TINNITUS
thE annUal tInnItUS aWarEnESS WEEK WaS hEld In fEBrUary. BUt hoW MUch do yoU actUally KnoW aBoUt thIS condItIon? and WhEn ShoUld yoU SIgnPoSt PatIEntS to thE gP?
Ear a word in your S
tatistics have suggested that almost 180,000 people in northern Ireland have tinnitus
of varying severity, with around 9000 affected by the condition so badly that many have said that it made their life unbearable and that it had had a significant impact on their mental health.
But what exactly is tinnitus? tinnitus is a symptom of a problem in the hearing system. It’s very common and is thought to affect between ten and fourteen per cent of adults in the UK. While it’s more common in people aged over 60, it affects people of all ages, including young children. tinnitus is often described as ‘ringing in the ears’, but several types of sound can often be heard, including buzzing, humming, grinding, whistling and sizzling.
the most common type of tinnitus is ‘subjective tinnitus’. It is called this because only the person with the tinnitus can hear the sounds. ‘objective tinnitus’ – which is very rare – occurs when a clinician using a stethoscope placed close to the affected ear can also hear it. Sometimes the noise associated with tinnitus can beat in time with the pulse/heart and in these cases it is known as ‘pulsatile tinnitus’. for a small number of people, tinnitus can sound like fragments of songs or tunes and this is known as ‘musical hallucination’.
22 - PharMacy In focUS
tinnitus affects people in different ways. Most people who have the condition aren’t troubled by it or affected by it. however, there are some people who find it has a serious impact on their life, which can cause or worsen anxiety, such as hearing difficulties, sleep problems or depression.
What causes tinnitus? Exactly how and why tinnitus occurs isn’t yet fully understood, but it’s generally thought that tinnitus is the sound of increased activity in the brain caused by a reduction in activity within the cochlea (the hearing organ in the inner ear) or the hearing nerve. tinnitus can be linked to many things that affect the hearing system. Most cases are linked to age-related hearing loss, or hearing loss caused by exposure to loud noise. other, less common, links include: • Some ear conditions and diseases • Ear, head or neck injuries • certain medications used to treat serious diseases.
It’s strongly accepted that there’s a strong link between stress and tinnitus. all sources of stress can be a trigger for tinnitus, or can make it worse. So, a vicious cycle develops: stress makes tinnitus worse, which leads to greater stress and anxiety.
certain drugs can cause damage to the inner ear, resulting in hearing loss, balance problems and tinnitus.
these are known as ‘ototoxic drugs’ and can result in temporary tinnitus.
the main drugs known to cause tinnitus as a side effect are: • cytotoxic rugs – certain platinum- containing drugs, such as cisplatin, which is used to treat cancer.
• aminoglycoside antibiotics, which are used to treat very serious infections such as meningitis.
• Macrolide antibiotics, which are used to treat lung and chest infections.
• Quinine, which is used to treat some cases of malaria.
• aspirin. It’s very unlikely that the small dose of aspirin that many patients use to treat headaches or flu will cause tinnitus. In the past, aspirin was prescribed in very high doses to treat some rheumatological conditions and, on occasion, this did lead to tinnitus, but it usually disappeared once the aspirin was stopped. these large doses of aspirin are rarely prescribed now but, if you have any concerns that aspirin is causing a patient’s tinnitus, advise them to speak to their gP about getting an alternative medication.
Can tinnitus be prevented? Unfortunately, tinnitus can’t always be prevented, but there are a few ways in which patients can help protect themselves:
Infections: tinnitus can be caused by ear infections, so advise patients, who use earplugs or hearing aids, to keep them scrupulously clean. If they’re suffering from a build-up of wax, advise them to soften the wax with olive oil drops. once softened, the wax may release itself.
Earplugs: If patients are going to be in a setting where they are exposed to loud sounds over 85dB, they should use earplugs and should stay away from speakers. If they regularly listen to music through headphones, advise them to set the level to safe.
What therapies are available? all of the therapies used to treat tinnitus work on the basis that they train the brain to ‘filter out’ tinnitus to the point where it no longer affects a patient. gPs should refer patients to an audiologist or tinnitus specialist where they will be recommended to try various options such as hearing aids, sound therapy, relaxation exercises, counselling or cognitive behavioural therapy.
Inaugural tinnitus event on 15 September, the UK’s first ever ‘talking tinnitus UK Expo’ will be held in Birmingham. for more information visit
tinnitus.org.uk
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