Template:Cite journal</ref>

Differential diagnosisEdit

Other potential sources of the sounds normally associated with tinnitus should be ruled out. For instance, two recognized sources of high-pitched sounds might be electromagnetic fields common in modern wiring and various sound signal transmissions. A common and often misdiagnosed condition that mimics tinnitus is radio frequency (RF) hearing, in which subjects hear objectively audible high-pitched transmission frequencies that sound similar to tinnitus.<ref>Template:Cite journal</ref><ref name="pmid17495664">Template:Cite journal</ref>

PreventionEdit

File:HSR 1996 II 3.3c.svg
Safety sign from the UK Government Regulations requiring ear protection

Prolonged exposure to loud sound or noise levels can lead to tinnitus.<ref name=CPG2014>Template:Cite journal</ref> Custom made ear plugs or other measures can help with prevention. Employers may use hearing loss prevention programs to help educate and prevent dangerous levels of exposure to noise. Government organizations set regulations to ensure employees, if following the protocol, should have minimal risk to permanent damage to their hearing.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Certain groups are advised to wear ear plugs to avoid the risk of tinnitus, such as that caused by overexposure to loud noises like wind noise for motorcycle riders.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> This includes military personnel,<ref name="pmid32334867"/> musicians,<ref>Template:Cite journal</ref> DJs,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> agricultural workers,<ref>Template:Cite journal</ref> and construction workers<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> as people in those occupations are at a greater risk compared to the general population.

Several medicines have ototoxic effects, which can have a cumulative effect that increases the damage done by noise.<ref name="pmid32334867"/> If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.<ref name="pmid33080070"/><ref name="pmid21796866">Template:Cite journal</ref><ref>Template:Cite journal</ref><ref name="pmid8934581">Template:Cite journal</ref>

ManagementEdit

If a specific underlying cause is determined, treating it may lead to improvements.<ref name="Baguley McFerran Hall 2013"/> Otherwise, the primary treatment for tinnitus is talk therapy,<ref name=Lang2013/> sound therapy, or hearing aids. There are no effective drugs that treat tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref>

PsychologicalEdit

The best-supported treatment for tinnitus is cognitive behavioral therapy (CBT).<ref name=Lang2013/><ref name=":0" /><ref name=Hoarre2011/> It decreases the stress those with tinnitus feel.<ref>Template:Cite journal</ref> This appears to be independent of any effect on depression or anxiety.<ref name=Hoarre2011>Template:Cite journal</ref> Acceptance and commitment therapy (ACT) also shows promise in the treatment of tinnitus.<ref>Template:Cite journal</ref> Relaxation techniques may also help.<ref name="Baguley McFerran Hall 2013"/> A clinical protocol called Progressive Tinnitus Management has been developed by the United States Department of Veterans Affairs.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

Sound-based interventionsEdit

The application of sound therapy by either hearing aids or tinnitus maskers may help the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects.<ref name="Baguley McFerran Hall 2013"/><ref name="pmid24622861">Template:Cite journal</ref><ref>Template:Cite journal</ref> There are several approaches for tinnitus sound therapy. The first is sound modification to compensate for the individual's hearing loss. The second is tailored music therapy, notched at the tinnitus frequency, which may affect lateral inhibition of the notched neural region, suppressing tinnitus.<ref>Template:Cite journal</ref><ref name="Hesse Doc04">Template:Cite journal</ref>

There is some tentative evidence supporting tinnitus retraining therapy, which aims to reduce tinnitus-related neuronal activity.<ref name="Baguley McFerran Hall 2013"/><ref name="pmid20238353">Template:Cite journal</ref><ref name="Hesse Doc04"/> An alternative tinnitus treatment uses mobile applications that include various methods including masking, sound therapy, and relaxation exercises.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Such applications can work as a separate device or as a hearing aid control system.<ref>Template:Cite journal</ref>

Neuromonics is another sound-based intervention. Its protocol follows the principle of systematic desensitization and involves a structured rehabilitation program lasting 12 months. Neuromonics therapy employs customized sound signals delivered through a device worn by the patient, which aims to target the specific frequency range associated with their tinnitus perception.<ref>Template:Cite journal</ref>

Physical therapyEdit

Physical therapy for tinnitus focuses on relaxing jaw and neck muscles that may contribute to symptoms. Muscle tension, particularly in the jaw muscles like the masseter and medial pterygoid, can radiate to the ears, leading to somatic tinnitus. Specialized physical therapists use neuromuscular techniques to alleviate tension in these areas, which may reduce tinnitus intensity and associated pain in connected areas, such as the jaw, teeth, and ears.<ref>The Effect of Physical Therapy on Somatosensory Tinnitus</ref>

