History has shown us that the tinnitus phenomenon is not a recent one. Hippocrates, who suffered from it 400 years B.C., described this phenomenon in detail. More recently, Ludwig Van Beethoven, who suffered from deafness, sought by any means, at the end of his life, a way «to overcome the ringing trouble which mortified him» and which was certainly part of his depression. In the 19th century, Vincent Van Gogh, «assaulted by hearing hallucinations», mutilated himself by cutting off his ear.
The origins of the French word «acouphène» can be found in the ancient Greek language (Akouein «hear» and Phainein «appear»).
As for Anglo-Saxons, they use the term tinnitus (noise).
According to a study conducted amongst the French population, as part of the 17th National Audition Day in partnership with IPSOS (a survey institute) and Crédit Agricole (a bank) in March 2014:
3 710 000 people suffer from permanent tinnitus
12 290 000 people detect tinnitus from time to time
In total, about 16 million French people are affected by tinnitus.
Tinnitus is a clinical symptom of an abnormal stimulation of the hearing system characterized by the perception of a chronic sound with no external sound source that only the affected patient detects as an intrusive sound.
Its presence can show itself unilaterally, bilaterally or can be described as being perceived in the middle of the head and heard in an interrupted or irregular way at variable strengths and frequencies. Moreover, cases of patients experiencing multiple tinnitus frequencies in the same ear are frequent.
Tinnitus can take on different tones described as: a pure whistling, the noise of a cricket, of a cicada, and even of a bee, the whistling of a pressure cooker, the sound of the wind, of a waterfall, of waves, the static of an electrical device, the ringing of bells …
We notice that, most of the time, tinnitus is of a very weak intensity, inferior to 10 dB. However, this fact contrasts with the psychological impact, which can sometimes be quite considerable for certain patients.
Here is a definition of tinnitus that Dr. Joël Waterkeun heard from one of his patients.
(France Acouphènes – special edition – Tinnitus inventory, 2010/2011)
Tinnitus is a «silent pain» hard to describe, to share, it’s a source of intense focalisation by our brain. It disturbs and disarms the sufferer, with its array of neurological, psychological and even sometimes psychiatric signs. Some patients even suffer from serious psychological upset.
Two types of tinnitus can be distinguished, depending on whether they are detected by the doctor with a stethoscope (objective pulsatile tinnitus) or only heard by the patient (subjective pulsatile tinnitus).
Objective tinnitus is extremely rare and is the result of either a vascular anomaly (known as objective pulsatile tinnitus), or an abnormal tightening of the ENT sphere muscle, or a structural defect of the inner ear (known as subjective pulsatile tinnitus).
Subjective tinnitus represents more than 95% of tinnitus cases and is of a completely different complexity. It can originate in any part of the auditory system, from the outer ear to the brain, the most frequent place being the cochlea.
Objective Pulsatile Tinnitus
This is linked with a rise or a change in the blood flow passage in the vessels situated near the ears and therefore follows the cardiac rhythm and pulse. It is also often increased by physical activities, head movements or a state of anxiety and is perceived as rushing sounds or clicks at regular intervals.
It can be the result of arterial damage, veinous anomalies, high blood pressure or intracranial hypertension, otospongiosis or it can come from a tumour and must, therefore, result in further, detailed examinations.
Objective Non-Pulsatile Tinnitus
This has a mechanical cause, notably tubal gapping and articular or muscular contractions.
This comes from a functional disorder situated in the auditory channel, which is interpreted by the central nervous system as a noise, it can be associated with an otological pathology or defined as idiopathic tinnitus in the absence of a diagnosed cause.
Tinnitus can occur at any age, nevertheless, the studies show the predominance of the appearance of tinnitus in line with the increase in a patients’ age, tinnitus being then closely linked with the audition loss due to aging (presbyacusia).
However, childhood tinnitus does exist and the patient, assuming it to be normal, never takes it into account and only becomes aware of it once they are grown-up.
How tinnitus is experienced is extremely variable and subjective from one patient to another depending on whether it is perceived simply as a discomfort or as a permanent and disabling intrusion affecting the quality of daily life.
