Tinnitus

Tinnitus is a phantom sound people start to hear when hearing loss develops. Once it starts, it does not go completely away, but things can be done to make it manageable, other things can make tinnitus worse.

Level of disturbance can vary from day to day, but tinnitus may be;

1. a mild distraction or silent enough to be either unnoticed or distract concentration,
2. moderate and result in interfering with the ability to work and socializing, or
3. severe which can significantly detract from their quality of life.

Unfortunately, tinnitus remains after an ear can no longer hear.

There are different forms of tinnitus that if not managed can cause different additional issues. Included are reasons for tinnitus, might result in different sound or sounds, and means of tinnitus management.

All forms of tinnitus get worse with stress.

1. Subjective Tinnitus
2. Gaze Evoked Tinnitus
3. Additional Forms

1. Subjective Tinnitus

Schwannoma tumor damage of both the vestibular nerve (balance) and cochlear nerve (hearing), called vestibular schwannoma (VS), the hallmark tumor of individuals with neurofibromatosis Type 2 (NF2), slowly starts as Subjective Tinnitus before the development of deafness.

When tinnitus starts, it is important to see an Ear, Nose, and Throat Doctor (ENT) (otolaryngologist), immediately and neurologist for an MRI.

Subjective tinnitus is a common hearing disorder with a potentially devastating impact on the quality of life (QoL), characterized by sound perception in the absence of an acoustic stimulus. _[1]

Unfortunately completely severing the cochlear nerve will not be the end of the tinnitus. Subjective tinnitus is a sound that has no external source. Sounds might include:

Subjective Tinnitus Sounds

beeping buzzing chirping crickets drums hissing (plus a tone)

ocean Sound popping ringing roaring roaring pulse whistling

Tinnitus Management Options

• Distraction

Distraction: Focusing on tinnitus results in an endless cycle of stress, headaches, and louder seeming tinnitus levels.

• White Noise Generators: There are different White Noise Generators to try.
• Hearing Aids: Typical hearing aids for sound amplification, as well as hearing implants like the cochlear implant (CI), or an auditory brainstem implant (ABI).
  Even if the hearing aid does not offer much audible sound, any amount of sound can be distraction enough to help potentially reduce Tinnitus.
• Stress Reduction

It has been debatable for some time if this is or is not a problem. But, a study at the Deafness Institute in the UK concluded it is not a tinnitus trigger.

• Caffeine and Water

While caffeine could help stop tinnitus, excessive caffeine can also trigger tinnitus. If the tinnitus could be the result of excessive caffeine drinking water will help.

• Vitamin B12

Vitamin B12 is in many foods, but for different reasons, are sometimes best taken as oral vitamin B12 supplements, or vitamin B12 injections. These are options to discuss with a doctor to fit personal needs.

• Brain Stimulation (active thinking)^[4]

Reading, or learning; a new language, to do something differently, or something new.

• Deep Brain Stimulation (brain implant)^[5]

A simple form of brain stimulation after lack of hearing is an ABI, but other implants and options may have the same result.

• Tinnitus Retraining Therapy (TRT)

2. Somatosensory Tinnitus - Gaze-evoked Tinnitus (GET)^[1]

Gaze-modulated tinnitus (GET), is tinnitus noted as common following cerebellar pontine angle surgery, damage from vestibular schwannoma, but there are also reports of GET with no surgical history. GET may be the result of single-sided or bilateral damage. It is similar to phantom limb syndrome (deprivation of sensory input) where eye movement results in different sounds that only the individual with GET can hear.

GET Sounds

Eye movement in different directions can change volume and tone of the sound made from GET.

GET Management

While some of what can help with subjective tinnitus may help with GET like, the distraction options that work best for subjective tinnitus require some amount of hearing.

• Auditory brainstem implant (ABI)
• Repetitive eye movement: left to center, right to center, up to the center, and down to center several times consecutively.

3. Additional Non-NF2 Forms of Tinnitus

There are additional forms of tinnitus unlikely to result from NF2 issues that are a result of either other conditions, loud noises or medications. Objective Tinnitus is a health-related form, also unlikely for NF2, vestibular schwannoma damage.

