What is tinnitus and how often does it happen?
These are sounds that are heard in one or both ears or in the head, and sometimes in both at the same time. People who hear noise describe it as a squeak, ringing, banging, hum, whistle, or rustle. Regardless of the nature and type of sounds, they are all called tinnitus. When a doctor uses the term tinnitus, he is referring to a specific sound or sounds that the patient hears. The term “continuous tinnitus” is used to describe sounds that are heard continuously, while “intermittent tinnitus” is the sound heard intermittently for hours to days or weeks. The subjective tinnitus that occurs in the vast majority of patients is heard only by the affected person. Noises that can be detected in some way with a microphone or heard directly with the ear or with a stethoscope applied to the patient’s head are called objective tinnitus. Such noises are extremely rare.
Almost all of us experience periodic ringing in our ears. This is especially noticeable in silence. Such momentary, passing sounds have no clinical significance and do not require medical advice.
What causes tinnitus?
Tinnitus is associated with abnormalities in the auditory analyzer and is the result of changes in the activity of the fibers of the auditory nerve. In most cases, it is believed that irreversible damage to the outer hair cells of the cochlea is the source of tinnitus. Simply put, the activity in the pathway of the auditory analyzer changes. New theories suggest that damage to the peripheral auditory system reduces the amount of information about sound transmitted from the auditory centers to the brain. In response, the central nervous system increases activity at the level of the cerebral cortex, which is perceived as tinnitus.
Why is tinnitus a concern?
Not only does the auditory system participate in the process of perceiving noise, but also other parts of the brain, such as the limbic system (responsible for emotions) and the autonomic nervous system (responsible for defense reactions). All people are different, and they react differently to various signals and experience tinnitus in different ways. On the one hand, there may be a disgruntled patient, for whom the noise is a serious problem that prevents them from leading a normal life, and on the other, there may be a person who is not bothered with tinnitus at all or is only bothered to a small extent or only in some situations, for example, when they fall asleep or rest, or work in silence. It should be emphasized that there is no relationship between noise parameters such as loudness or pitch and the degree of their intensity. In other words, for some people, the appearance of extraneous sound in the ears, even the quietest, is a serious problem that interferes with a normal life, while for others, ear noise does not interfere at all. This indicates that the degree of irritation is determined not by the place of origin and characteristics of the noise, but by the consequences that the signal causes in the human nervous system.
Most often, the tinnitus presents itself as subjective tinnitus for the patient. This means that no one else can hear this sound. That is why there is a misunderstanding of the patient’s problem by the people around them.
Is tinnitus a disease, and is it a threat?
Tinnitus is not a disease, but only a symptom of various changes in the inner ear. To find out the cause of tinnitus, an audiological diagnosis should be carried out in order to exclude organic pathologies that require surgical intervention by a doctor. Although tinnitus is not a disease, it often leads to nervous tension, anxiety, unexplained fears, discomfort, and often causes depression, so tinnitus must be treated.
What are the most common causes of tinnitus and how can it be prevented?
Possible causes of tinnitus include:
- Sulfuric plugs in the ear canal are a common cause of tinnitus. Removal of residual sulfur by flushing or using an electric suction usually results in immediate relief and the patient no longer feels the noise.
- Otitis media and upper respiratory tract infections cause obstruction in the Eustachian tube and pressure changes in the middle ear, which can manifest as tinnitus and hearing impairment in the patient.
- Ototoxic drugs that damage the hearing organ can cause both hearing loss and tinnitus. If a patient suspects that the pharmacological drug they use is causing side effects, such as tinnitus or hearing impairment, the patient should immediately inform the doctor who prescribed the drug.
- Head and neck injuries can cause tinnitus, which can be accompanied by symptoms such as dizziness, imbalance, headaches, and memory problems.
- Acoustic trauma. The noise damages the hair cells in the inner ear. The risk group mainly includes people who are exposed to noise for extended periods of time, such as military personnel, musicians, call center workers, lovers of discos and loud concerts, or young people listening to music with headphones.
- Diseases of the cardiovascular system. Patients often complain of a “pressure surge” as the cause of tinnitus.
- Endocrine diseases. Tinnitus is often associated with thyroid disease, as well as diabetes and insulin resistance. Tinnitus can occur with both hyperthyroidism and hypothyroidism.
- Stress in the form of so-called “acute stress” or chronic stressful situations is a factor that young or busy people cite as a potential cause of tinnitus.
- Changes in the cervical spine. There is often a link between discopathy and degenerative changes in the cervical spine and tinnitus.
- Temporomandibular joint dysfunction can also cause tinnitus. These changes can be suspected as a potential cause of tinnitus if it occurs simultaneously with chewing food and muscle pain in the joint area.
- Tumors. Tumor changes in the area of the auditory analyzer are a rare cause of tinnitus, however, each individual case of tinnitus, especially unilateral tinnitus with concomitant hearing loss, should be consulted with a specialist in this field.
This list does not cover every possible cause of tinnitus.
Tinnitus can begin at any point in the auditory analyzer between the inner ear and the brain. The noise can be continuous or intermittent, intermittent or chronic.
