Persistent Tinnitus: Causes, Treatments, and When to Seek Imaging

Q: Persistent Tinnitus: Causes, Treatments, and When to Seek Imaging

Hello Mr. <br>Q： You mentioned that "tympanometry, hearing tests, brainstem auditory evoked potentials, and EEG are all normal..." Is it necessary to perform a CT scan for tinnitus that has persisted for six months? Should we just observe for now? I would also like to ask what fa

Tinnitus for two months?

Hello Doctor: Two months ago, I started experiencing tinnitus without any apparent cause.
There is no feeling of ear blockage, and the sound seems to be emanating from the nasopharynx.
It is a high-pitched, non-directional ringing sound that does not affect my hearing in daily life.
I went to a major hospital and underwent tympanometry, hearing tests, auditory brainstem response, and EEG, all of which were normal.
The doctor prescribed Suzin, benzodiazepines, and baclofen, but after one or two weeks, I felt there was not much effect, so I stopped taking them.
I usually don't notice the tinnitus unless I'm alone in a room.
I would like to ask if persistent tinnitus for six months warrants a CT scan? Should I just continue to observe for now? Additionally, I would like to know what factors can influence tinnitus or if there are any supplements I can take?

QQQQQ, 30~39 year old female. Ask Date: 2024/06/24

Dr. Jiang Junyi reply Neurology

Hello Mr.
Q: You mentioned that "tympanometry, hearing tests, brainstem auditory evoked potentials, and EEG are all normal..." Is it necessary to perform a CT scan for tinnitus that has persisted for six months? Should we just observe for now? I would also like to ask what factors can affect tinnitus, or what supplements can be taken? Do you accept carotid ultrasound and autonomic nervous system examinations? If there is unilateral tinnitus combined with hearing loss, it is recommended to conduct brain imaging studies.
If financially feasible, an MRI is suggested to assess the condition of the intracranial vessels.
For supplements, you can consider taking B vitamins and ensuring adequate hydration, along with sufficient rest to enhance the body's repair capabilities.
It is advisable to consult a neurologist for examination and discussion.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health and peace.
Dr.
Jiang Junyi, Hua Hospital/Tao Hospital, cares about you.

Reply Date: 2024/06/24

More Info

Persistent tinnitus, often described as a ringing, buzzing, or hissing sound in the ears, can be a perplexing and distressing condition for many individuals. Understanding its causes, potential treatments, and when to seek further imaging studies is crucial for effective management.

Causes of Tinnitus
Tinnitus can arise from a variety of factors, and in many cases, the exact cause remains elusive. Common causes include:
1. Hearing Loss: Age-related hearing loss (presbycusis) or noise-induced hearing loss are among the most prevalent causes of tinnitus.

2. Ear Conditions: Conditions such as ear infections, earwax buildup, or Meniere's disease can lead to tinnitus.

3. Neurological Disorders: Conditions affecting the auditory pathways, such as acoustic neuroma or other tumors, can also cause tinnitus.

4. Medications: Certain medications, particularly ototoxic drugs (e.g., some antibiotics, chemotherapy agents, and high doses of aspirin), can induce tinnitus.

5. Stress and Anxiety: Psychological factors can exacerbate the perception of tinnitus, making it more noticeable.

6. Other Health Conditions: Conditions such as hypertension, diabetes, and thyroid disorders may also contribute to the onset of tinnitus.

Treatments for Tinnitus
While there is no one-size-fits-all treatment for tinnitus, several approaches can help manage the symptoms:
1. Sound Therapy: Using background noise or white noise machines can help mask the tinnitus sounds, making them less noticeable.

2. Cognitive Behavioral Therapy (CBT): This psychological approach can help patients cope with the distress caused by tinnitus and reduce its impact on daily life.

3. Medications: Although no specific medication is approved for tinnitus, some patients find relief with certain antidepressants or anti-anxiety medications.

4. Hearing Aids: For those with hearing loss, hearing aids can amplify external sounds, which may help mask tinnitus.

5. Tinnitus Retraining Therapy (TRT): This combines sound therapy with counseling to help patients habituate to the tinnitus sounds.

When to Seek Imaging
In your case, since you have experienced tinnitus for two months without significant hearing loss and have undergone various tests (tympanometry, audiometry, auditory brainstem response, and EEG) that returned normal results, it may not be immediately necessary to pursue imaging studies like CT or MRI. However, certain factors may warrant further investigation:
- Duration: If the tinnitus persists beyond six months, especially if it worsens or is accompanied by other symptoms (e.g., hearing loss, dizziness, or unilateral symptoms), imaging may be indicated to rule out structural causes such as tumors or vascular issues.

- Change in Symptoms: If you experience a sudden change in the nature of the tinnitus or develop new symptoms, it is essential to consult your healthcare provider promptly.

- Associated Symptoms: Symptoms such as vertigo, balance issues, or unilateral hearing loss may necessitate imaging to evaluate for conditions like acoustic neuroma or other central nervous system disorders.

Factors Influencing Tinnitus
Several factors can influence the perception of tinnitus, including:
- Noise Exposure: Exposure to loud sounds can exacerbate tinnitus.

- Stress and Fatigue: Increased stress levels can heighten awareness of tinnitus.

- Diet and Lifestyle: Caffeine, alcohol, and nicotine may worsen tinnitus in some individuals.

- Health Conditions: Managing underlying health issues, such as hypertension or anxiety, can help alleviate tinnitus symptoms.

Supplements and Lifestyle Changes
While there is no definitive supplement proven to cure tinnitus, some individuals report benefits from:
- Zinc: Some studies suggest that zinc supplementation may help in cases of tinnitus associated with hearing loss.

- Ginkgo Biloba: This herbal supplement is often touted for improving circulation and may help some individuals with tinnitus.

- Vitamin B12: Deficiency in B12 has been linked to tinnitus, so ensuring adequate levels may be beneficial.

Conclusion
In summary, persistent tinnitus can be a challenging condition to manage. While imaging studies may not be immediately necessary, ongoing observation and consultation with an ear, nose, and throat (ENT) specialist or audiologist can provide further guidance. It is essential to monitor your symptoms and seek medical advice if there are any changes or new developments. Engaging in sound therapy, stress management techniques, and considering dietary adjustments may also contribute to alleviating your symptoms.

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