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Tinnitus & Balance

What is tinnitus?
Tinnitus is the illusion of sound when there is none. It may be a ringing, roaring, clicking, hissing, or buzzing sound in the ears. It may occur in one or both ears, be soft or loud, high pitched or low pitched. Approximately 10 percent of the adult population of the United States has experienced tinnitus for more than three months.

What causes tinnitus?
Tinnitus (pronounced tin-NY-tus or TIN-u-tus) indicates something is wrong in the auditory system (the ear, the auditory nerve that connects the inner ear to the brain, or the parts of the brain that process sound). Earwax may be blocking the ear canal, or it can be the result of a number of health conditions, including:

  1. Noise-induced hearing loss
  2. Ear and sinus infections
  3. Diseases of the heart or blood vessels
  4. Ménière’s disease
  5. Brain tumors
  6. Hormonal changes in women
  7. Thyroid abnormalities

Tinnitus can be the first sign of hearing loss in older people or a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.

Noise exposure is a common cause of tinnitus. Factory or construction workers, road crews, and musicians can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain.

Soldiers exposed to bomb blasts can develop tinnitus if the shock wave of the explosion squeezes the skull and damages brain tissue in areas that help process sound.

Pulsatile tinnitus, a rhythmic pulsing in the ear usually in time with your heartbeat, is a rare type of tinnitus most often caused by problems with blood flow in the head or neck. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.

Some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and memory and concentration problems. For some, it is a source of mental and emotional anguish.

Why do I have this noise in my ears?
Although tinnitus sounds as if it is in our ears, it really is in the neural circuits or networks of brain cells. Tinnitus may begin in the ear, but it continues in the brain. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after a wound or broken bone has healed.

Scientists are unsure of what causes tinnitus. Some think it the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by turning up the sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise.

Or damage in the inner ear may change signaling activity in the auditory cortex, the part of the brain that processes sound. Or abnormal interactions between neural circuits could cause tinnitus.

What should I do if I have tinnitus?
Check with your primary care doctor to be sure nothing is blocking your ear canal, such as earwax.

If your doctor cannot find any medical reason for your tinnitus, you may be referred to an otolaryngologist (also known as an ear, nose, and throat an ENT doctor). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.

What if the sounds in my ear do not go away?
Tinnitus may continue or get worse. It may become so severe that it becomes difficult to hear, concentrate or even sleep. Your doctor will work with you to help find ways to reduce the severity of the noise and its impact on your life.

Are there treatments that can help me?
Tinnitus isn’t curable yet. Below are some treatments that doctors may recommend and that have helped people cope with the condition.

Hearing aids can be helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear. The better you hear, the less you may notice your tinnitus.

Counseling may help you change the way you think about and react to your tinnitus. You may learn some things to make the noise less noticeable, to help you relax during the day or to fall asleep at night.

Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.

Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might be all you need to help you fall asleep.

Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.

Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits.

Antidepressants and anti-anxiety drugs might be prescribed by your doctor to improve your mood and help you sleep.

Other medications may be available at drugstores and on the Internet as an alternative remedy for tinnitus, but none of these preparations has been proved effective in clinical trials.

Can I do anything to prevent tinnitus or keep it from getting worse?
Noise-induced hearing loss, the result of damage to the sensory hair cells of the inner ear, is one of the most common causes of tinnitus. Anything you can do to limit your exposure to loud noise—by moving away from the sound, turning down the volume, or wearing earplugs or earmuffs—will help prevent tinnitus or keep it from getting worse.

What are researchers doing to better understand tinnitus?
Many things can go wrong along the path a sound travels from the inner ear to the brain to cause tinnitus.

Promising research directions include:

  1. Electrical or magnetic stimulation of brain areas involved in hearing. Implantable devices already exist to reduce the trembling of Parkinson’s disease and the anxieties of obsessive-compulsive disorder. Similar devices could be developed to normalize the neural circuits involved in tinnitus.
  2. Repetitive transcranial magnetic stimulation (rTMS). This technique, which uses a small device placed on the scalp to generate short magnetic pulses, is used to normalize electrical activity in the brains of people with epilepsy. Through preliminary trials of rTMS in humans, researchers are looking for the best spots to stimulate in the brain in order to suppress tinnitus. The National Institute of Deafness and Communication Disorders funds these studies. Researchers are also looking for ways to identify which people are most likely to respond well to stimulation devices.
  3. Hyperactivity and deep brain stimulation. Researchers have observed hyperactivity in neural networks after exposing the ear to intense noise. Understanding specifically where in the brain this hyperactivity begins and how it spreads to other areas could lead to treatments that use deep brain stimulation to calm the neural networks and reduce tinnitus.
  4. Resetting the tonotopic map. Researchers are exploring how to take advantage of the tonotopic map, which organizes neurons in the auditory cortex according to the frequency of the sound to which they respond. Previous research has shown a change in the organization of the tonotopic map after exposing the ear to intense noise. By understanding how these changes happen, researchers could develop techniques to bring the map back to normal and relieve tinnitus.

