Tinnitus and dizziness as signs of damage to the inner ear

Noise in ears - These are auditory sensations observed in the absence of an external sound signal. In most cases, we are talking about subjective tinnitus (only the person himself can hear it), and only sometimes about objective noise (if, for example, the auditory sensation is caused by involuntary muscle vibration, then the doctor can also hear it - using a phonendoscope).

Data on the prevalence of tinnitus vary widely. This is explained precisely by the fact that tinnitus is not recorded objectively. The following experiment was conducted: people who had never complained of tinnitus before were placed in conditions of absolute silence. And 93% of those who took part in the experiment said they heard some kind of noise. On the one hand, we can simply not pay attention to the fact that we have tinnitus, since we live in a constant external sound background (for a city resident, this is a standard situation). On the other hand, in the absence of an external signal, hearing becomes sharper and begins to “read” the noises of the body itself, or the nervous system “makes up” for the missing sounds by generating a signal on its own (at the level of the nervous system this is no longer an acoustic vibration, but an electrochemical process).

Classification of noise in the head and ears

Due to the variety of noise variants, they were classified - combined into groups, common according to the causes of occurrence or characteristics of the course of the disease.

EPFowler (1947) identified two types of tinnitus:

• objective, or vibrator (occurs as a result of vibrations of any parts of the body, exists in reality, can be recorded using a phonendoscope or the use of other diagnostic methods);
• subjective, or non-vibratory (felt by a person, but does not occur in reality, the source of the hum in real life is absent; it cannot be assessed from the outside; it is also called the term “tinnitus”).

In their practice, doctors use a classification of noise based on its cause and distinguish:

• noise of the external, middle ear;
• muscular;
• vascular;
• central;
• peripheral noise.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Depending on the quality characteristics, the following are distinguished:

• one-sided or two-sided;
• pulsating or monotonous;
• arising from time to time or present constantly;
• low-frequency hum or high-frequency squeak, ringing;
• barely noticeable or strong, intense noise.

Incorrect fitting of hearing aids

As a rule, in this case, a person is bothered not so much by noise or hum, but by whistling in the ears. Fortunately, the problem can be solved with proper configuration. And in the Signia line, for example, there are hearing aids with a tinnitus masking function.

Did you know that if a hearing-impaired person has been bothered by extraneous and causeless sounds for a long time, then often it is after setting up the devices that the unpleasant sensations either soften or go away completely. Isn't that right for you? Tell your audiologist about this.

Causes

Noises in a person’s head are not always a symptom of pathology. Many sounds arise in our body during its life - during blood flow, joint movement, contraction and relaxation of muscles. They are masked by other sounds present around us and seem invisible to us, and in conditions of complete silence we can pay attention to them.

However, in most situations, extraneous noise, humming and other sounds in the head or ears are a sign of a pathological condition and a reason to contact a specialist.

Vibrator noise is caused by:

• diseases of the temporomandibular joint;
• neuromuscular diseases (gap of the auditory tube, myoclonus of the muscles of the soft palate, middle ear);
• changes in blood vessels (heart valve defects, narrowing of arteries, problems with veins, arteriovenous shunts).

Subjective noise may be based on:

• metabolic disorders (diabetes mellitus, thyrotoxicosis, hyperglycemia, hypoglycemia, atherosclerosis);
• brain tumors;
• neuroma of the VIII pair of cranial nerves;
• diseases of the hearing organ (cerumen plug, otitis, sensorineural hearing loss, labyrinthitis, neoplasms, Meniere's disease, trauma);
• damage by toxic substances (medicines that have a toxic effect on the organ of hearing, methyl alcohol and others);
• diseases of the spine (degenerative-dystrophic changes, instability and others);
• neurological diseases (acute and chronic cerebrovascular accidents, multiple sclerosis, neurocirculatory (vegetative-vascular) dystonia);
• hypertonic disease;
• mental disorders (neurasthenia and other neurotic disorders, depression, schizophrenia);
• exposure to noise and vibration in production;
• traumatic brain injuries (bruises, contusions).

