Tinnitus can be defined as a sound hallucination , that is, perceiving a sound that does not exist. The patient with tinnitus perceives a sound that no one else can hear. It is an approximate definition, since a first classification of tinnitus divides them into subjective and objective tinnitus.. The subjective ones are the ones that best fit the previous definition. The objective tinnitus is one that, with the appropriate means, could be heard by another person external to the patient.
The causes can be varied. A target tumor may be due to, for example, small lesions in the temporomandibular joint, which, when mobilized, produce audible clicks, or dysfunction of the eustachian tube.. If it is pulsatile, it could be justified by hypertension, where the patient hears his own heartbeat, benign intracranial hypertension, etc.
In the case of subjective tinnitus , in many cases they are related to a hearing loss. It is thought that then the auditory pathway is reorganized at the subcortical level and sends a somewhat "strange" electrical signal to the auditory cortex, compared to the "normal" signal that would result from the unmodified auditory pathway.. That modified signal is interpreted by the auditory cortex as a noise.
The diagnosis of tinnitus is based on the clinical history. When the patient tells us that he notices a beep or a noise like that of an engine, an express pot, a fan, the sound of running water ... we already have the tinnitus there. The first test to be performed, in an unavoidable way, is an audiometry to know if the patient hears well or not. The second test is called acuphenometry.
With the acufenometría we try to characterize the tinnitus, find a sound that seems as much as possible and thus know its frequency and intensity. From the diagnostic point of view it is not very useful but it could have implications in the treatment. Then we have several questionnaires for tinnitus.
Personally, I usually use the Tinnitus Handicap Inventory : in this questionnaire, several questions related to tinnitus are passed to the patient, assigning a score depending on the response. According to the final score we can get an idea of the impact that tinnitus has on the patient's life.
Another questionnaire, the Tinnitus Hypersensitivity Test , explores hyperacusis, a phenomenon that can be associated with tinnitus, where the patient feels great discomfort or even pain, before sounds whose intensity does not cause discomfort in other people. Patients with hyperacusis are those who can not stand, for example, being at a party with several people talking at the same time. It also has an important impact for the treatment.
Other diagnostic methods: exploration of anxiety levels, brain magnetic resonance, exploration of the temporomandibular joint and somatosensory trigger points, etc, depending on our diagnostic suspicion.
The treatment depends on the diagnosis. If the tinnitus is due to a hearing loss, it would be logical to restore or improve the patient's hearing. Depending on the cause of the hearing loss we can resort to surgery or hearing aids. If the tinnitus is due to temporomandibular joint dysfunction, mandibular discharge splints, orthodontic techniques can be used.. If it is due to excessive stress, relaxation techniques, anxiolytics ...
In general, most patients come looking for a "magic pill" that removes tinnitus. That pill simply does not exist. Many medications have been used but most of them have no appreciable effect. In general, the anxiolytics and the treatments that affect the dopaminergic auditory-membrane pathway seem that they could have some effect, but they also produce drowsiness and this is a side effect little tolerated by many patients.
Behavioral measures are quite effective in general. Probably do not make tinnitus disappear, but it does become bearable and does not influence the patient's daily life, the tinnitus becomes, for example, as the noise that is always present when you live in a street with a lot of traffic: there is always a background noise, but there comes a time when those who live in that house practically do not realize that noise.
These measures are aimed at "teaching the brain what to hear and what sounds to ignore": avoid silent environments and use other sounds to mask the tinnitus, perform activities that distract attention and avoid focusing on the tinnitus. The sound therapies are very interesting: tinnitus and hyperacusis are treated using other sounds, such as fractal sounds, masking, residual inhibition, tinnitus retraining therapy, sequential sound therapy ...