Tinnitus FAQ
www.bixby.org/faq/tinnitus.html
a resource for understanding tinnitus,
not a substitute for a health care provider
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Tinnitus FAQ |
www.bixby.org/faq/tinnitus.html
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Temporo-Mandibular Joint Syndrome (TMJ)
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| Meniere's Disease |
Meniere's is a very serious disease of the inner ear, resulting in extended vertigo attacks, major hearing loss, and frequently tinnitus.
Here is one sufferer's (not myself) story:
Antecdotal Report Concerning Meniere's Disease |
What are the symptoms?
In my case it started with a constant fullness in my right ear and the constant ringing. I also noticed I wasn't hearing very well and I was having some vertigo attacks. What tests would a physician do to diagnose it? First was a hearing test. This was followed by an MRI to ensure there wasn't a tumor to deal with. There was also the physical to ensure there was no other underlying cause, including Diabetes. Then being referred to a surgeon who specializes in this kind of thing. He did further hearing tests and another test which I will have to get the name for you. It consists of lights on the wall that you follow with your eyes. They also insert warm and cold water into each ear (ENG/AU test) to measure the response; a short vertigo spell is the result for healthy ears. There is also a special set of hearing tests that they do. Are there any known environmental causes, or is it one of those things that "just happens" to people? One possible cause is Diabetes. Other than that no one that I have spoken with knows. It may also be hereditary. Usually doesn't show up until later in life 40 and beyond, and can burn itself out in 3 - 5 years. Some have it earlier in life (me at 35) and could have it the rest of our lives. What are the common treatments? Anti-vertigo drugs? Surgical operations on the inner ear balance mechanisms? The most common treatment for mild episodic Meniere's I guess would be to rule out Diabetes and allergies. For the vertigo attacks usually the prescription drug Antivert is used or the over the counter drug Meclizine. Both tend to relive the vertigo. For more chronic cases a low dosage of Valium can help. When things get bad enough the next procedure is an Endolymphatic Transmastoid Shunt. This helps to keep some of the pressure of the inner ear. Changes in diet can help. Removal of sodium, caffeine and alcohol can help. Usually a mild diuretic is prescribed. In general, imagine yourself back when you first encountered Meniere's. What kind of summary info would have been helpful to you? Knowing that it can be treated with medication and there is the hope that it will burn itself out keeps me going. There does seem to be a connection with the tinnitus and the Meniere's. I have noticed over the last two years that the tinnitus gets worse and my hearing decreases prior to a vertigo episode or series of vertigo episodes. 25mg of Meclizine usually has the vertigo under control in 20 - 30 minutes for a mild attack. A severe attack can leave you completely disoriented such that there is no real up or down. An attack this severe usually has bouts of nausea and vomiting with it. I find lying down in a quiet dark room helps while the medicine kicks in. Anti-nausea drugs can help. In my case when I have had a severe episode I usually feel 'out-of-sorts' for a couple of days. |
Meniere's, Tinnitus, & Gentamicin, |
| Originally, streptomycin was tried as a treatment for medically intractable
Meniere's (before considering surgical approaches). As best I can determine,
the technique was developed at Tulane Univ by Charles Norris in the US and
first tested by Dr. John Shea Jr. in Memphis, Tennessee, USA. Doctors knew
that streptomycin could destroy hearing and balance. Early interest was in
seeing if the vestibular system could be suppressed with small doses during
space travel in order to reduce motion sickness experienced by NASA astronauts.