Objective tinnitus (pulsatile tinnitus)^[2] is an internal sound that usually has the same rate as the heart. This form of tinnitus is easily found by feeling the pulse at the same time as listening to the tinnitus.

Pulsatile tinnitus is due to a change in blood flow in the vessels near the ear or to a change in awareness of that blood flow. The involved vessels include the large arteries and veins in the neck and base of the skull and smaller ones in the ear itself.

4. Reasons for Increase in Volume and Annoyance

Hearing loss can be temporary, slow developing, temporary, a person may be Hard of Hearing (HoH) with some level of sound, or complete hearing loss/deafness can have a seemingly increase in volume or annoyance as a result of:

1. Stress
2. Aspirin as well as other medications
3. Vitamin B12 deficiency; Like all other pills either prescription, supplement, or otherwise talk to your doctor before taking B12 if you think you may need to take it for a possible deficiency. (cigarettes smokers are at high risk of tumor growth if taking Vitamin B12)

5. Issues Tinnitus Can Cause

1. Problems Sleeping
2. Poor Word Recognition

Tests for hearing loss include volume and pitch of sound but also include word recognition since there is no other way to determine the actual volume of Tinnitus sounds.

3. Phonophobia

Fear of loud sound; the volume of what is considered loud would change as hearing loss as the level of tinnitus gets worse.

4. Hyperacusis (Hyperacusis)

Fear of a certain range of sound.

5. Misophonia

Misophonia is hatred of sound of a certain type of sounds, may cause anger. Not limited to volume or pitch.

6. Sources

1. "Impact of Tinnitus" A,erican Tinnitus Association. (Material reviewed April 2018)
   Source: https://www.ata.org/understanding-facts/impact-tinnitus


2. Don McFerran FRCS, Consultant Otolaryngologist, Essex County Hospital, Colchester. "Pulsatile tinnitus." BTA. The British Tinnitus Association. Last updated on 12 April 2011.
   Source: http://www.tinnitus.org.uk/pulsatile-tinnitus


3. Sanchez, T. G., & Rocha, C. B. (2011). "Diagnosis and management of somatosensory tinnitus: review article." Clinics, 66(6), 1089-1094.
   Source: http://www.scielo.br/scielo.php?pid=S1807-59322011000600028&script=sci_arttext


4. van Gendt, Margriet J., et al. "The Relation between Perception and Brain Activity in Gaze-Evoked Tinnitus." The Journal of Neuroscience 32.49 (2012): 17528-17539.
   Source: http://www.jneurosci.org/content/32/49/17528.full


5. Smit, Jasper V., et al. "The impact of Deep Brain Stimulation on tinnitus." Surgical neurology international 7.Suppl 35 (2016): S848.
   Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5134112/


6. Roberts, Daniel S., et al. "Tinnitus Suppression After Auditory Brainstem Implantation in Patients With Neurofibromatosis Type-2." Otology & Neurotology 38.1 (2017): 118-122.
   Source: https://journals.lww.com/otology-neurotology/Abstract/2017/01000/Tinnitus_Suppression_After_Auditory_Brainstem.18.aspx | DOI: 10.1097/MAO.0000000000001230


7. Sanchez, Tanit Ganz, and Marcio Ricardo Barros Pio. "The cure of a gaze-evoked tinnitus by repetition of gaze movements." Int. Arch Otorhinolaryngol 11 (2007): 345-349. Source: http://www.arquivosdeorl.org.br/additional/acervo_eng.asp?Id=451


8. Phelps, Srephanie. "Gaze-evoked tinnitus by repetition of gaze movements." YouTube. (2018)
   Source: https://www.youtube.com/watch?v=30DdYpeT-Bc&feature=youtu.be


9. Salter, Spencer. "We 'may' have discovered a potential remedy for tinnitus - by accident." Linked. (2019)
   Source: https://www.linkedin.com/content-guest/article/we-may-have-discovered-potential-remedy-tinnitus-spencer/

6. Also See

• Meditation - Biofeedback/Neurofeedback
• Vestibulocochlear Nerve
  Vestibular Schwannoma - Hearing, and Balance