Neurological Tinnitus

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Tinnitus is the perception of sound in the ear when there is no external source of the noise. Tinnitus is not considered a medical issue; rather, it is considered to be a symptom. It is often a sign that something is wrong with the auditory system.

Tinnitus noise can manifest as a ringing, clicking, whooshing, thumping, humming, buzzing, or roaring noise in the ear. The frequency of the noise or the degree is dependent on the underlying cause of the ringing. Also, the pitch of the noise varies.

In some cases, the tinnitus noise can be low and negligible, while in other cases, the noise can be so high that it interferes with normal daily activities. Tinnitus can affect one or both ears. Depending on the cause, tinnitus can be temporary or permanent.

Common causes of tinnitus are sudden or constant exposure to loud sounds, earwax blockage, trauma or injury to the head, growth of tumors in the ear, autoimmune inner ear diseases, ototoxic medications, and ear infection.

Besides the ringing in the ear, tinnitus can be accompanied by other symptoms like inability to concentrate, difficulty sleeping, and inability to hear conversations, especially in crowded places.

Types of Tinnitus

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Tinnitus is classified based on the type of sound and the cause of the tinnitus. Below are common types of tinnitus.

1. Subjective tinnitus

Subjective tinnitus is the most common type of tinnitus. It is also known as non-vibratory or non-auditory tinnitus. The tinnitus patient can only hear subjective tinnitus noise.

It is often caused by exposure to loud sounds and can lead to hearing loss. Subjective tinnitus can appear and disappear suddenly and can last for about 3 to 12 months. But in some cases where the hair cells in the inner ear are damaged, the tinnitus can be permanent or degenerate to hearing loss.

2. Objective Tinnitus

Objective tinnitus, also known as vibratory tinnitus or pseudo-tinnitus, is a rare kind of tinnitus caused by involuntary movements, twitching, or muscle contractions.

Objective tinnitus can be caused by eustachian tube dysfunction, neurologic disease, or muscle spasm around the middle ear. Unlike subjective tinnitus, objective tinnitus can be heard by an external observer.

In most cases, when the cause of the tinnitus is identified and handled, the tinnitus noise in the ear will disappear.

3. Pulsatile Tinnitus

In some cases, tinnitus can present itself as a rhythmic noise that aligns with the tinnitus patient’s heartbeat. It is often caused by a change in the blood flow in the blood vessels close to the ear. Pulsatile tinnitus is also known as synchronous pulse tinnitus or vascular tinnitus, or rhythmic tinnitus.

Pulsatile tinnitus sound is often heard as a whooshing or thumping sound. It is often loud and distracting. This type of tinnitus can also be caused by a change in blood flow and blood flow difficulty in blood vessels close to the ear.

4. Neurological Tinnitus

Neurological tinnitus is a type of tinnitus caused by problems related to the brain's auditory functions. A common cause of neurological tinnitus is Meniere's Disease.

Our major focus in this article is neurological tinnitus. We will be taking you through all you need to know about neurological tinnitus and how it occurs.

For a proper understanding of neurological tinnitus, we will first be explaining the structure of the ear, and how it receives sounds, then we will proceed to explain what neurological tinnitus is all about.

The Structure of The Ear

The ear is the organ of the body responsible for hearing and balance. It is divided into three major parts: outer, middle, and inner ear.

The Outer Ear

The outer ear, also known as the external ear, consists of two major parts: the earlobe and the pinna. The pinna is made of skin and cartilage; it is the shell-like part of the external ear which directs sound waves outside the ear into the auditory canal.

The ear canal transmits the sound wave received to the tympanic membrane or the eardrum, which begins to vibrate when the sound being transmitted hits it. The eardrum or tympanic membrane is a thin membrane that separates the outer and middle ear.

The Middle Ear

The middle ear is an air-filled space between the outer and inner ear that contains three tiny bones, also known as ossicles. The three bones are called incus, stapes, and malleus. These three bones form a link between the eardrum and the inner ear through the cochlea.

When the eardrum begins to vibrate as a result of the sound waves it received, the vibration is transmitted to the ossicles. The ossicles amplify the sound and transmit the vibration to a thin membrane between the middle and inner ear known as the oval window.

