TINNITUS AS A SYMPTOM OF MENIERE'S DISEASE
Types of tinnitus
There are two types of tinnitus - objective and subjective. Objective tinnitus can be heard by someone else as well as the sufferer. Less than 1 % of tinnitus is objective but must be investigated. Subjective tinnitus can only be heard by the sufferer and can be caused by any of the following conditions.
Otologic
Presbycusis (ageing), Meniere's Disease, otosclerosis, trauma, e.g. head injury, noise induced hearing loss, chronic otitis media (middle ear infection).
Metabolic
Thyroid problems, high cholesterol levels, zinc and/or vitamin deficiency.
Neurological
Fractured skull, whiplash, multiple sclerosis, post meningitis.
Pharmacological
Aspirin in high doses, heavy metals, e.g. arsenic, aminoglycoside e.g. Streptomycin, Gentamycin.
Psychological
Depression, anxiety.
Dental
Temporo-mandibular joint dysfunction.
Idiopathic
Where no specific cause can be found.
Mechanism of tinnitus
The actual mechanism of tinnitus is still disputed. The traditional theories centre on the cochlea (inner ear) as the source of tinnitus. The noise is envisaged as arising from some disfunctioning of the tiny hair cells. More recently new theories, notably that of Jastreboff argue that tinnitus really arises in the brain, particularly that part responsible for our emotional responses (Limbic system). Tinnitus is seen as a response arising within this system to noises originating within the auditory pathway which, in a particular individual, are perceived as unpleasant - a type of conditioned response which persists and causes on-going distress. Certainly it is well-known that some persons may have loud tinnitus without being
What can be done about tinnitus?
Counsels of despair - "you will just have to live with it", "nothing can be done", etc., are no longer acceptable. Always, some help can be given by somebody, even though this may not mean the complete elimination of all tinnitus for a particular individual. Certainly, 'quick fix' solutions are seldom possible and management usually means working with a patient for some time.
All patients with tinnitus should have a proper evaluation by an ear, nose and throat specialist. They should have their history taken and an ENT examination to look for abnormalities. As an absolute minimum they should have an air/bone audiogram done under proper test conditions and often will have further and more complicated audiometric tests. In a few instances x-rays, scans or blood tests may be ordered. It is important to first address any treatable condition which may either cause or aggravate the tinnitus.
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