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

Symptoms of ear congestion

Associated symptoms for various ear diseases:

Cause	Symptoms
Pain	Ear discharge	Itching	Hearing loss	Autophony	Noise	Sensation of fluid transfusion	Manifestations of general intoxication
Sulfur plug	No	No	Not really	Yes	Not really	Not really	No	No
Otitis externa	Yes	Not really	Yes	Yes	Not really	No	No	Not really
Tubootitis	Not really	No	No	Yes	Yes	Not really	No	Not really
Otitis media	Yes	No	No	Yes	Yes	Not really	No	Yes
Suppurative otitis media	Yes	Yes	Not really	Yes	Not really	Not really	No	Yes
Exudative otitis media	No	No	No	Yes	Yes	Not really	Yes	No
Sensorineural hearing loss	No	No	No	Yes	Not really	Yes	No	No

Rumble in my head

It can also be normal if it appears when a person is in a noisy environment (on a street with active traffic, in a crowded place, in a noisy industry) and after returning to a quiet place, it gradually goes away within two hours. Sometimes it appears as a side effect of a number of medications - antidepressants, anticancer drugs, some antibiotics and NSAIDs. It can also occur in the postoperative period during operations on the organ of hearing - in this situation it is a consequence of intervention in the apparatus that conducts sounds, and after a while it goes away on its own.

Increased body temperature

If the noise appears along with an increase in body temperature, an infectious process can be suspected.
In most cases, the body is able to cope with viruses or bacteria on its own. A doctor's help is required in the following cases:

• General weakness has appeared, there is intoxication.
• Symptoms are accompanied by loss of appetite and nausea.
• There is insomnia or drowsiness.
• A headache occurs.
• There are visual impairments.

A sharp increase in body temperature is also considered dangerous - if within 2-3 hours it rises above 38.5 degrees.

You should also consult a doctor if the temperature is low, but lasts longer than 3 days in a row.

Diagnosis and treatment of noise in the head

When this unpleasant symptom appears, you should not waste time doing self-diagnosis, try to cope with it yourself, or hope that “it will pass.” The correct decision for the patient is to seek help from a specialist.

Diagnosis of diseases accompanied by noise in the head is carried out by doctors of various profiles - therapists, otolaryngologists, neurologists, psychotherapists/psychiatrists. But most often, patients with such a problem turn first to a neurologist.

First of all, the doctor’s task is to specify the noise, to understand what exactly the patient feels - a high-frequency squeak, ringing, buzzing, buzzing or hum, one- or two-sided, accompanied by pulsation or not; clarify the intensity of sensations and the symptoms that could accompany them. If the patient does not tell him himself, the doctor will ask leading questions about whether there is hearing loss, congestion in the ears, headache (usually occipital) pain, a tendency to increase or decrease blood pressure, find out what somatic diseases the person seeking his appointment suffers from. Human. Based on these data, the specialist will suggest what type of tinnitus he is dealing with - objective or subjective. Then he will conduct an objective examination - examine the organ of hearing and perform a number of tests necessary to make a diagnosis.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

At the end of this diagnostic stage, the neurologist will make a preliminary diagnosis (or several putative diagnoses) and prescribe further examination to clarify it, in particular:

• general blood and urine analysis;
• blood biochemistry (lipidogram, coagulogram, ferritin);
• duplex or triplex scanning of neck vessels;
• MRI of the brain or cervical spine;
• consultation with an ENT doctor.

The scope of examinations is determined individually, depending on the specific clinical situation.

If a somatic doctor has not established the cause of noise in the head, he will assume the psychogenic nature of this condition and recommend that the patient consult a psychiatrist or psychotherapist. The specialist will have a targeted conversation with the patient, find out what complaints he has, focusing on feelings of anxiety or fear, decreased mood, especially in the morning, sleep disturbances, severe weakness, palpitations, sudden fluctuations in blood pressure, and will clarify whether this condition is permanent or temporary, not Is it related to stress? If a patient is suspected of neurosis, psychosomatic disorder or depression, the doctor will conduct a series of tests to clarify the diagnosis.

Only after the diagnosis has been established is it recommended to begin treatment for noise in the ear and head.