The Inner Ear

The inner ear contains two major structures; the cochlea and three semicircular canals. The cochlea, which is responsible for hearing, is filled with fluids and also contains the organ of Corti. The organ of Corti contains thousands of specialized sensory hair cells.

When the vibration transmitted from the middle ear through the oval window gets to the inner ear, tiny waves are formed in the inner ear fluid. These tiny waves make the projections of the hair cells known as cilia vibrate. The hair cells convert this vibration into nerve signals or impulses and send them to the brain, where they are interpreted as sound.

The semicircular canals also contain hair cells, but unlike those found in the cochlea, the hair cells in the semicircular canals are responsible for detecting movement. When there is head movement, the fluid in the semicircular canals moves; this movement is detected by the hair cells. The hair cells then send nerve impulses about the body’s position and head relative to gravity to the brain.

This enables the body to make the required postural adjustments for the maintenance of balance. When this function is interrupted, vertigo or loss of balance will be experienced.

Understanding Neurological Tinnitus

Ear examination

 

In understanding neurological tinnitus, it is important to understand what a neurological disorder or disease is.

A neurological disorder is a disorder that affects the brain as well as the nerves found throughout the human body and the spinal cord. Neurological disorders are often accompanied by symptoms such as muscle weakness, loss of sensation, poor coordination, and paralysis.

Causes of neurological problems include genetic disorders, congenital abnormalities or disorders, brain injury, spinal cord injury, nerve injury, degeneration, trauma, brain tumor, and malnutrition.

Neurological diseases can affect Vision, cognition, movement, communication, or hearing depending on where the damage happened or the nerve affected. In the case of neurological tinnitus, the part of the brain responsible for receiving sound signals is affected.

Neurological causes of tinnitus include head injury, multiple sclerosis, acoustic neuroma, syphilis, meningitis, whiplash, cerebellopontine-angle tumors, infections such as Lyme disease, and otitis media.

A major cause of neurological tinnitus is Meniere’s disease. Meniere's disease is a disease that affects the inner ear and causes vertigo, tinnitus, and hearing loss.

Meniere's disease affects hearing, and it is characterized by a feeling of fullness or pressure in the ear. While the exact cause of Meniere’s disease is not known, doctors have linked it to the buildup of fluid in the inner ear.

As stated earlier, the inner ear is responsible for balance and hearing. This build-up of fluid affects the sound flow and interferes with the signals your brain receives, thereby causing balance problems, tinnitus, or hearing loss.

The exact reason for the buildup of the fluid in the inner ear is unknown, but some studies have identified poor drainage due to the abnormal structure of the ear as one of the causes. Viral infections, blow to the head, allergic reactions, and autoimmune diseases have also been identified as possible causes.

Neurological diseases like Meniere's disease can affect the brain, and this can result in tinnitus. In some cases, your ear’s noise is not being generated by your ear; instead, it is caused by the brain trying to protect the body from overwhelming auditory stimuli.

When sound is not being transmitted from the ear to the brain, as a result of blockage of the ear canal, age, or noise-induced hearing loss, the brain is forced to produce sounds to replace the missing sound that should be coming from the ear.

The brain's limbic system, which is the part of the brain responsible for the regulation of behavioral and emotional responses (especially those needed for survival, such as feeding and reproduction), is expected to stop the sounds generated by the brain from reaching conscious auditory processing. When the brain's limbic system fails to stop the sound, it results in tinnitus.

Researchers believe that if the dysregulation between the brain's limbic system and the auditory systems is fully understood, it may form the basis for developing medications for neurological tinnitus.

Another reason for neurological tinnitus is the awareness or the increased consciousness of the brain's activities. Normally the background neurological activity is masked by the noise from everyday sounds. When the ear's ability to hear external sounds is affected, with no sound coming into the ear again, the background neurological activities’ noise becomes more obvious.

In addition to the awareness of the noise from background activities, the brain tries to cover up for the hearing loss by increasing the auditory system’s sensitivity. This is often aimed at trying to see if the heightened sensitivity can make the ears pick any external noise. But since this is not possible, it causes the head noise’s intensity and loudness to be more obvious.