Learn more:
The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, smell, taste, voice, speech, and language. Please see the list of organizations at www.nidcd.nih.gov/directory.

Tips for managing tinnitus

Primary source: National Institutes of Health

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Note: If no author is given, the source is cited instead.
Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of HearingLab or its staff.

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Dizziness Can Be a Drag: Coping with Balance Disorders

August 2012 | NIH News in Health

dizziness cartoon

Imagine reaching for something on a grocery shelf and suddenly feeling unsteady. Or looking over your shoulder to back up the car and having things start whirling around you. Most people feel dizzy now and then. But if that feeling persists or interferes with your daily life, it could be a sign of a balance disorder.

A balance disorder makes you feel as if you're moving, spinning or floating, even though you're quite still. More than 4 in 10 Americans will experience an episode of dizziness sometime during their lives that's significant enough to send them to a doctor.

Dizziness can range from feeling lightheaded to woozy to disoriented. Feeling that you or your surroundings are spinning is called vertigo. Any of these sensations can be extremely distressing.

"Balance is a multisystem function," explains NIH hearing and balance expert Dr. Daniel Sklare. It begins with a series of signals within the tiny balance organs of the inner ear. These organs work with your brain's visual system to give you a sense of your body's position. They also keep objects from blurring when your head moves. Sense receptors in skin, joints and muscles also send balance-related signals to the brain. The brain receives and coordinates information from all these different body systems. Balance disorders can arise when any of these signals malfunction.

Because balance is so complex, it can be hard to figure out the underlying cause of certain problems. Some balance disorders can begin suddenly. They might arise from an ear infection, a head injury or certain medications. Low blood pressure can lead to dizziness when you stand up quickly. Disorders related to vision, muscles, bones or joints can also contribute to balance problems.

"As America gets older, many people with imbalance have a collection of these problems," says Dr. Gordon Hughes, NIH clinical trials director for hearing and balance. "They might have aging of the ear, aging of vision, cataracts, muscle weakness from losing some muscle mass or arthritis in the hips, plus other problems like diabetes."

Researchers have identified more than a dozen different balance disorders. The most common is a sudden, often harmless burst of vertigo that might arise with an abrupt change in the position of the head, like when you bend over to tie your shoes. Technically known as benign paroxysmal positional vertigo (BPPV), this condition can result from a head injury or simply from getting older. BPPV sometimes occurs when tiny calcium crystals in the inner ear become displaced. In that case, your doctor can treat BPPV by carefully moving the head and body to reposition these particles. An NIH-supported clinical trial showed that this treatment works well for BPPV.

Another common balance disorder is known as Ménière's disease. It can develop at any age, but most often strikes adults between 40 and 60 years of age. Symptoms include intense vertigo, hearing loss, nausea, tinnitus (a ringing or buzzing in the ear) and a feeling of fullness in the ear. Ménière's disease usually affects only one ear.

Some people with Ménière's disease have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some affected people have vertigo so extreme that they lose their balance and fall. These episodes are called "drop attacks."

An attack of Ménière's symptoms, while not life-threatening, can feel completely overwhelming. The symptoms arise because of a change in fluid volume within the inner ear. But its underlying cause remains unknown. Scientists estimate that 6 in 10 people either get better on their own or can control their vertigo with diet, drugs or devices. In severe cases, surgical therapies can end the dizziness but might affect hearing.

NIH-funded researchers at the University of Washington are now exploring a new treatment option to stop a Ménière's attack. An implant behind the ear is designed to control abnormal electrical activity in the nerve that sends balance information to the brain, bringing the sensation of spinning to a halt. The device is now being tested in clinical trials.

If you think you may have a balance disorder, talk with your health care provider. Your doctor can assess whether your symptoms might be caused by a serious disorder, such as a heart or blood condition. If an inner ear balance disorder is likely, you may be referred to a specialist such as an otolaryngologist, a doctor with expertise in the ear, nose and throat. You might receive a hearing test, a balance test and possibly an imaging study of the brain.

Work with your doctor to figure out how to cope with your dizziness on a daily basis and reduce your risk of injury. For example, wear low-heeled shoes or walking shoes outdoors. You might decide to try using a cane or walker. Safe, secure handrails in stairwells and grip handles in bathrooms can help make your home safer. Driving a car may be especially hazardous, so ask your doctor if it's safe for you to drive.

A specialized rehabilitation therapist can give you a set of head, body and eye exercises to help reduce dizziness and nausea.

Meanwhile, researchers continue to work to develop new, more effective approaches. In one experimental rehabilitation strategy, now in clinical trials, scientists have created a "virtual reality" grocery store. It allows people with balance disorders to walk safely on a treadmill through computer-generated store aisles. While holding onto a grocery cart, they can look up and down, turn their heads and reach for items on virtual shelves. By doing this, they safely learn how to navigate an environment that can be challenging for someone with a balance problem.

"The key for people looking for treatment is to go to the best team of clinical experts that they can gain access to," says Dr. Sklare. "It's very important to get that level of assessment."