Tinnitus: Symptoms, Causes, and Treatment

Hello. This is Miaoll Korean Medicine Clinic, Incheon Songdo Branch. Today, we will discuss tinnitus. Tinnitus is also known as ear ringing. It refers to a condition where various sounds, such as a "ringing" or "buzzing" sound, are perceived in the ear, disrupting daily life. Generally, tinnitus is a symptom rather than a disease, and thus can arise from various causes. It is also a symptom that healthy individuals occasionally experience. However, if the symptoms are severe enough to interfere with daily life, appropriate treatment is necessary.

Classification of Tinnitus by Cause

McCombe, A., Baguley, D., Coles, R., McKenna, L., McKinney, C., & Windle-Taylor, P. (2001). Guidelines for the grading of tinnitus severity: the results of a working group commissioned by the British Association of Otolaryngologists, Head and Neck Surgeons, 1999. Clinical Otolaryngology and Allied Sciences, 26(5), 388–393. doi:10.1046/j.1365-2273.2001.00490.x

Tinnitus is classified into various types depending on its cause.

Medication History Also Needs to be Checked

Tinnitus can appear as a side effect of over 130 different medications. Therefore, if tinnitus has developed relatively recently and there is a history of medication use, it is necessary to check for drug intake. The table above presents medications, including analgesic anti-inflammatory drugs and antibiotics, that can cause tinnitus.

Various Tinnitus Sounds

The sounds that can appear during ear ringing are highly varied. They can manifest as various sounds, such as a high-pitched whine, a sharp ringing, the sound of a kettle boiling, cicada chirping, TV static, mechanical noises, vacuum cleaner sounds, or ocean waves. You can find examples of sounds that can occur with tinnitus by visiting the address above.

Tinnitus Assessment and Questionnaire Tools

Objective tinnitus, which can be objectively confirmed by a physician, is quite rare (within 5%). Since most tinnitus symptoms are subjective, assessment can be quite challenging. It is difficult to actually confirm the sounds perceived by the patient.

Among the representative tinnitus assessment questionnaire tools is the THI (Tinnitus Handicap Inventory). It consists of 25 questions, and a simplified version is also often used. THI Korean Translated Version

Each item is scored as No (0 points), Sometimes (2 points), or Yes (4 points), and the total score is used to classify tinnitus into grades 1, 2, 3, 4, and 5. Tinnitus severity is assessed based on the score as follows:

• 0-16: slight
• 18-36: mild
• 38-56: moderate
• 58-76: severe
• 78-100: catastrophic

The simplified version of THI sometimes uses only questions 1, 8, 10, 12, 18, 20, 21, 22, and 23. Reference: Link

Considerations for Tinnitus Patients

When taking a medical history from tinnitus patients, the following factors should be considered: Duration of tinnitus, sound characteristics, number of sounds, specific patterns, subjective loudness, time of day tinnitus is perceived, and VAS (Visual Analogue Scale) for distress caused by tinnitus.

It is often accompanied by depression or anxiety, so these are also evaluated together. There is a significantly high correlation between depression, anxiety, and tinnitus. Patterns of anxiety and depression can heighten nervous sensitivity, making tinnitus feel more severe. Conversely, worsening tinnitus can lead to chronic anxiety and depression. There is a great deal of mutual influence between them.

In tinnitus treatment, considering neuropsychiatric symptoms such as anxiety and depression and combining appropriate treatments helps lead to a positive treatment outcome.

Tinnitus Treatment

There are various treatments for tinnitus, including sound therapy, pharmacotherapy, and relaxation-meditation therapy, but there are also many cases where treatment is not very effective. Particularly in cases where tinnitus has been present for a long time or where symptoms are very severe, we often observe a significantly reduced treatment response.

In traditional Korean medicine, the causes of tinnitus are categorized into "deficiency" (허) and "excess" (실) for treatment, and it is also recognized as important to restore the balance of body and mind. Accordingly, treatment aims to alleviate symptoms by combining various therapies in the craniofacial region, including acupuncture, pharmacopuncture, and manual therapy, to help improve circulation in the craniofacial area and normalize the function of auditory organs.

For tinnitus caused by structural abnormalities in the craniofacial and cervical regions, such as cervicogenic tinnitus or temporomandibular joint disorder (TMJ disorder), physical therapy and self-exercises can help alleviate symptoms. Reference: Link