Medicines for noise in the head and ears

Conservative therapy often helps to cope with this symptom. Depending on the manifestation of which disease the noise is, the patient may be prescribed medications from the following groups:

• antibacterial, anti-inflammatory drugs (for infectious and inflammatory diseases of the ear);

• vascular drugs (improve blood circulation, nutrition of brain cells, dilate blood vessels);
• nootropics (improves metabolic processes in the cells of the nervous system);
• B vitamins (improve trophism of nervous tissue);
• trimetazidine (nourishes the heart muscle);
• iron supplements (if the noise is based on iron deficiency anemia);
• betahistine (for noise due to increased pressure in the cochlear labyrinth);
• antidepressants, anti-anxiety drugs, antipsychotics (if the pathology is psychogenic);
• sedatives, hypnotics – if the patient complains, it is not the inability to sleep;
• medications containing caffeine (for a tendency to low blood pressure, severe weakness and other symptoms of asthenia).

If the cause of the disease is cerumen, the doctor will wash it out of the ear and the noise will disappear.

Surgery

With confirmed damage to the autonomic nervous system, non-vibratory tinnitus can be eliminated by surgical intervention in the area of ​​the nerves of the tympanic cavity or cervical sympathetic nodes.

Surgery on damaged structures of the tympanic cavity or cochlea will help get rid of objective noise.

Other treatment methods

As auxiliary methods of therapy, the patient may be prescribed:

• wearing a hearing aid, electrical stimulation of the auditory nerve (with decreased hearing acuity);

• physical therapy;
• massage;
• physiotherapy;
• psychotherapy.

Inflammation

Inflammatory causes of ear congestion:

• external otitis of any etiology (fungal, bacterial, viral);
• eustacheitis (tubootitis);
• catarrhal otitis media, bullous otitis (with influenza);
• purulent otitis media (including chronic);
• exudative otitis;
• adhesive otitis media

With inflammation in the nasal cavity, paranasal sinuses or pharynx, swelling of the nasopharyngeal mouth of the auditory tube occurs, due to which the pressure in the tympanic cavity and the environment ceases to equalize, and the drainage function of the auditory tube is disrupted. The infectious agent, together with the discharged contents from the nasal cavity and paranasal (paranasal) sinuses, enters the auditory tube and tympanic cavity, causing inflammation of the auditory tube - eustacheitis (tubo-otitis) and otitis media.

Due to inflammation, swelling of the mucous membrane of the middle ear and eardrum occurs, sound-conducting mechanisms stop working normally, and ear congestion occurs, and hearing decreases. A common cause of dysfunction of the auditory tube and the development of otitis in children is hypertrophy of the nasopharyngeal tonsil and adenoiditis. In adults, vasomotor and allergic rhinitis and deviated septum are common causes of swelling at the mouth of the auditory tube. The cause may also be a violation of blood circulation and innervation in the inner ear.

With inflammation in the external auditory canal, swelling of its walls appears, fungal or purulent masses clog the ear canal, and the surface layers of the eardrum become inflamed (myrinigitis). Because of this, the mobility of the eardrum, necessary for proper sound transmission, is reduced.

Most of the described forms of otitis often occur as complications of acute respiratory diseases, sinusitis, rhinitis, especially in the case of improper cleansing of the nasal cavity. In addition to the feeling of congestion during otitis media, shooting, sharp or aching pains, hearing problems, bloody, fungal, purulent discharge, itching, a feeling of pulsation or fluid transfusion in the ear can be added.

A feeling of ear fullness also occurs when:

• water getting into the ears (usually when swimming), the water usually evacuates on its own and does not require intervention;
• when a cerumen or epithelial plug forms (can also occur after water gets into the ear due to swelling of the cerumen plug);
• foreign bodies getting into the ears: insects, earbuds, cotton wool from cosmetic sticks, etc.

After eliminating the provoking factor, the discomfort disappears and hearing is restored.

How to relieve an attack of severe noise in the head and ears

Treatment for severe head noise depends on its cause. If it occurs suddenly, is intense, is accompanied by vomiting, severe pain, heaviness in the head, dizziness, significantly worsens the person’s condition, and it is dangerous to fight it on your own - it is important to call an ambulance as quickly as possible.

