Tinnitus is a disease that has an enormous impact on the quality of life of those affected and is often accompanied by psychiatric comorbidities. In a Medical Tribune webinar, an expert explained how clarification and individual treatment can be achieved in practice.
In Egypt, tinnitus was already known as a “storm in the ear” 2,000 years ago, but today it is much more likely to be referred to as a “storm in everyday practice,” says Dr. Eliane Ebnöther, senior physician at the Olten Cantonal Hospital, from her own experience.
Die Prevalence In any case, it increases with age: 13.7% of people between 45 and 64 years suffer from tinnitus, as a systematic review showed (1). One in four people over 64 is affected. On the one hand, this has to do with the psychosocial conditions in old age and, on the other hand, with the progressive age-related hearing loss, says the expert.
A period of three months marks the transition from acute tinnitus to chronic tinnitus. A distinction can also be made between subjective and objective tinnitus. The former is much more common, accounting for 95% of cases, and can be attributed to many different causes (see box):
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autogenous
Noise exposure
Presbyakusis
Inflammation (otitis media)
sudden hearing loss
Morbus Menière
Otosclerosis -
ototoxisch
e.g. after chemotherapy with cisplatin -
functional
through stress and psychological strain
The much rarer one objective tinnitus can be pulsatile, i.e. pulse-synchronous, or muscular. Tubal dysfunction, retrocochlear masses or temporomandibular joint pathologies also need to be kept in mind.
In any case, it is important Dangerous causes of pulse-synchronous tinnitus to exclude: such as vascular malformations (AV malformations, glomus tumor) or atherosclerotic narrowings (e.g. carotid stenosis).
Last but not least, it is important to choose between one compensated and one uncompensated tinnitus to distinguish. The latter can have a massive impact on quality of life and can be associated with anxiety and sleep disorders as well as depression and suicidality.
Tinnitus can be diagnosed using… Tinnitus Handicap Inventory (according to Goebel and Hiller) can be divided into four degrees of severity – from mild to severe. This records:
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Emotions (frustration, irritability, fear),
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social interaction (effects on relationships with friends and family, social activities),
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Cognition (difficulty concentrating,
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Difficulty reading) and
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Behavior (sleep disorders, difficulty coping with everyday life).
With the help of the Tinnitus Handicap Inventory, not only can the severity and thus the level of suffering be determined, but also the course of the disease under therapy.
But first there are some things to consider Red Flags to be clarified, explained the speaker. By measuring blood pressure and pulse, a hypertensive disorder can be ruled out and auscultation of the neck can be used to look for a pulse-synchronous flow murmur.
A Doppler ultrasound of the arteries supplying the brain can be done if one is suspected AV Fistula or one Glomustumor be performed. To one craniomandibular Dysfunction To rule this out, you should ask about pain in the jaw joint and grinding at night (bruxism) and, if necessary, seek dental expertise.
Especially if there is a tinnitus at the same time Hearing loss occurs, an ENT consultation should be carried out. Using ear microscopy you can: chronic inflammation – like a Cholesteatom – diagnose. Transnasal fiber endoscopy is used to visualize the internal tube entrance and check tube function.
Die Hearing test is made up of different studies:
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Reintonaudiometry,
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Tinnitus Match (method to determine the individual pitch and loudness of a tinnitus noise),
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speech audiometry,
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Tympanometry,
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Stapedius reflexes and
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otoacoustic emissions.
Further investigations are: Brainstem audiometrydie Vestibular test (for dizziness), MRI of the cerebellopontine angle for asymmetrical hearing loss (especially vestibular schwannoma) as well as Angio-MRT or Angio-CT bei pulse synchronous tinnitus
After organic or dangerous causes have been ruled out, the first step is to explain the disease to the patient and convince them that the diagnosis is harmless. “There are no general treatment recommendations for tinnitus. It usually boils down to one thing individually tailored therapy “which is based on the severity, the level of suffering, the expectations, the comorbidities and the origin,” emphasized Dr. Ebnöther.
In general, it’s about working together with the patient The Coping Strategy to develop.
If there is a hearing loss at the same time, that will happen Hearing rehabilitation (Hearing aid, possibly a cochlear implant) plays an important role in promoting the input of the hair cells and reducing deprivation. This is particularly successful if the hearing loss has the same frequency as the tinnitus. The effect of so-called Noiserndevices that create a background noise to drown out tinnitus have not been proven.
Die S3 guideline “Chronic tinnitus” recommends avoiding the administration of medication to treat chronic tinnitus, as there is insufficient data on the effectiveness of medication treatments specifically for tinnitus. This also applies to corticosteroids. This is the only exception acute stageif the tinnitus is part of a sudden hearing loss occurs.
A Cochrane-Review (2)which has the effect of Ginkgo biloba in around 2000 tinnitus patients did not come to a consistent conclusion for tinnitus treatment with Ginkgo biloba compared to placebo. Ginkgo biloba is definitely an option that can be considered, especially for dementia patients with tinnitus, says Dr. Ebnöther.
Melatonin Although it does not affect the tinnitus itself, it is important in that it addresses the sleep disorders associated with tinnitus. Betahistine, cannabinoids and dietary supplements are not recommended due to a lack of evidence.
The best studied and evaluated procedure for tinnitus is the cognitive behavioral therapy. This showed in one Cochrane-Review (3) not only positive effects on the subjective loudness of tinnitus, but also with regard to depressive symptoms and quality of life.
Also Tinnitus-Apps help patients develop habituation. “They are certainly a good option that you would be happy to recommend to your patients,” said the expert. However, compared to cognitive behavioral therapy, the apps are somewhat less effective.
Finally, Dr. Ebnöther, how important it is psychiatric comorbiditiessuch as anxiety and adjustment disorders, sleep disorders and depression, to be recognized and treated. If all else fails, says the ENT doctor, for example in the case of acute suicidality, then you have the option of completing an inpatient six-week tinnitus program in which those affected are offered a wide range of therapies: from acupuncture and breathing therapy to relaxation, physiotherapy and psychotherapy, right up to hearing aid care if necessary.
date: 2026-02-09 02:22:00