What is Tinnitus?

Tinnitus is colloquially known as ringing or humming. We can define it as the sound that patients perceive in their ears or heads without an external stimulus. On the other hand, patients may describe this as hearing a ringing sound, humming, or buzzing in their ear.
 
Can you give information about the formation mechanism of tinnitus?
Although the exact cause of tinnitus is unknown, it is widely assumed that it is caused by limited or complete damage to the inner ear and auditory nerve, as well as by energy bursts known as spontaneous otoacoustic emission.
 
“Patients may not come with only ear-related or brain-related problems. In ear-related pathologies, tinnitus can be seen with or without hearing loss due to exposure to loud noise or ototoxicity in the inner ear structures or auditory nerve damage. Tinnitus might be seen in people with acute sensorineural hearing loss. As one of the different mechanisms of tinnitus, we can show that the sounds created by the body, which are perceived in the brain, pass through the skull base and are perceived in the brain. As an example of this, the patient can hear sounds in the form of intracranial flow sounds, pulse sounds, heartbeats, as tinnitus, due to the different perception of flow velocities caused by vascular structures such as fistulas and aneurysms seen in vascular structures. Tinnitus can be defined in patients who clench their teeth as some physiological body sounds that occur due to muscular spasms generated by jaw movements or due to vibration or involuntary movements of the muscles, especially if the patient has conductive hearing loss.”
 
KÜÇÜK giving information about the classification of tinnitus: “In general, there are two types of classification as objective tinnitus and subjective tinnitus. Objective tinnitus is a perceived sensation of sound that occurs in the absence of external acoustic stimulation but can also be heard by the examiner. Objective tinnitus may be more common in aneurysms, venous malformations, or hypertension-related tinnitus. It is more common in vascular diseases such as arteriovenous malformations caused by vascular abnormalities or arteriovenous plaques, which are more common in elderly people. Subjective Tinnitus is a ringing heard solely in the patient's own ear, in their head, and is not audible to the physician or anyone else. These are typically sensorineural tinnitus, stress and anxiety-related tinnitus, or psychotic tinnitus.”
 
“Another classification is pulsatile and non-pulsatile tinnitus. Pulsatile tinnitus presents as an intermittent pulsation. Patients may describe it to us as I hear my pulse, I hear my heartbeat, and we see it mostly in vascular pathologies. Non-pulsatile tinnitus, on the other hand, is tinnitus that the patient describes as a continuous, uninterrupted ringing that continues in the same tone. We can see it frequently in neurological disorders, sudden sensorineural hearing loss or due to trauma.”
 
What are the causes or predisposing factors that can cause tinnitus?
Hearing loss and dizziness are the first things we look for in a patient with tinnitus. We can usually see tinnitus if patients have sensorineural hearing loss. Fluid accumulation, eardrum adhesions, eardrum thickenings, patent tuba Eustachian, and ringing due to the Eustachian tube's failure to balance pressure are all symptoms of middle ear pathology. Tumoral lesions and vascular pathologies in the ear can cause tinnitus. Neurological causes such as Multiple Sclerosis, intracerebral tumors, intracerebral hemorrhages, stress and depression, temporomandibular joint syndrome due to clenching, plugs in the external ear canal, excessive noises, drug use (salicylic acid, nonsteroidal anti-inflammatory and some psychotic drugs) and using these drugs, we can see a lot of tinnitus complaints due to reasons such as stopping these drugs suddenly. We notice significant increases in tinnitus complaints in patients with uncontrolled hypertension and diabetes, both due to blood pressure abnormalities and as a reflection of blood sugar irregularities. In addition, tinnitus complaints increase in cases such as anemia, iron deficiency or heart failure.
 
For patients who have noticed tinnitus; "If the tinnitus persists, the patient should see an ENT specialist." Assistant Professor Nurten KÜÇÜK stated that a complete history should be taken, relevant tests should be performed, and imaging techniques such as MRI and tomography should be utilized if necessary, and if no problem exists, the patient should be transferred to another department. She advised that if the patient has complaints of ringing and fullness in the ear, particularly if she has hearing loss, she should not put off seeing the doctor.
 
 
How is tinnitus audiologically and clinically evaluated?
Physical examination of the patient, hearing test, tympanometry test and evaluation of ear pressure are required.  If there is no pathology in these, clinical blood pressure, thyroid hormones, sugar, electrolyte values, mineral values tests should be requested to see the general condition of the patient. It is absolutely necessary to request blood pressure monitoring, to examine whether there is depression or anxiety affecting the patient's life, and to question whether neck pain, headache, and dizziness are present. If there is no problem with these, the neurological examination should be done, and if necessary, the cardiac examination should be done. If we can identify the underlying cause of tinnitus, it is necessary to re-arrange tinnitus drugs and treatment methods for that cause simultaneously in order to minimize the patient's tinnitus.