Tinnitus | Info & qualified tinnitus specialists

28.11.2023
Leading Medicine Guide Editors
Author
Leading Medicine Guide Editors

The term tinnitus aurium comes from Latin and means "ringing of the ears". Tinnitus includes all ear and head noises that cannot be attributed to an external sound source. This is an acoustic perception that usually only the affected person can hear. The sound is described as ringing, beeping, humming or hissing.

Here you will find further information and selected tinnitus specialists and centres.

ICD codes for this diseases: H93

Selected tinnitus specialists and centres

Brief overview:

  • What is tinnitus? A sound that only the affected person hears constantly and is perceived as annoying. It is usually a humming, hissing, beeping or ringing sound.
  • Types: A distinction is made between an objective (the sounds emanate from blood vessels or muscles and subjective tinnitus (there is no origin for the sound).
  • Symptoms: The constant perception of a sound is stressful and can lead to irritability, concentration and sleep disorders, muscle tension, headaches and other symptoms.
  • Causes (objective tinnitus): Sounds can be caused by constricted blood vessels, muscle spasms in the head area, an ear tumour and other conditions. 
  • Causes (subjective tinnitus): Medical experts assume that it develops in a similar way to phantom limb pain. Hearing loss, acoustic trauma, middle ear infections it can also be caused by drugs, stress, psychological strain and other pre-existing conditions.
  • Degree of severity: Depending on how disturbing the affected person finds the noise, tinnitus is classified into one of four degrees of severity, ranging from "not disturbing" to massive impairment of life.
  • Diagnosis: After the patient interview, the doctor performs a hearing test and brainstem audiometry. A double sonography, an MRI and a blood test help him to clarify the cause.
  • Treatment: In the case of objective tinnitus, the underlying disease must be treated. Chronic subjective tinnitus can rarely be cured. Here, the focus is on alleviating the discomfort and dealing with the noise.

Article overview

What is tinnitus?

Doctors distinguish between

  • the rare objective tinnitus and
  • the frequent subjective tinnitus.

In objective tinnitus, an endogenous sound source causes noise. The sounds emanate from the musculature or the blood vessels and can often be heard with a stethoscope.

In the vast majority of cases, however, sufferers are plagued by subjective tinnitus. Only the person affected can perceive the sound. If the ear noise has been present for less than six months, doctors speak of acute tinnitus. Longer lasting complaints are called chronic tinnitus.

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Tinnitus is not a disease, but merely a symptom. Nevertheless, it is perceived by some sufferers as life-impairing and causes psychological stress.

In some cases, ringing in the ears can have a serious impact on professional and/or personal life.

In Germany, around four percent of all adults are affected by tinnitus. As a rule, more women than men suffer from ear noise. More and more young people under 30 are also affected.

Acute tinnitus goes away in 80 percent of cases, sometimes even without treatment. With chronic tinnitus, the chance of recovery is significantly lower. However, the ear noise usually becomes less significant over time.

How do you recognise tinnitus?

Almost everyone has experienced a noise coming from inside at some time. As spontaneous as it comes, it goes again. However, if this does not happen, doctors speak of tinnitus.

Affected people report sounds like

  • Ringing,
  • Whistles,
  • Noise,
  • Saws or
  • Humming.

The sounds can be permanently there or appear with pauses. They can be loud or quiet.

Health problems can occur due to the continuous acoustic stress:

Causes for tinnitus

How does objective tinnitus develop?

Sound sources in the body that are located in the inner ear or in the surrounding tissue cause objective tinnitus. The causes are organic in nature:

  • Constricted blood vessels (the sound is usually perceived in sync with the pulse)
  • Cramps of the ear or palate muscles
  • Ear tumour
  • Complaints in the jaw joint
  • Closure defect of the Eustachian tube (connection between middle ear and nasopharynx)

How does subjective tinnitus develop?

There are many possible causes for subjective ringing in the ears. Very often, tinnitus is the result of a hearing disorder. Medical experts assume that tinnitus develops in a similar way to phantom pains that occur after an amputation.

Due to the hearing impairment, corresponding signals are missing or are only perceived weakly. The brain tries to compensate by increasing the activity in the corresponding area and producing its own sounds.

If the tinnitus develops for non-organic reasons, stress is usually the trigger.

The following factors can trigger or promote tinnitus:

  • Age-related or inherited deafness
  • Hearing loss
  • Noise and acoustic trauma
  • Meniere's disease (disease of the inner ear)
  • Middle ear infection
  • Eardrum defect
  • Eustachian tube dysfunction
  • Occlusions or narrowing in the external auditory canal (also earwax!)
  • Foreign body in the ear
  • Tumours
  • Otosclerosis (disease of the inner ear bone)
  • Drugs
  • Certain medicines such as some painkillers, antibiotics, antidepressants or chemotherapy drugs
  • TMJ problems, teeth grinding and tension of the neck muscles
  • Stress
  • Mental stress
  • Emotional problems
  • Chronic noise pollution
  • Burnout

Tinnitus
Constant noise can be psychologically very stressful © Stasique | AdobeStock

Into which degrees of severity is tinnitus classified?