Shea and others soon recognized that streptomycin could be used in two ways for Meniere's. Either a large dose could be used to chemically destroy the neural hair cells of the inner ear (giving a result similar to nerve section, but without surgery) or a carefully monitored dose could be used so that treatment would stop as soon as any hearing or vestibular damage could be measured. The latter idea was based on the thought that either the vestibular signal could be weakened or even that the cells in the vestibular (balance) system in the ear that were misfiring and causing vertigo might be selectively destroyed with streptomycin. It was also known that aminoglycosides had complex activity within the tissues of the inner ear and had a particular affinity for tissue believed responsible for the production of endolymph. (Overproduction of endolymph or failure of resorption is believed to be the principal cause of Meniere's symptoms and the symptoms of some other inner ear problems, as well.) Dr. Shea was somewhat successful in developing this treatment. It has been tried now around the USA, in Italy, Australia, Canada, and elsewhere in numerous variations but is not generally known to practicing ENTs. The newer form of the treatment is to use gentamycin instead of streptomycin because it is safer. The drug is administered either into the middle ear and allowed to perfuse through the round window into the inner ear or given by (systemic) injection. Patient goes home same day. Results have been very good as far as I can tell. One large unilateral study (people with Meniere's in one ear) showed the following results: vertigo gone in over 90% of cases, tinnitus GONE in more than 80% of cases. Another large study found vertigo gone in 85.5% of cases, improvement of hearing of at least 10 db in 26.7%, disappearance of pressure or fullness in 78.4%, and the disappearance of tinnitus in 51.6% of cases and its significant reduction in another 24.2%. Researchers (e.g., T. Sala in Italy) think that the gentamicin permanently affects the"vascular stria" and the "dark cells" so that less endolymph is produced and causes changes in a number of cellular biochemical processes in the inner ear. Of major importance to those with Meniere's affecting both ears is the finding that the Meniere's may be "cured" by either parenteral injections or middle ear applications. Sala cites four additional references that report on treatment/cure of bilateral Meniere's using streptomycin or gentamicin. He argues for gentamicin, due to its greater affinity for tissues believed responsible for endolymph production and because of its lower toxicity. He argues also that the topical administration of gentamicin can be used even when little or no hearing loss is present, since the dosing can be stopped before significant hearing loss occurs. Because the drug then (allegedly) results in reduction of endolymph pressure, no further hearing loss or vertigo attacks are expected. Thus gentamicin perfusion therapy appears to be a viable treatment at any stage of Meniere's unilateral or bilateral, and may preserve hearing and balance if used soon enough. Sala also argues that treatment with aminoglycosides could be expected to be effective against tinnitus or balance disorders due to any of a wide variety of causes, not just Meniere's. I have not seen any research done on this assertion. A finding of major importance is that when the earliest patients from about 15 years ago are examined today, the improvements made by the streptomycin therapy are still there, suggesting that the treatment may be permanent. Please note that if you seek this treatment or ask your doctor to consider it you will probably have difficulty. S/he will probably never have heard of it. I have a list of about six doctors in the US who perform the treatment in at least some versions. There is obviously Sala in Italy (Venice), and I have a lead to a doctor in Australia and Canada. This information is just my take on some fairly technical journal articles. The opinions are those of medical doctors who wrote the journal articles but the words are mine. I am not a medical doctor, just a Meniere's patient like many of you. References: Dickens, John R.E., M.D., and Graham, Sharon S., Meniere's Disease--1983-1989. The American Journal of Otology, Vol. 11, Number 1. January 1990. Sala, T., Transtympanic administration of aminoglycosides in patients with Meniere's disease, Archives of Oto-Rhino-Laryngology, 245:293-296. 1988. Pyykko, I., Ishizaki, H., Kaasinen, S., Aalto, H., Intratympanic gentamicin in bilateral Meniere's disease, Otolaryngology--Head & Neck Surgery, 110(2):162-167. Feb 1994. Shea, J.J. Jr., and Ge, X., Streptomycin perfusion of the labyrinth through the round window plus intravenous streptomycin, Otolaryngologic Clinics of North America, 27(2):317-24. April 1994. |
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| Endolymphatic Hydrops |
Endolymphatic hydrops (see http://lab9924.wustl.edu/Intro4.htm) is a condition similar to Meniere's that involves vertigo without hearing loss, as described by another contributor:
Antecdotal Report Concerning Endolymphatic Hydrops |
| I have a problem with one ear that is called endolymphatic hydrops, which is something like Meniere's without a severe hearing loss. Apparently the fluid in the semicircular canals responds to changes in body fluid levels - which it isn't supposed to do- and sends messages to say you are dizzy. I have spontaneous vertigo attacks and motion induced dizziness - all lasting only a short time. Well, what does this have to do with tinnitus? I also have tinnitus in that ear, which is helped by some things I have been taught to do for dizziness. Eating small meals several times a day keeps your body fluid levels fairly consistent. Also avoid salt. That really makes a difference with tinnitus and avoid too much sugar as well. Other things to be careful of are fatigue and dehydration. All these things have been helpful for me. |
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| Hyperacusis |
Hyperacusis is defined as a collapsed tolerance to normal environmental sounds. It is a rare hearing disorder whereby a person becomes highly sensitive to noise. Sometimes people think they have hyperacusis because they are bothered by loud sounds like music, heavy equipment or sirens. This is not hyperacusis because these sounds are loud to the normal ear. Individuals with hyperacusis have difficulty tolerating sounds which do not seem loud to others. The ears lose much of their normal dynamic range, and everyday noises sound unbearably or painfully loud. Simply stated, it is like the volume control on your hearing is stuck on HIGH! Hyperacusis can affect people of all ages and is almost always accompanied by tinnitus, an ailment that causes sufferers to hear constant ringing, buzzing or static. Unlike hyperacusis, tinnitus is very common and is associated with many hearing disorders. Hyperacusis and tinnitus can affect one or both ears. Recruitment is a similar hearing disorder which is often confused with hyperacusis. The difference is that an individual with hyperacusis is highly sensitive to sound but has no hearing loss whereas a person with recruitment is highly sensitive to sound but also has hearing loss. This is an important difference.
