RINGING IN THE EARS

Ringing in the ears, or tinnitus, affects between 9.6-13.4 percent of the U.S. population, according to studies conducted by Kochkin, Tyler, and Born (2011) and Jay M. Bhatt, Harrison W. Lin, Neil Bhattacharyya (2016). Tinnitus prevalence increases as a function of age and severity of hearing loss. While the most common cause of tinnitus is hearing loss, other causes may include the following: a small plug of wax, ear infections, a hole in the eardrum, stiffening of the middle ear bones, allergies, high or low blood pressure, diabetes, a tumor, injury to the head or neck, or medications. Tinnitus is a common side effect of medications, and when multiple medications are taken together, the potential for drug interaction (creating new side effects, which could include tinnitus) increases. If tinnitus becomes chronic, whether it is constant or intermittent (comes and goes), you should talk to your doctor. A review of medication should be performed to see if tinnitus could be a result of change in medication or change in routine of drug therapy. Your doctor should check the outer ear for wax build-up or a tear in the eardrum. The physician should check blood pressure and may screen for diabetes or other medical problems. Because hearing loss is the most common cause of tinnitus, your doctor should also refer you to an audiologist for a full comprehensive audiometric and tinnitus evaluation. A referral to an otolaryngologist (ear-nose-throat, or ENT) is also advisable. Once tinnitus is diagnosed and medical concerns have been eliminated, your audiologist can discuss ways to reduce or eliminate tinnitus in a natural, effective way. If hearing loss is diagnosed, tinnitus is most likely a result of a lack of auditory stimulation to the auditory nerve bers, which increases the spontaneous ring rate of the auditory nerve bers. The auditory brainstem (subconscious) sends this information to the auditory cortex, where auditory attention is placed on the sound, and higher priority is placed on the incoming signals. As the information from the auditory nerve continues and passes back through the auditory system in the brain, the limbic system may attach negative emotions to the sound (“I don’t like that noise”), which causes a response from the autonomic nervous system (stress center of the brain), which may increase adrenaline, all of which may increase auditory attention, making the tinnitus louder. Understanding this biofeedback loop in the brain is the rst step to reducing the severity of tinnitus. Your audiologist may recommend tinnitus retraining therapy or cognitive behavioral therapy for tinnitus abatement. Amplification is also a common intervention tool, as increasing auditory stimulation of the auditory nerve often reduces the spontaneous ring rates of the nerve bers that innervate damaged areas of the cochlea (inner ear). Sound enrichment therapy is an easy way for the patient to mask the tinnitus themselves, at home. By avoiding dead silence and enriching the environment with a little more sound (turning on a fan or similar white noise), more auditory information is sent to the auditory brainstem, which reduces auditory attention on the tinnitus, and often may allow it to fade into the background, where it may be ignored. Diet and lifestyle changes are also a natural way to potentially reduce tinnitus. Patients with tinnitus should avoid stimulants, such as caffeine and nicotine, as they can increase spontaneous ring rates of nerve bers and excite the auditory system, which may make tinnitus louder. Salt may impair blood circulation and cause uid retention, which could affect the uid- lled inner ear. By reducing salt intake, tinnitus can sometimes be alleviated. Ginkgo biloba has been shown to increase blood ow to the head, neck and brain, while simultaneously reducing in ammation in the blood vessels. Taken consistently, symptoms of tinnitus may begin to reduce with time. Another supplement that has shown potential in reducing tinnitus is Co-Enzyme Q10 (CoQ10). According to the Journal of Otolaryngology – Head and Neck Surgery, CoQ10 can reduce the number of noises heard, as well as the intensity of the tinnitus. Daily exercise improves blood circulation and releases endorphins. This reduces stress, which may help to break-up the biofeedback loop in the auditory system, thereby reducing tinnitus. Other stress-reducing activities are also recommended (i.e. having regular massages or utilizing a stress ball), as these can have a positive effect on reducing tinnitus. If you have experienced tinnitus, talk to your physician and request a referral to Better Hearing and Balance Connection. They will schedule a comprehensive evaluation to determine the best individual recommendation for reducing your tinnitus severity, and they can also help coordinate any necessary referrals to other healthcare professionals. Better Hearing has two locations to better serve you: 407 Town Center NE in Bella Vista and 906 NW 8th St. in Bentonville. Dr. Gretchen Magee, Au.D. and Dr. Shawn Key, Au.D. can diagnose and treat tinnitus, hearing loss, and balance disorders. Call 479-657-6464 to schedule your appointment today.