Friday, June 4, 2010

Head Noise or Tinnitus

Head Noise or Tinnitus

Head noise, or tinnitus, is common. It may be intermittent or constant, mild or severe, and vary from a low roar to a high-pitched type of sound. It may be subjective (audible only to the patient) or objective (audible to others). It may or may not be associated with hearing impairment.

Tinnitus must always be thought of as a symptom and not a disease, just as pain in the arm or leg is a symptom and not a disease. Tinnitus is cause by abnormal stimulation of the hearing mechanism.

Because of the complexity of the hearing mechanism, especially in the nerve or brain, some forms of tinnitus are poorly understood.

Tinnitus may or may not be accompanied by a hearing impairment. Hearing is measured in decibels (dB). A hearing level of 0 to 25 dB is considered normal for conversational speech.

Hearing Mechanism

In order to understand the possible causes of tinnitus, one must have some knowledge of the hearing mechanism. This mechanism is made up of five main divisions: the external ear, the middle ear, the inner ear, the nerve pathways and the brain.

There are two muscles in the middle ear: the stapedius, attached to the stapes bone (stirrup) and the tensor tympani, attached to the malleus bone (hammer). These muscles normally contract briefly in response to very loud noise or as a result of a startle reaction.

On occasion one or both of these muscles may begin to contract rhythmically for brief periods of time, for no apparent reason. Because the muscles are attached to one of the middle ear (hearing) bones these contractions may result in a repetitious sound in the ear. The clicking, although annoying, is harmless and usually subsides without treatment.

Should the muscle spasm continue, medical treatment (muscle relaxants) or surgery (cutting the spastic muscle) may be necessary.

Muscular tinnitus resulting from spasm from one of the various muscles of the throat attached to the eustachain tube is uncommon, but can also result in episodes of rhythmic clicking in the ear. This is called palatal myoclonus and usually responds to muscle relaxants.

Muscular tinnitus resulting from spasm from one of the various muscles of the throat attached to the Eustachian tube is uncommon, but can also result in episodes of rhythmic clicking in the ear. This is called palatal myoclonus and usually responds to muscle relaxants.

Vascular Tinnitus

There are two large blood vessels intimately associated with the middle and inner ear: the jugular vein and the carotid artery. These are the major blood vessels supplying the brain.

It is not uncommon to hear one’s heart beat or to hear the blood circulating through these large vessels. This may be noticeable when an individual has a fever, a middle ear infection, or after engaging in strenuous exercise. This circulation increase is temporary and usually subsides when the exertion or fever are reduced. It is not audible to others.

On occasion the sound of blood circulation will become audible to others. This can be due to thickening of the blood vessel wall (a normal occurrence as one grows older), a kink in the vessel or an abnormal growth on the vessel wall. Further testing may be necessary to determine the cause and treatment indicated in these uncommon cases.

External Ear Tinnitus

Obstruction of the external ear canal by wax, foreign bodies, or swelling may produce a hearing impairment or pressure on the eardrum. This frequency results in a pulsating type of tinnitus.

Middle Ear Tinnitus

Disturbances of function of the middle ear may result from allergy, infection, injury, scar tissue or impaired motion of the three middle ear bones. These disturbances often result in hearing impairment and may lead to head noise. But there is no relationship between the degree of hearing loss and the intensity of the tinnitus.

Stress and Depression

Stress, physical or emotional, is present in everyone’s life periodically. In some individuals it is chronic and can result in symptoms or lead to depression. At times a symptom such as tinnitus may in itself lead to depression and this can then make the tinnitus more bothersome; a vicious cycle develops.
Knowing this, we may recommend that a patient with severe tinnitus be treated with antidepressants or antianxiety medications. Patients of this type are also the ones who are most likely to benefit from biofeedback treatment.


If the examination reveals a local or general cause of the head noise, correction of the problem may alleviate the tinnitus. In most cases, however, there is no medical or surgical treatment which will eliminate tinnitus.

General Measures

1.     Avoid all forms of loud sound. If you must be exposed, use ear protectors such as ear plugs or ear muffs. If you are exposed to certain sounds which increase your head noise, make it a point not to repeat that experience.
2.     Make every effort to avoid nervous anxiety, for this only stimulates an already tense auditory system. Make every attempt to obtain adequate rest and avoid overfatigue.
3.     The use of nerve stimulants is to be avoided. Therefore, excessive amounts of coffee (caffeine) and smoking (nicotine) should be avoided.
4.     Learn as quickly as possible to accept the existence of the head noise as an annoying reality and then promptly and completely ignore it as much as possible. Tinnitus will not cause you to go deaf, will not result in your losing your mind, or cause your death. Immediately forget such distracting and terrifying thoughts.
5.     Tinnitus is usually more marked after one goes to bed and his surroundings become quiet. Any noise in the room, such as a loud ticking clock or a radio will serve to mask the irritating head noises and make them much less noticeable.
6.     Sears has available a bedside noise masker that can be adjusted to various tones and intensities. This instrument is known as a “Sleep Mate.” “Sleep-A-Tone”, a device available from hearing aid dispensers is also a good tinnitus masker. The natural sounds of surf, rain, or wind may be selected at the desired intensity.
7.     If one sleeps in an elevated position with one or two pillows, less congestion to the head will result and the tinnitus may be less noticeable.
8.     Sedatives of various types may be used occasionally for temporary relief.
9.     Should any question arise regarding your tinnitus, feel free to call or write to Dr. Child at any time.
Memorial Medical Center
2000 South 900 East
Salt Lake City, UT
Ph. (801) 464-7510
Fax 464-7558

Adapted from the Patient Discussion Booklet Series of the House Ear Institute.

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