Unfortunately, because hyperacusis is so rare, little research has been done so little is known about it. The onset is usually caused by exposure to loud noise (either prolonged or a single episode) or a head injury. Some experts speculate that the cause is damage to the auditory nerves. Currently, a popular theory is that there has been a breakdown or dysfunction in the efferent portion of the auditory nerve. Efferent meaning fibers that originate in the brain which serve to regulate or inhibit incoming sounds. If the cause would be damage to the auditory nerve then why does hyperacusis most often show up in patients who have little or no discernable hearing loss? One possibility is that the efferent fibers of the auditory nerve are selectively damaged even though the hair cells that allow us to hear pure tones in an audiometry evaluation remain intact. The real problem is that no one clearly understands how the brain interprets sound. Medicine has much to learn about the auditory system before hyperacusis and many other auditory problems can be fully understood. Other contributing causes of hyperacusis are thought to be Temporomandibular Syndrome (TMJ), Williams Syndrome, Bell's Palsy, Meniere's Disease and Tay-Sachs Disease. Also as many as 40% of all autistic children are sensitive to noise, however their condition is called hyperacute hearing. Autistic children currently receive Auditory Integration Therapy (AIT) to resolve their sound sensitivities. These treatments do not work on hyperacusis and can actually worsen our condition - particularly the tinnitus because it is administered at uncomfortably loud sound levels.
Currently all treatments for hyperacusis are experimental. The most promising treatment comes from Dr. Pawel Jastreboff who have patients with hyperacusis listen to static (white noise) from ear appliances called maskers. The theory is that by listening to a specific kind of white noise at a barely audible volume for a disciplined period of time each day that the efferent system of the auditory nerve will be retrained through desensitization to once again tolerate normal environmental sounds. The treatment has been somewhat successful on a select number of patients but usually no improvement is seen during the treatment period for at least the first 3 months. Treatment may take as long as 2 years.
Although there may be as many as 1% of the population who are sound sensitive, hyperacusis sufferers go well beyond the definition of sound sensitive and often cannot tolerate their surroundings or even people's voices. Because the media has not publicized this disorder it is hard to get a handle on how rare hyperacusis is, however, it may be as little as one in every 50,000 people. That is extremely rare!
Because so little is known about it, doctors either have no idea what is wrong with us or give us poor advice. Some even subject our ears to tests which only make our ears worse. A person who comes down with hyperacusis needs immediate counseling. No one can even imagine what this condition is like unless they experience it first hand. Running water, rustling newspaper pages, people talking, slamming doors, kitchen silverware and driving in a car can all be intolerable particularly without ear protection. Most hyperacusis patients wear ear protection - either foam ear plugs or ear muffs when they are in areas which are not sound-friendly. When ears suddenly become traumatized it is even difficult to sleep because the sufferer's stress level is so high. To help individuals who are experience the trauma of hyperacusis, an international support network has been established called The Hyperacusis Network.
[The above information was provided courtesy of The Hyperacusis Network.]
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Temporo-Mandibular Joint Syndrome (TMJ) |
One contributor has this to say about the TMJ/tinnitus connection:
Antecdotal Report Concerning TMJ |
| The Sternocleidomastoideus muscle connects on your sternum by the collar
bone on both sides and goes back to the back of the ear. It's about 6-10
inches long and when it gets tight, it can pull on the TMJ area thereby creating
a pull on the muscles and ligaments around the inner ear area. Almost certainly
the final "pull" is the sphenomandibular ligament which connects the ear
drum and TMJ. An osteopath can work with this. Xanax or other benzo's can
provide tension relief as well. The masseter and temporalis muscles (those
in front of the ear and above the ear can cause the same TMJ/tinnitus problems.
If a person wants to know if their tinnitus is connected to their TMJ in
some way, have them 1) clench their teeth- does it change the tinnitus? 2)
push in hard on the jaw with your palm. Does the tinnitus change? (Get
louder/softer, pitch or tone change) 3) Push in on the forehead with your
hand hard. Resist with the head. Any changes? In about half the people I
talk to, they find a TMJ correlation they never even dreamed of...