The distress that tinnitus induces in an affected person is revealed by a considerable change in their perception of everyday life, (the spouse is often implicated) suspicious and fearful of being confronted with a serious illness and which is expressed by obsessive questionings such as: «am I going to die?, do I have a tumour ?, am I going mad or deaf ?, is that noise going to increase again?».
Indeed, ignorance and the lack of understanding of this symptom produce most worrying hypothesis. This feeling is reinforced by the complexity of tinnitus and the difficulty for the medical community, often considered as failing to make a precise diagnosis, which would enable them, if not to reassure, at least to explain.
Whatsmore, the helplessness of parts of the medical community with regards to tinnitus too often still leads to a typical response:
«It’s not serious, we don’t know how it evolves, anyway there is no treatment, so go home, you must live with it» end of quote.
On the other hand it’s necessary to highlight the extraordinary work conducted by some ENT doctors, groups and multidisciplinary teams relentlessly researching and educating us about this unwanted intruder.
The fact remains that for some patients suffering from tinnitus and already beset by a deep distress, the feeling of scorn or incredibility coming from the attitude of their family, of their friends and even more of the medical community only adds to it. This distress can then turn into resignation, the last resort, leading the patient into depression. We can see the same thing in the spouse due to the resentment built up in the relationship.
The impact of tinnitus on daily life
Apart from the obvious changes brought about by tinnitus, in the sharing of domestic chores in a household as well as in social and professional relationships, it leads to other suffering, often more insidious, like:
Affecting concentration, hearing ability and communication, a golden rule establishes itself: silence…
- The reading of a book or of a magazine as well as the noise of a conversation can be disturbing and can prove to be painful by the unwanted presence of «inner noise» which distorts the capacity to concentrate.
Affecting the quality of sleep:
Some patients can feel anxious when faced with periods of oppressive silence during which tinnitus is more easily perceived, thereby causing insomnia.
Modifying one’s own self-confidence and one’s own image:
- Feeling exhausted and powerless towards the unsolvable, a tinnitus sufferer can then develop a low regard of himself along with a feeling of worthlessness.
Here is a list of the most frequent causes of the appearance of tinnitus, established by Professor Bruno Frachet (France Acouphènes source).
|01 Sound traumatism||19 Loop V / VIII|
|02 Otospongiosis||20 Neurinoma of VIII|
|03 Tubal catarrh, serous earache, labyrinthitis||21 Psychological problems apart from depression|
|04 Suspicion of a dysfunction of the temple-mandibular joint||22 Sleep apnea syndrome|
|05 Head trauma||23 Stenosis of the external duct, exostosis|
|06 Sudden deafness||24 Involvement of the middle ear muscles|
|07 Anomaly resulting from internal medicine||25 Complex neurological problems|
|08 Bad news, mourning||26 Headache|
|09 Low or high blood pressure||27 Involvement of the aspirin|
|10 Inner ear||28 In relation with the hormonal cycle|
|11 Cervical etiology||29 Carotid breath perceived|
|12 Post-operating otological tinnitus||30 Gastro-oesophagian reflux|
|13 Normal audition||31 Tympanic retraction|
|14 Depression||32 General anaesthetic|
|15 Suspicion of a peri-lymphatic leak||33 Epidural anaesthetic|
|15 bis||34 Thyroid|
|16 Ototoxicity||35 Stress|
|17 Identified pathology of the middle ear||50 …|
|18 Lying position tinnitus (nap)||100 Presbyacusia|
|01 Sound traumatism|
|03 Tubal catarrh, serous earache, labyrinthitis|
|04 Suspicion of a dysfunction of the temple-mandibular joint|
|05 Head trauma|
|06 Sudden deafness|
|07 Anomaly resulting from internal medicine|
|08 Bad news, mourning|
|09 Low or high blood pressure|
|10 Inner ear|
|11 Cervical etiology|
|12 Post-operating otological tinnitus|
|13 Normal audition|
|15 Suspicion of a peri-lymphatic leak|
|17 Identified pathology of the middle ear|
|18 Lying position tinnitus (nap)|
|19 Loop V / VIII|
|20 Neurinoma of VIII|
|21 Psychological problems apart from depression|
|22 Sleep apnea syndrome|
|23 Stenosis of the external duct, exostosis|
|24 Involvement of the middle ear muscles|
|25 Complex neurological problems|
|27 Involvement of the aspirin|
|28 In relation with the hormonal cycle|
|29 Carotid breath perceived|
|30 Gastro-oesophagian reflux|
|31 Tympanic retraction|
|32 General anaesthetic|
|33 Epidural anaesthetic|
Obviously, very high sound levels are predominant in the course of our lives and the traumatic curse they produce, affects every generation with no exception.
