Tinnitus is caused by damage to the sensory hair cells in the cochlea of the inner ear. In the absence of stimuli at a particular frequency it is theorized that there is an imbalance between excitatory and inhibitory neural pathways resulting in neural hyperactivity. There are measures which can help to prevent tinnitus but unfortunately in the vast majority of cases there is no effective treatment. Once it is confirmed that the tympanic membrane is normal and there is no cerumen in the ear canal, no effusion, no infection, and if the tinnitus is persistent and bothersome, the best thing is an audiological examination. Audiograms help to determine the pattern of hearing loss, and to indicate if there is significant risk of tumor, which is an unlikely cause. If there is hearing loss associated with bothersome tinnitus the use of hearing aids is sometimes helpful.
Tinnitus prevention includes:
1- Use NSAIDs infrequently or not at all.
2- Increase routine consumption of dietary fresh fruits, berries, unsalted nuts, fish, herbs and spices in order to obtain sufficient zinc, magnesium, flavonoids and other polyphenols.
3- Do not listen to loud music with headphones or ear buds.
4- Eliminate artificial flavorings and sweeteners, especially aspartame.
At a later date we will publish a complete article about the genetics of age related hearing loss and the rationale and details behind specific preventive dietary measures.
The New England Journal of Medicine mentions psychotherapy in this review article. The issue of psychotherapy mentioned in this article merits clarification. Tinnitus represents a malfunction of the central nervous system which is exacerbated by the absence of normal auditory stimulation, and may be the first symptom of hearing loss. While hearing loss can be measured there is still no way to measure tinnitus with instruments. People who have very loud and persistent tinnitus may suffer from depression and panic when they realize that it is not improving. Initial management may include sound machines with white noise, rain, waves or other sounds to mask the tinnitus until it becomes less distressing. Eventually after about five years patients may reach a state where the tinnitus is present, but they do not feel emotional distress with it. Until they reach acceptance psychotherapy can be beneficial in some cases. A review article can be found at the following link
Rothaus C. What nonpharmacologic approaches presently exist for the management of tinnitus? NEJM Resident 360
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