Noises can also occur outside the auditory system, that is, in the muscular or skeletal system in the head and neck region or in the temporomandibular joint, and be retransmitted to the auditory system.
NEUROPLASTICITY
The tVNS method, or electrical stimulation of the auricular branch of the left vagus nerve, is a new treatment for tinnitus. Its task is to lead to changes in the brain and to eliminate or reduce the perceived tinnitus. This method involves the use of the innovative Parasym device. The effectiveness of this method is based on the phenomenon of brain neuroplasticity. Neuroplasticity is the ability of the brain to repair itself by generating new neural connections. These emerging new neural connections can change the nature of the response. The tVNS method aims to improve neural plasticity, which focuses on a specific area of the brain associated with tinnitus (targeted plasticity).
How does this method work?
Stimulation of the vagus nerve affects the basal cholinergic nuclei, which induce permanent changes in the cerebral cortex. Through this mechanism, stimulation of the vagus nerve in combination with auditory stimuli promotes reorganization at the auditory cortex’s level. Thus, the main goal of the method – to reorganize this altered activity so that it affects noise reduction. A patient with tinnitus has a highly agitated sympathetic nervous system. This manifests itself in the form of high levels of tension and stress. When the aural branch of the vagus nerve is stimulated, the opposite system is stimulated: the parasympathetic system. Due to this, this over-activity of the sympathetic nervous system can be suppressed. In addition, stimulation of the vagus nerve is thought to decrease activity in the limbic system, which includes the hippocampus and amygdala. These structures are considered potential locations where tinnitus can occur.
Audiological diagnostics
A prerequisite for starting therapy is an audiological diagnosis in order to determine the site of possible noise. The patient is referred for therapy based on the medical history collected by the doctor and the completed and signed questionnaire. The doctor will decide if the therapy will be effective for the patient and will give an appropriate referral. Cooperation with the medical staff, who will carry out the necessary examinations and make the correct diagnosis, is the key to success and an integral step from which the whole process begins.
Who can benefit from this therapy?
This method can be offered to patients with irritating tinnitus. Irritating tinnitus is one that so negatively affects the patient’s quality of life that they actively seek help. All people are different, they react differently to various signals and experience tinnitus in different ways. On the one hand, there may be a disgruntled patient, for whom the noise is a serious problem that prevents them from leading a normal life, and on the other, there may be a person who is not bothered with tinnitus at all or is only bothered to a small extent or only in some situations, for example, when they fall asleep or rest, or work in silence. It should be emphasized that there is no relationship between noise parameters such as loudness or pitch and the degree of their intensity. In other words, for some people, the appearance of extraneous sound in the ears, even the quietest, is a serious problem that interferes with a normal life, while for others, ear noise does not interfere at all. This indicates that the degree of irritation is determined not by the place of origin and characteristics of the noise, but by the consequences that the signal causes in the human nervous system.
This method is also intended for patients with chronic tinnitus that lasts more than 6 months. Patients with acute tinnitus, that is, lasting less than 6 months, should first wait for their tinnitus to subside spontaneously. If the tinnitus persists throughout 6 months, the patient can be referred for therapy.
For whom is the therapy not suitable?
– Patients with objective (measurable) noise or somatosensory noise:
- Somatosensory noise is noise associated with head movements. If the noise disappears with any movement of the head, it may be due to some disturbance outside the auditory system, for example, in the temporomandibular joint, or it may be the result of changes in the cervical spine or its surrounding structures. In this case, prior consultation with a physiotherapist is necessary.
– Patients who have an active medical device such as a pacemaker, hearing implant, or any other electronic or metal device.
– Patients with cardiovascular diseases or atherosclerosis, including congestive heart failure, diagnosed with severe coronary heart disease or after a recent heart attack (no more than 5 years ago).
– Patients diagnosed with bradycardia (slow heartbeat) or cardiac arrhythmias (abnormal heart rhythm).
– Patients who have undergone surgery to cut the vagus nerve in the neck (vagotonia).
– Patients with significant narrowing of the arteries (atherosclerosis of the carotid arteries).
– Patients with undiagnosed pain sensations.
– Children.
– Pregnant women.
Duration of the therapy
The Parasym device is provided to the patient for a period of 12 weeks. Therapy sessions take place at home for 1 hour a day. After 3 months, about 60% of the respondents experienced a disappearance or decrease in the intensity of the tinnitus. However, reduction is more likely than complete elimination. The therapy is based on the simultaneous stimulation of the left vagus nerve and binaural sound stimulation. The stimulation always involves the left nerve because research shows that this is associated with fewer side effects compared to the right vagus nerve. The patient signs a special rental agreement for this device for the duration of the therapy. During the first visit, the patient is also instructed on how to use the Parasym device correctly. Each patient undergoing this therapy can also count on our constant support and care throughout the entire treatment process.
Possible risks
When using the Parasym device in accordance with the instructions, the level of possible risk is very low. A systematic review of 1,322 patients (in 51 studies) who underwent vagus nerve stimulation through the skin was carried out in 2018. This review found that only 2.6% of participants withdrew from further treatment due to side effects. The most common side effect was skin irritation resulting from stimulation, which usually disappeared shortly after the stimulation ended.
