Tinnitus

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Tinnitus, also known as “ringing in the ears,” is a condition characterised by the perception of noise or ringing, buzzing, hissing, or clicking sounds in the ears when no external sound is present. It can affect one or both ears and may vary in pitch, frequency, and duration. Tinnitus is a symptom rather than a disease itself and can result from a variety of underlying causes. It ranges from being a mild nuisance to a debilitating experience for those affected. This article explores the causes, types, symptoms, diagnosis, treatment, and management strategies for tinnitus, aiming to provide a comprehensive overview of this complex condition.

 

Understanding Tinnitus

Tinnitus is not a singular condition but a symptom of an underlying health issue. It is one of the most common health conditions, affecting approximately 10% to 15% of the adult population worldwide. While it is more prevalent among older adults, tinnitus can affect individuals of any age, including children.

 

Causes of Tinnitus

The causes of tinnitus are diverse and can involve various parts of the ear, compromising the outer, middle, and inner ear, as well as the pathways that lead to the brain. Common causes include:

 

  • Hearing Loss: Age-related hearing loss or noise-induced hearing loss is one of the most prevalent common causes of tinnitus.
  • Ear and Sinus Infections: Infections can lead to an increase in fluid pressure in the inner ear, causing tinnitus symptoms.
  • Earwax Buildup: Excessive earwax can block the ear canal and contribute to hearing loss and tinnitus.
  • Medications: Some medications, including certain antibiotics, cancer medications, and diuretics, can have tinnitus as a side effect.
  • Cardiovascular Problems: Conditions that affect blood flow, like high blood pressure or aneurysms, can cause pulsatile tinnitus, where the noise is rhythmic and often in sync with one’s heartbeat.
  • Neurological Disorders: Diseases like multiple sclerosis can affect the auditory pathways, leading to tinnitus.
  • Meniere’s Disease: This inner ear disorder is characterised by episodes of vertigo, hearing loss, and tinnitus.
  • Head or Neck Injuries: Trauma to the head or neck can affect the inner ear, hearing nerves, or brain function linked to hearing.

 

Types of Tinnitus

Tinnitus is categorised into two main types:

 

  1. Subjective Tinnitus: The most common type, where the sound is only heard by the affected individual. It can be caused by problems in the outer, middle, or inner ear, as well as issues with the auditory nerves or the auditory pathways in the brain.
  2. Objective Tinnitus: A rare form where the doctor can also hear the sound during an examination. This type of tinnitus may be caused by vascular anomalies, muscle contractions, or inner ear bone conditions.

 

Symptoms of Tinnitus

Tinnitus is primarily characterised by the perception of noise or ringing in the ears, but it can also manifest as other sounds, including buzzing, hissing, whistling, swooshing, or clicking. The sound may vary in pitch from a low roar to a high squeal and may be present in one or both ears. For some, tinnitus is a constant presence, while for others, it may come and go.

Diagnosis of Tinnitus

Diagnosing tinnitus involves a thorough medical history and a physical examination. Our ear, nose, and throat (ENT) specialist may also perform several tests, including:

 

  • Hearing Tests (Audiograms): These tests assess the individual’s hearing range and sensitivity.
  • Movement Tests: The patient may be asked to clench their jaw, move their eyes, or perform other simple tasks to see if the tinnitus changes, which can help identify the underlying cause.
  • Imaging Tests: CT scans or MRIs may be used to check for structural issues in the ear and brain.

 

Treatment and Management

There is no one-size-fits-all treatment for tinnitus, and the effectiveness of treatment can vary according to individuals. Treatment strategies aim to manage the condition and improve the individual’s quality of life:

 

  • Hearing Aids: For patients with hearing loss, hearing aids have the potential to amplify external sounds, making tinnitus less noticeable.
  • Sound Therapy: Using external sounds to partially or completely mask the tinnitus can provide relief. This can include white noise machines, specialised ear masks, or hearing aids with a tinnitus-masking feature.
  • Medications: While no medication directly treats tinnitus, some can help manage the stress, anxiety, and depression that often accompany the condition.
  • Tinnitus Retraining Therapy (TRT): This therapy combines sound therapy with directive counselling to retrain the brain to perceive the tinnitus sounds as less bothersome, helping to minimise the impact of tinnitus on daily life. TRT aims to achieve habituation to tinnitus, where the patient learns to gradually pay less attention to the tinnitus sound, thereby reducing its impact.

 

In most cases, tinnitus does not require surgery as it is often managed through non-surgical treatments. However, surgery may be considered as a treatment option in rare cases where tinnitus is caused by underlying conditions such as vascular abnormalities, tumours, or anatomical issues that cannot be addressed with conservative methods.

 

Conclusion

Tinnitus is a complex condition with a wide range of causes and manifestations, making it a uniquely personal experience for each individual. While there is currently no cure for tinnitus, a combination of treatments and coping strategies can significantly reduce its impact on quality of life. Understanding the condition, seeking help from an experienced ENT specialist, and actively managing symptoms can empower those affected by tinnitus to lead fulfilling lives despite the challenges it presents.

When should you see an ENT specialist in Singapore?

Please consult an ENT specialist if you are suffering from any ear, nose, or throat symptoms. It is also advisable to visit an ENT doctor if you experience persistent mouth breathing due to a chronic blocked nose or encounter snoring issues.

Dr Ker Liang sees adults and children for general ENT conditions and provides comprehensive management in a broad range of Ear, Nose, and Throat, as well as Head and Neck conditions. In particular, she has a special interest in treating throat and voice conditions, including persistent sore throat, voice issues, snoring, and Obstructive Sleep Apnoea (OSA).

Medical Teaching

Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.

Medical Teaching

Assistant Professor Ker Liang has a passion for teaching and is an Assistant Professor with NUS Yong Loo Lin School of Medicine (YLLSOM). As the NUS-NUH Otolaryngology Department Undergraduate Medical Director, Dr Ker Liang supervises the training of medical students from YLLSOM, NUS. She is actively involved
in the training of postgraduate junior doctors and residents in the Head and Neck Surgery department. She was conferred with an Undergraduate Teaching Award by the National University Health System in 2016 for her outstanding efforts as an Otolaryngology educator.

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Dr Ker Liang
ENT Surgeon

MBBS (S’pore), MRCS (Edin),
MMed (ORL), ACGME-I (ORL)

Specialising in the diagnosis and treatment of a wide range of conditions affecting the

ENT system, our doctor brings expertise, compassion, and a personalised approach to

every patient interaction. From common concerns such as allergies and sinus issues to

more complex conditions like hearing loss and throat disorders, our ENT specialist is

equipped to address your unique health needs with skill. 

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