Minimising ringing in the ears

Q I am 65 and was recently diagnosed with tinnitus. When the doctor said there was no cure for it, I felt helpless.

I wonder if my hearing loss might be related to an incident that happened when I was less than 10 years old.

A cockroach went inside my ear and kerosene was poured into it to kill the cockroach, which was then extracted by a barber with an ear pick.

Should I get a second opinion?

Also, I have been going to the gym for the past four years, where I lift heavy weights. Is it possible that the stress on the shoulder and neck muscles might have also placed stress on my ear drums, causing or accelerating tinnitus?

I have occasional coughs that are unrelated to the cold or flu. Should I get this checked by the otolaryngologist as well?

Finally, can acupuncture help to reduce the noise in my ear?

A I empathise with your tinnitus condition as you have significant negative feelings which have affected you psychologically.

There are treatment options for tinnitus and you may wish to consult your family doctor for a referral to an appropriate physician.

Some red flags are hearing loss associated with tinnitus, and nasal or neck symptoms.

TYPES AND CAUSES

Tinnitus affects about 20 per cent of the general population. This increases to 40 per cent with ageing.

When the person's tinnitus is described as rhythmic and similar to one's heartbeat, he will need to be checked for abnormal vascular pathology or disease in the blood vessels in the head and neck region.

And if it is described as a static, hissing or cricket sound, the problem is usually due to an infection, such as that of the inner ear or middle ear. It can also be linked to trauma.

Hearing loss that occurs in only one ear requires investigation by an ear, nose and throat (ENT) surgeon.

A flexible nasoendoscopy test is mandatory when there are symptoms such as bleeding from the nose, blood-stained phlegm or neck growths - for example, neck nodes or swellings. This is to check for nasopharyngeal cancer, as the main symptom of this disease is growths in the neck. This outpatient procedure, when performed with topical anaesthesia, is painless.

Accelerated hearing loss and tinnitus may also occur after certain types of chemotherapy, antibiotic consumption or systemic illnesses such as diabetes.

When symptoms worsen over time or if there are additional issues, such as dizziness, imbalance or hearing deterioration, one has to seek an ENT surgeon to be checked for inner ear conditions that are treatable.

TREATABLE VS CURABLE

There is a misconception about conditions which are curable and those that are treatable.

Benign lumps can be cured by surgery alone and they do not recur.

However, there are conditions, such as chronic pain, which have no cure but, certainly, scientifically proven treatment options are available.

Similarly, it is important to treat tinnitus patients with acute insomnia to prevent the onset of psychological depression and anxiety.

The ultimate aims are to reduce one's awareness of the noise that results from tinnitus, and to minimise the overall annoyance and lifestyle impact.

Exercise is good when performed in moderation. However, I would caution against strenuous exercises that may result in extreme exhaustion, fatigue or pain.

As for your cough, there are many causes for chronic cough, such as allergic rhinitis and gastric reflux. This would be better evaluated by your primary care doctor.

Meanwhile, there is a lack of evidence-based outcomes that supports the use of acupuncture alone in treating tinnitus.

Researchers tend to support the use of sound-based and educational therapies (SBE) to treat the condition, such as tinnitus retraining therapy or neuromonics.

These methods involve treatment by a trained therapist, who uses counselling techniques and sound therapy to train the brain to get used to the tinnitus signal.

The success of SBE has resulted in other researchers using this in combination with alternative or complementary medicine, such as acupuncture, to treat tinnitus.

In a 2013 paper by Singapore General Hospital that was published in the Annals Of The Academy Of Medicine, the results of tinnitus retraining therapy in 702 patients were analysed.

Almost seven in 10 said they were less annoyed by the condition after the therapy. Of these patients, eight in 10 of them described a reduction in their awareness of tinnitus as well.

DR CHAN YEW MENG,

senior consultant at the department of otolaryngology at Singapore General Hospital

This article was first published on May 21, 2015.
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