Noise in head / Tinnitus

It is an annoying symptom met frequently. May be intermittant or persistant. May be low or hig pitch. May be heard by other people or by the patient alone. May be with or without hearing loss.
Tinnitus is not a disease alone, it is a result of a problem, disesase. There are many causes of tinnitus.
Hearing mechanism: There are 5 parts in hearing process. Outer, middle, inner ears, hearing nerve pathway and brain.

External ear: Between auricle and tympanic membrane. These structures collect and transmits the sound waves.

Middle ear: Between tympanic membrane and internal ear. Tympanic membrane and three little ossicles take a role here. They transmit and augment the vibrations to the inner ear. Fluid in the inner ear canal is effected by these vibrations.

Inner ear: It is a bony place in which liquid is circulating surrounded by membranes. Movement of this fluid triggers the nerve endings to producing nerve stimulus.

Nervous pathway: Stimulated nerves in the inner ear carries these signals to the hearing centers of the brain.

Brain: Brain evaluates these stimulations and we hear them as different sounds.

Outer ear tinnitus: Earwax, foreign body, swelling of the canal may obstruct the canal. These may effect the membrane also and can cause tinnitus. Venous dilatations around external ear canal may cause pulsative tinnitus.

Middle ear tinnitus: Any kind of problem in middle ear function may cause tinnitus. Any kind of scar tissue can stimulate nerve endings and can cause tinnitus, also venous tissue can cause pulsatile tinnitus.

Inner ear tinnitus: Factors effecting inner ear fluid pressure can cause tinnitus. Allergy, circulatory problems, infection can effect both fluid and membrane surrounding it.

Nerve pathway tinnitus: Nerve pathways are the most delicate organs of the hearing mechanism. A little problem in these nerves effect the hearing. Local infections, allergic edema, toxic effect of systemic diseases, very loud sounds, some drugs and chemicals may effect them.

Brain tinnitus: Any kind of swelling, circulatory problem may cause tinnitus. Mostly these are one sided tinnitus.

Hearing problem: Tinnitus can be with or without hearing problem. This is normal because they are in the same place and related to each other. People with tinnitus are afraid of being deaf, this is an unnecessary fear. Many hearing defficient people do not have tinnitus.

Treatment: If a certain disease is diagnosed as a cause of tinnitus, it is treated accordingly. The followings are adviced if there is no reason found for tinnitus.

1-Since stres can cause and trigger tinnitus try to do your best to get rid of it.
2-Try to find time to to rest.
3-Avoid alcohol, smoking and caffeine intake.
4-Learn that tinnitus is an annoying symptom and try to ignore it.
5-Your tinnitus will not cause you to die or be deaf. Get rid of these thoughts.
6-If you are in a very silent place try to put something around producing sound to feel tinnitus fewer like a clock, music.
7-Place your head above your heart level while sleeping.
8-Some relaxing medicine may help for a short time.

Result: Hearing is a very delicate mechanism. It is related with feelings, anxiety very much.
To be treated, patient should understand the mechanism of tinnitus exactly.

Tinnitus disability questionnaire

Explanation: Aim is to understand the degree of your tinnitus. Just answer yes, no or sometimes.

1-Do you have difficulty to consentrate because of your tinnitus?
Yes Sometimes No
2-Do you have difficulty to hear human beings because of tinnitus?
Yes Sometimes No
3-Do you get nervous because of tinnitus?
Yes Sometimes No
4-Do you feel mixed up because fo tinnitus?
Yes Sometimes No
5-Do you feel hopeless because of tinnitus?
Yes Sometimes No
6-Are you complaint of tinnitus very much?
Yes Sometimes No
7-Do you get difficulty getting into sleep?
Yes Sometimes No
8-Do you feel that you cannot get rid of your tinnitus?
Yes Sometimes No
9-Does tinnitus prevent you to get joy from your social activities?
Yes Sometimes No
10- Do you feel handicapped because of tinnitus?
Yes Sometimes No
11- Do you think that you get a terrible disease because of your tinnitus?
Yes Sometimes No
12-Does tinnitus cause lost of your life joy?
Yes Sometimes No
13-Does it prevent to do your responsibilities?
Yes Sometimes No
14-Do yo feel touchy becuase of tinnitus?
Yes Sometimes No
15-Is it difficult to read because ıf tinnitus?
Yes Sometimes No
16-Does it make you sad?
Yes Sometimes No
17-Do you think that tinnitus causes pressure in your relations with your family and friends?
Yes Sometimes No
18-Do you think that it is difficult to seperate your ideas from tinnitus and concentrate on other things?
Yes Sometimes No
19-Do you feel that you have not any control on your tinnitus?
Yes Sometimes No
20-Do you feel tired frequently because of tinnitus?
Yes Sometimes No
21-Do you feel depressed because of tinnitus?
Yes Sometimes No
22-Does tinnitus make you feel nervous?
Yes Sometimes No
23-Do you think that you do not overcome with tinnitus anymore?
Yes Sometimes No
24-Does tinnitus become worse when you have problems?
Yes Sometimes No
25-Does tinnitus make you feel unsafe?
Yes Sometimes No

Evaluation of the questionnaire (Aksoy S. 2007)
4 0 2
Yes Sometimes No

First degree 0-16 Weak (Only can be heard in quiet places)

Second degree 18-36 Medium    (Can be masked with noise and can be 
                                                   ignored while in activitiy)
Third degree      38-56 Moderate (Still routine activities can be performed 
                                                   even tinnitus is heard)
Fourth degree   58-76 Strong     (Tinnitus is heard almost always and may 
                                                   disturb sleep and daily activities)
Fifth degree       78-100 Disaster (Heard always, disturbs sleep and causes 
                                                    difficulty in routine work)

My persistent symptoms 31 May, 2013 - 12:14

I am writing to you from St. John's, Newfoundland (Canada). I have a sinus problem started in Nov 2008 upon working for more than a month in a gas plant. I did not have sinus problems prior to this date.

At that time, I may have been exposed to airborne asbestos and other irritants. In the place where I lived at that time, the Winter is so harsh. Temperature during Winter is normally at least 25 Cecilius below zero.

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