The increase in the tinnitus patient’s intensity makes the tinnitus patient more uncomfortable, which results in anxiety and stress. Anxiety and stress can also further worsen tinnitus; this is why antianxiety drugs are sometimes prescribed to tinnitus patients.

Tinnitus Treatments

Tinnitus cannot be cured, and depending on the causes, tinnitus can be temporary or permanent. The duration of the tinnitus is dependent on its underlying cause.

Tinnitus caused by earwax blockage often disappears when the earwax is removed because the earwax merely blocked the ear canal and prevented sound from passing through; little or no damage was done to the ear.

If the tinnitus is caused by a more serious medical condition like an autoimmune inner ear disease or Meniere's disease, the likelihood of the tinnitus being permanent is higher. This is because if prompt medical attention is not given to the ear, the ear’s structures can be permanently damaged.

Even though there is no cure for tinnitus, certain treatments and therapies can help alleviate the clinical symptoms and make it possible for tinnitus patients to go about their daily activities without much interference.

An ENT doctor often prescribes this treatment or therapy after an audiological test has been conducted. Below are commonly recommended tinnitus therapies.

1. Treating the Underlying Cause

If a blood vessel condition causes tinnitus, treating the blood vessel condition with the appropriate medication or surgery (when necessary) can expel the tinnitus.

Similarly, if tinnitus is caused by an ototoxic medication discontinuing the medication will make the tinnitus disappear. The same applies to tinnitus caused by earwax blockage; once the ear wax is removed, tinnitus symptoms will disappear.

2. Noise Suppression

Since permanent tinnitus cannot be cured, your doctor may recommend the use of certain devices to suppress the tinnitus noise. Devices used for noise suppression in tinnitus patients are masking devices and white noise machines.

White noise machines are devices that produce sounds similar to environmental or static sounds. This is very effective for neurological tinnitus, where the noise from background neurological activities causes tinnitus.

White noise devices help create enough background sound to make the noise from background neurological activities less obvious.

In the absence of real noise-masking devices, fans, air conditioners, and humidifiers can be used to produce white noise.

Masking devices are similar to hearing aids; they produce a continuous low-level white noise, suppressing the tinnitus noise and making it less noticeable.

3. Counseling

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Considering the effect of tinnitus on tinnitus patients’ emotional and psychological health, counseling is often a part of the therapies recommended for tinnitus.

The counseling aims to help the tinnitus patient change the way he perceives, thinks, or feels about the symptoms. This makes the tinnitus more bearable.

The major counseling options for tinnitus are cognitive behavioral therapy and tinnitus retraining therapy.

Cognitive Behavioral Therapy is carried out by a licensed psychologist who teaches tinnitus patients coping techniques that will enable them to carry out their daily activities without difficulty.

Tinnitus Retraining Therapy (TRT) is a combination of the use of sound masking devices and counseling by a trained professional or an audiologist. The tinnitus patient is given a masking device to wear to reduce the tinnitus symptoms and at the same time receives counseling.

Asides from helping with the tinnitus, the counseling session helps the patient cope with other problems linked to tinnitus, such as depression and anxiety.

4. Medications

Even though there is no specific medication for tinnitus, certain medications such as antidepressants and anti-anxiety drugs are prescribed to tinnitus patients. Most tinnitus patients suffer anxiety and depression.

The relationship between tinnitus and anxiety is circular; this means that tinnitus noise causes anxiety, and anxiety increases the tinnitus, resulting in more anxiety.

Giving medications that combat anxiety and depression, therefore, helps alleviate the tinnitus symptoms.

Conclusion

As you already know, neurological tinnitus is caused by a brain problem, not the ears, so it is not possible for you to self-medicate.

Identifying the exact cause of tinnitus and prescribing the appropriate treatment is the work of an audiologist or a healthcare professional. Therefore, it is important to always visit your doctor when you experience ringing or any other form of noise in your ear.

Do you have neurological tinnitus? What remedy or therapy was prescribed by your doctor. Share your experience with us in the comment section.

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