Depending on how much stress the affected person is under, doctors speak of four degrees of severity.

  • Grade 1: The affected person does not feel disturbed, the tinnitus is well compensated for
  • Grade 2: Although the ringing in the ears is largely compensated for, it has a stressful effect, especially in stressful situations or under mental and physical strain
  • Grade 3: The ringing in the ears is very disturbing. The symptoms have consequences in professional and private life. Sleep and concentration disorders, muscle tension as well as headaches affect everyday life just as much as feelings of helplessness.
  • Grade 4: Enormous burden for the patient. The persistent ear noise is often responsible for occupational disability and brings massive psychological disturbances. A normal social life is impossible owing to severe anxiety and/or depression.

Who diagnoses tinnitus?

The contact person for tinnitus is your ENT specialist. First, the doctor will take your medical history. He needs precise information about

  • the type and frequency,
  • possible triggers or changes in the symptoms over the course of the day, and
  • the strain it causes in everyday life.

This is followed by the physical examination.

An ear microscopy, for example, can provide information about whether

  • only earwax is present or
  • whether the eardrum is injured.

A hearing test clarifies the hearing performance of the inner ear, after all, hearing loss is often the cause of tinnitus.

Further investigations are

  • a brainstem audiometry to check the auditory nerve or
  • the tympanogram, which tests the mobility of the eardrum.

In the case of diagnostic imaging methods, the following in particular are used

prompted.

Anatomie menschliches Ohr
Anatomical structure and function of the ear © bilderzwerg / Fotolia

Tinnitus is not necessarily the result of disturbances in the hearing system. Disorders of the masticatory system or the cervical spine can also cause tinnitus. Therefore, further examinations usually follow.

Thus, a blood pressure measurement can indicate elevated blood pressure. This could possibly have led to vascular changes near the ear.

Further insights can be gained, for example, through

  • a blood test,
  • the examination of the masticatory apparatus or
  • an orthopaedic examination of the cervical spine.

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Treatment of objective tinnitus

With objective tinnitus, there is always an underlying disease that is responsible for the sound source in the body. Treatment therefore primarily involves the elimination of this condition.

In the case of a tumour or arteriosclerosis an operation may become necessary. For cramps in the middle ear, magnesium preparations bring initial relief. Medication is also used, for example to lower blood pressure or to dilate blood vessels.

An important pillar of the treatment is also the mental support of the patient. This could be education or coping training.

Treatment for subjective tinnitus

Acute tinnitus has the greatest chance of being cured. If treatment is started immediately, the prognosis for complete elimination of the ringing in the ears is greatest.

Chronic tinnitus, on the other hand, can rarely be cured. The relief of the symptoms and the best possible management of the ringing in the ears are the main focus of the treatment.

Under certain circumstances, the subjective ear noise can be caused by other diseases. Then, as with objective tinnitus, the treatment provides for the cure of the underlying disease. However, there are often other reasons that make more extensive treatment necessary.

The following treatments can be started individually or in combination:

  • Tinnitus counselling (coping training and education)
  • Tinnitus retraining therapy
  • Physiotherapy
  • Brain stimulation methods (magnetic and/or electrical)
  • Hearing aid acoustics (for hearing loss)
  • Physical therapies such as hydrotherapy, biofeedback or Tai Chi
  • Medicines

Tinnitus counselling

Tinnitus counselling is an essential part of the treatment for subjective and objective tinnitus.

The core points of counselling are education and individual counselling of the person concerned. Life situations are discussed in which the tinnitus disturbs particularly little or particularly badly. For example, some patients have hardly any problems with tinnitus during the day, but they do when they fall asleep.

Simple and efficient relief can, in some cases, come from

  • learning a relaxation technique or
  • an artificial background noise in the bedroom

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The declared aim of counselling is to encourage the patient and to show him or her how best to deal with the ringing in the ears.

Tinnitus retraining therapy

An important treatment method for chronic tinnitus is habituation therapy. The best-known form is tinnitus retraining therapy. TRT includes noise therapy in addition to counselling.

The treatment aims to divert the sufferer's attention away from the ear noise. This helps to push the tinnitus into the background.

A tinnitus masker is used for this purpose. The small device is designed to drown out the ear noise and completely erase it in the course of the treatment. This contrasts with the tinnitus noiser, which does not cover up the noise but distracts from the tinnitus by means of background noise.

Both variants can be used over a longer period of time, but success is not guaranteed.

Medication for tinnitus

Only in the acute form does drug treatment make sense. Medicines should achieve

  • the improvement of inner ear blood circulation,
  • the restoration of normal nerve activity in the brain and
  • the normalisation of signal processing in the inner ear.

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Prescribed

  • cortisone preparations,
  • Substances that stimulate blood circulation and relax muscles,
  • Dehydrating agents or
  • Calcium antagonists to calm the nerve cells.

Which doctor treats tinnitus?

The doctor for people with ringing in the ears is the ear, nose and throat specialist. This specialist can determine if the cause is a cold, earwax blocking the ear canal or if it is a hearing loss (sudden hearing loss). Problems with the cervical spine or jaw joint can also affect the functioning of the ears. The doctors listed here are highly qualified tinnitus specialists.

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