Shpidonov Gennady Stanislavovich

Neurologist

Rostov State Medical University (neurology)

10 years of experience

If it is a sign of chronic pathology, is already familiar to you, and is not the first time it has appeared, you can try to cope with the noise using the following self-help methods:

• taking a relaxing bath;
• a full eight-hour sleep (on a comfortable mattress with a comfortable pillow, in a dark room, in silence);
• physical activity (such as yoga or jogging in the park);
• listening to calm music.

Some people are helped to eliminate noise by so-called “masking” - listening to a pleasant, soothing sound (such as the splashing of waves, the murmur of a stream, the chirping of birds) directly in nature, using an audio recording or a special device.

Ringing degrees

Despite the difficulty of assessing the intensity of tinnitus, this symptom can be determined by the degree of noise intensity. Russian otorhinolaryngology has developed its own classification of noise intensity, thanks to Academician of the Russian Academy of Sciences I.B. Soldatov. This classification includes 4 degrees of tinnitus intensity and reflects the practical significance of this symptom.

1. Degree. At this degree, the patient easily tolerates noise, it does not affect the general condition and well-being of the patient and is noted only in the quietest conditions.
2. Degree. The patient experiences frequent distractions by noise in quiet areas or at night. In some cases, there is difficulty going to bed.
3. Ringing in the ears constantly bothers the patient, as a result of which the patient’s behavior is disrupted. He becomes irritable, the emotional background is constantly tense.
4. The patient experiences unbearable noise, which almost completely deprives him of sleep and makes daily activities difficult. The patient's ability to work is significantly reduced.

This classification, despite all the subjectivity, allows you to most effectively assess the severity and degree of ringing in the ears, which turns out to be very valuable in the rational planning of treatment measures and the elimination of this symptom.

Prevention of pulsating noise in the head

The noise that occurs in the pulse rhythm is characteristic of vascular pathology of the brain. It can be prevented by a person’s attentive attitude to his health throughout his life - quitting smoking, regular exercise, adherence to a work and rest schedule, a nutritious, balanced diet, blood pressure control, timely medical examinations and treatment of vascular diseases that have arisen in the early stages. If these diseases already exist, following the recommendations described above will help reduce the intensity of the hum, alleviate it, which will improve the person’s quality of life.

If pulsating noise appears in the head only in certain situations (under stress, when working at the computer), its prevention will be to minimize exposure to situations that provoke deterioration of the condition.

Basic treatment regimens for ear pathology*

Pathology	Basic treatment methods
Sulfur plug	Removal by rinsing or instrumental removal.
Otitis externa	Toilet of the external auditory canal, treatment with medications, ear drops, vasoconstrictor nasal sprays, systemic antibacterial or antifungal therapy, FTL**.
Tubootitis	Vasoconstrictor nasal sprays, blowing of the eustachian tubes according to Politzer, pneumomassage of the eardrum, FTL**, catheterization of the auditory tubes if necessary.
Otitis media	Vasoconstrictor nasal sprays, systemic antibacterial therapy, ear drops, Politzer ear blowing, pneumomassage of the eardrum, FTL**, if necessary, catheterization of the auditory tubes, lavage of the nasal cavity using the moving method. If necessary, surgical treatment - eardrum bypass or paracentesis. Complemented by the treatment of diseases of the ENT organs.
Suppurative otitis media	Vasoconstrictor nasal sprays, systemic antibacterial therapy, ear drops, Politzer blowing, if necessary, transtympanic injection of drugs, catheterization of auditory tubes, nasal lavage using the displacement method. If necessary, surgical treatment - eardrum bypass or paracentesis and other operations, FTL**. It is supplemented by treatment of pathologies of the nasal cavity, nasopharynx and paranasal sinuses, if indicated.
Exudative otitis media	Vasoconstrictor nasal sprays, mucolytics, Politzer blowing, catheterization of auditory tubes. If necessary, surgical treatment - eardrum bypass or paracentesis, FTL**. It is complemented by the treatment of pathologies of the nasal cavity, nasopharynx and paranasal sinuses.
Sensorineural hearing loss	Catheterization of auditory tubes, systemic vascular and vitamin therapy.

*These treatment regimens are not a recommendation for self-treatment and serve to familiarize patients with basic treatment methods. The final decision on treatment and examination methods is made by the doctor after the examination!

** FTL – physiotherapeutic treatment.