There is a highly recommended dentist knowledgable about TMJ/tinnitus cases who has 30 years of experience and has authored/co-authored several papers on the subject:
Doug Morgan, DDS (semi-retired with limited office hours - August, 2000) |
For more information about TMJ, visit the TMJ Foundation (a California public nonprofit corporation) WorldWideWeb site at http://www.tmjfound.com/ , or contact them at:
TMJ Foundation
P.O. Box 28275
San Diego, CA USA 92128-0275
fax +1 619 592-9107
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| Lyme Disease |
Lyme disease deserves special mention partly because it is so difficult to diagnose objectively; the commonly available serological tests have very high rates of false negatives. In the only study (by McDonald), the literature used objective measures (histopathology) to confirm test results, over 50% of currently infected patients were negative by ELISA and/or Western Blot. False positives are infrequent, occurring primarily in pts. exposed to other nasties such as syphilis or rocky mountain spotted fever. So serologies can be used to confirm but not to rule out diagnosis.
The Lyme Urine Antigen Test (LUAT) is a useful supplement test to serologies; it tests for current infection, as opposed to a history of exposure. It has some problems with low sensitivity; these can be improved by the following regimen. Give amoxicillin 500mg tid q5d; on days 3,4,5 take and test first-in-the morning urine specimens. The LUAT can be ordered by your MD from Immugenex, 1-415-424-1191. Other, better tests (including PCR) are under development, expected to be available for clinical use within the next few years.
For further online information about Lyme Disease, you may send the following command in the body of an e-mail message to listserv@lehigh.edu:subscribe LymeNet-L yourfirstname yourlastname. A regular newsletter is published here, and patients & physicians may exchange their stories.
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| Arnold Chiari Malformation (ACM) |
| The survey of patients was conducted by Darlene Long-Thompson, RN, MHSc.
Essentially there is (in ACM) extra cerebellum crowding the outlet of the
brainstem/spinal cord from the skull on its way to the spinal canal. This
crowding will commonly lead to headaches, neck pain, funny feelings in the
arms and/or legs, stiffness, and less often will cause difficulties with
swallowing, or gagging. There are those that believe it can cause tinnitus.
Often the symptoms are made worse with straining. Untreated, the chronic
crowding of the brainstem and spinal cord can lead to very serious consequences
including paralysis.
There are many ways to treat Chiari malformations, but all require surgery. When the diagnosis is suspected the study of choice is an MRI scan. These malformations are very difficult to see on CT scans and impossible to see on plain x-rays. If you are intending to have an MRI for another reason, e.g., Acustic Neuroma, the MRI technicians should be alerted to the possibility of ACM (if you are showing any symptoms listed above) since the "MRIing" will have to concentrate on the brain stem/cerebellum area to detect the problem. Most of the preceding (ACM) information provided courtesy of: Bernard H. Meyer. |
| Arnold Chiari Malformation involves the herniation of the cerebellum
and/or brainstem through the foramen magnum. This can cause problems in the
areas of cerebellar compression and dysfunction, cranial and spinal nerve
(including trigeminal and acoustic nerve) compression and inflammation, CSF
blockages and increased intracranial pressure (constant or intermittent),
and brainstem compression and inflammation.
ANY of these components can cause symptomology associated with tinnitus...(Think of the ringing in the ears or buzzing sound associated with light headedness or fainting... many ACM sufferers experience this either due to acoustic nerve involvement or to fluid and pressure dynamics). Because hard data on ACM is difficult to find (and often contradictory) it is difficult to find a source that says specifically any one symptom is related to ACM...but the symptoms are often categorized as...cerebellar syndrome, brainstem deficits, CSF obstruction, and cranial nerve deficits. Due to the close proximity of the acoustic nerve to the hindbrain region it would be one of the primary cranial nerves involved in the compression/inflammation syndrom.[sic]. Two of my references on this are as follows...Tinnitus and Neurosurgical Disease Journal: Journal of Laryngology & Otology
Authors: WA Shucart
M. Tenner
Citation: (4): 166-8
ISSN0144-2945
Tinnitus from Intracranial Hypertension
Journal: Neurology
Authors: KJ Meador
TR Swift
Citation: 34(9): 1258-61
ISSN 0028-3878
Preceding (ACM) information provided courtesy of: Darlene Long-Thompson, RN, MHSc. |
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