Testing for Tinnitus

Tinnitus is not a disease. It happens because of some other problem. The first thing you should do is visit your doctor. Your doctor can check you for some of the issues that may cause tinnitus.You should have your hearing tested by an audiologist. Some types of hearing loss and hearing problems can cause tinnitus. A hearing test can help you learn the cause and treatment options.
We cannot measure tinnitus directly.

The audiologist at Loud & Clear needs you to describe your problems and difficulties that you have. We need to ask you these questions, in order to help you:

• Do you hear ringing in your left ear? Right ear? Both?

• Is the ringing constant?

• Do you notice it more at certain times of the day or night?

• Can you describe the sound or the ringing?

• Is the sound high-pitched? Low-pitched?

• How loud is the sound?

• Does the sound ever get louder or softer? Does it change pitch?

• Are there times when the tinnitus gets worse? Does it happen when you drink caffeine? When you take certain medicines? After you hear loud noises?

• Does the tinnitus make it hard to sleep? To work? To concentrate?

• How annoying is your tinnitus?

  Learning about tinnitus can be a relief. You can start to take control of it by changing things that may make it worse.

Tinnitus Always Accompanies Meniere’s Disease

Meniere’s disease/ Endolymphatic Hydrops

A disorder of the inner ear that can affect hearing and balance to a varying degree.

Epidemiology:

Men and women are probably equally affected. In about 1/2 to 2/3 of the cases
Can begin at any age but patients typically present with symptoms between the ages of 20 and 40 years. In children is most often associated with congenital malformations of the inner ear.

Pathophysiology:

Ménière’s disease is idiopathic but it is believed to be linked to endolymphatic hydrops, an excess of fluid in the inner ear.
May be related to swelling of the endolymphatic sac or other tissues in the vestibular system of the inner ear due to too much endolymph secreted or decreased absorption by the stria vascularis Or the endolymphatic duct may be obstructed by scar tissue, or may be narrow from birth.

Signs & Symptoms:

• Hearing Loss: Fluctuating, progressive, u/l or b/l SNHL, usually in lower frequencies.
• Vertigo: Rotational vertigo (lasting from minutes to hours).
• Tinnitus: Roaring type (U/l or b/l tinnitus).
• Fullness: Sensation of fullness or pressure in one or both ears.

   Other symptoms:
• Severe nausea, vomiting, and sweating often occur.
• Symptoms get worse with sudden movement.

Diagnosis:

a) Caloric test:

Principle: Uses differences in temperature for diagnosis.
This test stimulates the inner ear and nearby nerves by delivering cold or warm water to the ear canal at different times.

Procedure: One ear is tested at a time after an otoscopic examination.
Cold water is injected initially and later followed with warm water.

Result: The eyes can be looked at directly or an ENG may be performed.
When cold water enters the ear and the inner ear changes temperature, it should cause fast, side-to-side eye movements called nystagmus. The eyes should move away from the cold water and slowly back.
Next, warm water is placed into the ear. The eyes should move toward the warm water and then slowly away.

b) Glycerol Test

Principle: Ingestion of glycerol, 1.5 g/kg body weight, causes a transient reduction of the hearing loss or improvement in the hearing thresholds.

Procedure:  Pure-tone audiometry is performed in a series: an initial examination before glycerol intake and then 1- 2 hours after glycerol administration and the difference in the thresholds is noted. Ingestion of glycerol: 1.5 g/kg body weight

Result: Positive: when the hearing thresholds are lowered ≥15dB at minimum 3 frequencies.

c) CHAMP: Cochlear Hydrops Analysis Masking Procedure (A modified ABR test.)

Principle: Cochlear hydrops is associated with an under masking phenomenon that can be observed during specialized ABR data collection using click stimuli mixed with a special type of high-pass masking noise and presented at a certain level.
It is hypothesized that cochlear hydrops alters the response properties of the basilar membrane which results in reduced masking effectiveness of high pass noise on the ABR to click stimuli. This results in the undermasking phenomenon.

Procedure: Recording ABRs to moderate level clicks and simultaneous I/l high-pass masking noise.
Clicks presented alone & with masking noise high-pass filtered at 8 kHz, 4 kHz, 2 kHz, 1 kHz and 0.5 kHz.

Result:  In normal hearing subjects:
Latency of wave V in the ABR is observed to increase as the cut off frequency of the high-pass masking noise is lowered because with each lowering of the high-pass masking noise cut off frequency, the response to the click is dominated by a lower-frequency region.
In MD patients:

Masking noise is insufficient such that the latency of wave V in the responses to the clicks and various high-pass masking noise conditions is similar to that of wave V in the response to clicks alone.
As cochlear hydrops alters the response characteristics of the BM such that the high-pass masking noise is less effective in masking activity from the frequency regions that are normally masked by the noise.

Antidepressant Medication May Worsen Tinnitus

Millions of people suffer from the constant sensation of ringing or buzzing in the ears known as tinnitus, creating constant irritation for some and severe anxiety for others. Research by scientists at OHSU shows why a common antidepressant medication may worsen the condition.

The study, published Aug. 22 in the journal Cell Reports, focused on the action of serotonin, an important neuromodulator in the brain. Researchers examined brain tissue in mice, specifically the dorsal cochlear nucleus where sensory integration and tinnitus occurs. Researchers discovered that neurons known as fusiform cells within this portion of the brain become hyperactive and hypersensitive to stimuli when exposed to serotonin.

“We saw that the activity of those neurons went through the roof,” said senior author Laurence Trussell, Ph.D., a professor of otolaryngology in the OHSU School of Medicine and scientist in the OHSU Vollum Institute.

If the findings bear up to additional research, the study could have implications for a common class of antidepressants known as selective serotonin reuptake inhibitors (SSRI). SSRIs can alleviate symptoms of moderate to severe depression and anxiety by increasing the level of serotonin in the brain. Serotonin is a chemical compound that acts as a neurotransmitter thought to be responsible for maintaining mood balance.

However, the research suggests that SSRIs prescribed to treat anxiety or depression may sometimes worsen patients’ tinnitus. Tinnitus is defined as the chronic perception of sound when there is no internal or external acoustic source.

“If you’re a physician treating a patient for depression who also has hearing loss or tinnitus, you may want to be careful about prescribing a drug that compounds their feelings of anxiety,” said Trussell, who also suffers from tinnitus and, in addition to his other roles, has an appointment in the Oregon Hearing Research Center at OHSU. “The SSRI may be enhancing the thing you’re trying to fix.”

Lead author Zheng-Quan Tang, Ph.D., a senior postdoctoral fellow in Trussell’s lab, noted that a review of existing scientific literature indicated that many patients reported an increase in tinnitus soon after they began taking SSRIs.

“Estimates vary, but at least 10 percent of the U.S. population is affected by tinnitus,” Tang said.

The OHSU scientists are interested in exploring another area of research focused on a type of ion channel in the membrane of neurons that is activated by serotonin. If the scientists can determine a way to deactivate those channels, they may be able to allow the beneficial effects of antidepressants while limiting the severity of tinnitus.

https://news.ohsu.edu/2017/08/22/study-suggests-serotonin-may-worsen-tinnitus