MedicationsEdit

Template:As of there were no medications effective for idiopathic tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref name=CPG2014/><ref name="Bauer2018">Template:Cite journal</ref> There is not enough evidence to determine if antidepressants<ref>Template:Cite journal</ref> or acamprosate are useful.<ref>Template:Cite journal</ref> There are conflicting studies regarding the effectiveness of benzodiazepines for tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref name="Bauer2018"/><ref name="Savage2014">Template:Cite journal</ref><ref name="pmid34205776">Template:Cite journal</ref> The usefulness of melatonin, as of 2015, is unclear.<ref>Template:Cite journal</ref> It is unclear if anticonvulsants are useful for treating tinnitus.<ref name="Baguley McFerran Hall 2013"/><ref>Template:Cite journal</ref> Steroid injections into the middle ear also do not seem to be effective.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> There is no evidence to suggest that the use of betahistine to treat tinnitus is effective.<ref>Template:Cite journal</ref>

Botulinum toxin injection has succeeded in some of the rare cases of objective tinnitus from a palatal tremor.<ref name="pmid27273401">Template:Cite journal</ref>

Caroverine is used in a few countries to treat tinnitus.<ref name=Martindale36>Template:Cite book</ref> The evidence for its usefulness is very weak.<ref name=Langguth2009>Template:Cite journal</ref>

NeuromodulationEdit

In 2020, information about clinical trials indicated that bimodal neuromodulation may reduce the symptoms of tinnitus. It is a noninvasive technique that involves applying an electrical stimulus to the tongue while also administering sounds.<ref>Template:Cite journal</ref> Equipment associated with the treatments is available through physicians. Studies with it and similar devices continue in several research centers.Template:Citation needed

In March 2023, the US Food and Drug Administration (FDA) approved Neuromod's Lenire device as a treatment option for tinnitus.<ref name="George 2023">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Everts 2023">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Philpott 2024">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In June 2024, the US Department of Veterans Affairs (VA) announced it would begin offering the treatment to veterans with tinnitus, making it the first bimodal neuromodulation device to be awarded a Federal Supply Schedule (FSS) contract from the US Government.<ref name="Philpott 2024" />

Some evidence supports neuromodulation techniques such as transcranial magnetic stimulation,<ref name="Baguley McFerran Hall 2013"/><ref>Template:Cite journal</ref> transcranial direct current stimulation, and neurofeedback.Template:Cn

Alternative medicineEdit

Ginkgo biloba does not appear to be effective.<ref name="Bauer2018"/><ref>Template:Cite journal</ref> The American Academy of Otolaryngology recommends against taking melatonin or zinc supplements to relieve symptoms of tinnitus, and reported that evidence for the efficacy of many dietary supplements (such as lipoflavonoids, garlic, traditional Chinese/Korean herbal medicine, honeybee larvae, and various other vitamins and minerals, as well as homeopathic preparations) did not exist.<ref name=CPG2014/> A 2016 Cochrane Review also concluded that evidence was not sufficient to support taking zinc supplements to reduce symptoms associated with tinnitus.<ref>Template:Cite journal</ref>

PrognosisEdit

While there is no cure, most people with tinnitus get used to it over time; for a minority, it remains a significant problem.<ref name=Lang2013/>

EpidemiologyEdit

AdultsEdit

Tinnitus affects 10Template:Ndash15% of people.<ref name=Lang2013/> About a third of North Americans over 55 experience it.<ref>Template:Cite journal</ref> It affects one third of adults at some time in their lives, whereas 10–15% are disturbed enough to seek medical evaluation.<ref>Template:Cite journal</ref> 70 million people in Europe are estimated to have tinnitus.<ref name="KarolinskaInstitutet">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="CORDIS">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>

ChildrenEdit

Tinnitus is commonly thought of as a symptom of adulthood, and is often overlooked in children. Children with hearing loss have a high incidence of pediatric tinnitus, even though they do not express the condition or its effect on their lives.<ref name="Celik et al">Template:Cite journal</ref><ref>Template:Cite journal</ref> Children do not generally report tinnitus spontaneously and their complaints may not be taken seriously.<ref>Template:Cite journal</ref> Among those who do complain, there is an increased likelihood of associated otological or neurological pathology such as migraine, juvenile Meniere's disease, or chronic suppurative otitis media.<ref>Template:Cite book</ref> Its reported prevalence varies from 12 to 36% in children with normal hearing thresholds, and up to 66% in children with a hearing loss. Approximately 3–10% of children have been reported to be troubled by tinnitus.<ref name="pmid20371585">Template:Cite journal</ref>

See alsoEdit

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ReferencesEdit

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Further readingEdit

External linksEdit

Template:Medical condition classification and resources Template:Diseases of the ear and mastoid process Template:Occupational safety and health Template:Authority control

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