It is therefore essential for a patient suffering from tinnitus to avoid exposing himself to high noise intensity levels, whether they come from a professional activity or from a hobby. Resorting to the use of noise-reducing earplugs is advisable if exposure to loud noise is inevitable.
Apart from respecting a good level of sound hygiene, physical activity enables one’s body to cope better and to beat stress resulting from a perceptible increase in tinnitus.
It is equally interesting to evaluate the impact that diet may have on tinnitus, especially if alcohol or stimulating beverages (tea, coffee, soda, energizing drinks…) are banished. Better eating and drinking habits lead to an improvement in symptoms.
It can be advisable not to live in silence, but to favour listening to a background noise in order to mask the presence of tinnitus.
Moreover, we must be aware that it is essential to maintain good social integration and not to isolate oneself.
Another important point is to inform your doctor that you suffer from tinnitus insofar as possible to avoid the prescription of an ototoxic medicine.
Appearance of a tinnitus symptom
The appearance of a tinnitus symptom, like a hyperacousia symptom, is classed as a medical emergency and it is imperative to see an ENT doctor within a 48-hour period.
Treatments and solutions
Our new curative avant-garde method
Alongside traditional treatments including medicines such as vasodilators, antidepressants, anticonvulsants, antiepileptics and tranquillizers, we can also use surgery, exclusively reserved for neurinom operations (auditory nerve cancer) or for accessible vascular anomalies and in particular for otospongiosis (middle ear).
As Doctor Bruno Pannetier highlights, «it is difficult to talk about medicines for tinnitus which is above all a symptom. Yet treating a symptom doesn’t mean treating the cause. It is indeed possible to relieve a patient with medicine, but that doesn’t mean he is healed… I invite you, insofar as possible, to use drugs to treat the consequences of tinnitus as a secondary measure: the rule being minimal prescription».
Let’s use the expression of Doctor Bruno Frachet who considers drugs as «temporary crutches» (France Acouphènes sources)
Dealing with an auditory loss in itself, it can be enough to remove the «tinnitus» signal by a masking effect in some cases of deafness, and in some very rare cases, to make it disappear.
We must also consider the possibility of a hyperbaric chamber, an immersion treatment in oxygen-enriched air, a process which has proved to be particularly effective in tinnitus cases.
Some patients will turn towards natural and energising medicine such as acupuncture, auricular-therapy, sophrology, Auri therapy, reflexology, osteopathy, homeopathy, hypnosis, phytotherapy, kinesiology, chiropractic, the Tomatis’ method, of which the advantages haven’t been evaluated yet but which nevertheless enables patients to better understand their state of stress.
On the other hand, there are therapies, classed as habit training or desensitisation called TRT (Tinnitus Retraining Therapy) or CCT (Cognitive and Behavioural Therapy). These are designed to help the patient to better understand and control his tinnitus in order to re-establish a comfortable life. As for TRT, it is based on using a noise generator.
It can also be recommended to mask tinnitus, which is a way to artificially occupy the ear in order to distract the auditory system from an intrusive presence.
To conclude, except for the ØREBLUE method, the aforementioned treatments or therapies can, at best, intervene to help manage stress, taking the focus away from the problem or reducing the way the symptom is experienced and only, on a few occasions, making it disappear. They are not a «miracle cure» in their own right.