What makes pulsating tinnitus so dangerous


Patients with tinnitus hear ringing in their ears such as whistling, hissing, or humming. The disturbance is not to be classified as dangerous. For some people, however, tinnitus that has become chronic means a significant impairment of their quality of life. In about 70% of the cases, the tinnitus resolves on its own.

Dr. Volker Kratzsch answers frequently asked questions about tinnitus - click here for the interview.

What is tinnitus?

Patients with tinnitus hear ringing in the ears such as Whistling, hissing or humming. In principle, the disruption is not to be classified as dangerous at first. Basically, tinnitus only leads to therapy if the person concerned feels impaired by it. The noise as such is not dangerous and - contrary to what is often feared by those affected - cannot cause physical harm, e.g. B. lead to hearing impairment. For some people, however, tinnitus that has become chronic means a significant impairment of their quality of life. In the majority of tinnitus sufferers, the tinnitus disappears within a few days, weeks or months even without therapy.

If a sudden hearing loss occurs at the same time as the tinnitus, the cause of which is not apparent, it is called a "sudden hearing loss". Then you should see your family doctor or an ENT doctor within a few working days. If the ringing in your ears persists for several weeks, you should also consult your doctor as soon as possible for clarification.

A distinction is made between acute and chronic tinnitus based on the duration. The time limit seems to be clearly defined, but the time limit is of little importance for the diagnostic procedure or therapy:

  • acute tinnitus: the onset of tinnitus was less than three months ago. During this time interval, the noise often disappears spontaneously.
  • chronic tinnitus: the tinnitus has been noticeable for more than three months. Now the likelihood of disappearing with and without therapy is significantly lower. The aim of therapy now is to learn to cope with tinnitus.

Symptoms of tinnitus

First of all, it must be emphasized that the translation of tinnitus as noise in the ear corresponds to perception, because for us all noise is projected onto the ear. The ear is not the place of origin, but rather a change in perception in central sections of the brain (including the central auditory pathway, emotional evaluation and attention control in the midbrain). The tinnitus would not stop if the auditory nerve was interrupted immediately after it emerged from the inner ear. This means that the information about tinnitus cannot come out of the ear, otherwise it should have disappeared afterwards.

Tinnitus manifests itself differently from patient to patient. The noises in the ears can occur, for example, as beeping, humming, humming or whirring, hissing or screeching, but other tinnitus variants have also been described. For some people, the tones are consistently intense, or they swell rhythmically up and down. Basically, the majority of patients with tinnitus get along well without therapeutic intervention ("I have tinnitus, mostly doesn't bother me", "I've got used to it", are frequent statements). Only when the tinnitus leads to a significant reduction in quality of life does the need for medical and / or therapeutic intervention arise.

Common stressors associated with tinnitus can include:

  • Hyperacusis
  • Sleep disorder
  • Limitation of physical performance
  • dizziness
  • Pain and tension in the shoulder and neck area
  • Difficulty concentrating, nervousness, restlessness
  • Depressed mood
  • Fear of the future

Such stresses can be recorded in tinnitus patients using standardized questionnaires (e.g. Tinnitus Questionaire TQ; Tinnitus Handicap Inventory THI).

Causes - development of tinnitus

Tinnitus is not a disease in itself. Rather, he is a Symptom of different disorders.
Possible physical or emotional causes can be:

Physical causes

  • all diseases that cause hearing loss, e.g. B.
    • Sudden hearing loss
    • Otosclerosis
    • chronic noise damage or a bang dream
    • Meniere's disease (hearing loss, tinnitus, attacks of dizziness)
    • Old age hearing loss
  • rare causes

Mental causes

Only rarely can a single cause be identified and proven. The development of tinnitus is often due to the complex networks that exist between the hearing and the brain. One differentiates:

Subjective tinnitus: The subjective tinnitus is the most common. He can only be heard from those affected, he lets himself be not audible to others do.

Objective tinnitus: Objective tinnitus is extremely rare. It is created by a measurable sound source at the ear. With the help of special devices, the doctor can make the patient's ear noises audible.

Investigations - diagnostics

For acute noises in the ear, your ENT doctor first point of contact. He examines the ears, the entire hearing and other organs. In an interview, he collects the previous medical history. He asks about the beginning, about possible triggers such as noise exposure or stress and about previous illnesses. He will also let you describe the noises in your ears precisely.

The following examinations, among others, are then used:

  • Hearing test (audiometry)
  • Tinnitus matching to identify the volume and frequency of the sound
  • Ear microscopy
  • Examination (reflection) of the nasopharynx
  • Checking the auditory nerve function
  • Supplementary examinations can be: balance check, checking for tooth or jaw misalignments, clarification of high blood pressure or changes in the cervical spine / shoulder-neck muscles

Therapy for tinnitus

The treatment depends heavily on the individual case. There is no general, clearly effective therapy. Different methods are used.

Is there a new onset of tinnitus (acute tinnitus) with hearing loss, hearing loss is common. Then the examination should be carried out by the ENT doctor within 2 working days if possible. Presumably the doctor will then do the above. Carry out examinations, but postpone therapy for about 1 week. If the hearing loss does not recover within this period, short-term (approx. 1 week) cortisone therapy should be carried out. If hearing normalizes within this period, but the tinnitus remains, cortisone therapy cannot be considered, as cortisone can only affect hearing. The doctor will then discuss the further procedure with you individually, but infusion treatment is no longer indicated today. Incidentally, according to the European Tinnitus Guideline 2019, a subjectively significant increase in loudness in pre-existing tinnitus without hearing loss is not treated with infusions or cortisone.

If the ringing in the ears lasts more than three months, doctors speak of one chronic tinnitus. Here, symptom relief is the primary goal of therapy. Targeted treatment is difficult. Certain behavioral techniques that can be learned can help to change the subjective unpleasant sensation.

The European Tinnitus Guideline 2019 makes a strong recommendation for tinnitus-related behavior therapy. Using behavioral therapy, the patient should learn strategies to cope better with persistent tinnitus. Stress usually makes tinnitus worse. Therefore relaxation techniques such as autogenic training or yoga are also helpful. It is also important that the patient is fully informed that the tinnitus is not threatening, especially in order to avoid senseless therapy attempts. In particular, unreflective research on the Internet (approx. 20 million links) can lead to a multitude of pointless measures as well as more intensive preoccupation with tinnitus to an increase in complaints.

If the tinnitus is accompanied by a hearing disorder, hearing aids are useful. In many cases, tinnitus will decrease as hearing normalizes.

What you can do yourself:

  • learn to deal better with stress factors
  • Learn relaxation exercises
  • distract from tinnitus
  • Identify the trigger
  • Avoid withdrawing
  • to do sports
  • Avoid noise

Rehabilitation measures for tinnitus

In a rehabilitation clinic, tinnitus patients receive therapeutic measures to alleviate and deal with the symptoms of the disease.

Therapeutic offers can be:

  • Behavioral psychotherapy
  • Individual and group discussions
  • psycho-educational thematic groups
  • Coping with tinnitus
  • Coping with fear
  • Coping with depression
  • Confidence training
  • Relaxation training
  • physical therapy
  • occupational therapy offers
  • Social counseling
  • Sports such as cardiovascular training and functional gymnastics

last changed on: 07/31/2019

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