Sjogren's Syndrome info

Tinnitus

On this page:

What is tinnitus?

Tinnitus is commonly described as a ringing in the ears, but it also can sound like roaring, clicking, hissing, or buzzing. It may be soft or loud, high pitched or low pitched. You might hear it in either one or both ears. Roughly 10 percent of the adult population of the United States has experienced tinnitus lasting at least five minutes in the past year. This amounts to nearly 25 million Americans.

What causes tinnitus?

Tinnitus (pronounced tin-NY-tus or TIN-u-tus) is not a disease. It is a symptom that something is wrong in the auditory system, which includes the ear, the auditory nerve that connects the inner ear to the brain, and the parts of the brain that process sound. Something as simple as a piece of earwax blocking the ear canal can cause tinnitus. But it can also be the result of a number of health conditions, such as:

  • Noise-induced hearing loss
  • Ear and sinus infections
  • Diseases of the heart or blood vessels
  • Ménière’s disease
  • Brain tumors
  • Hormonal changes in women
  • Thyroid abnormalities

Tinnitus is sometimes the first sign of hearing loss in older people. It also can be a side effect of medications. More than 200 drugs are known to cause tinnitus when you start or stop taking them.

People who work in noisy environments—such as factory or construction workers, road crews, or even musicians—can develop tinnitus over time when ongoing exposure to noise damages tiny sensory hair cells in the inner ear that help transmit sound to the brain. This is called noise-induced hearing loss.

Service members exposed to bomb blasts can develop tinnitus if the shock wave of the explosion squeezes the skull and damages brain tissue in areas that help process sound. In fact, tinnitus is one of the most common service-related disabilities among veterans returning from Iraq and Afghanistan.

Pulsatile tinnitus is a rare type of tinnitus that sounds like a rhythmic pulsing in the ear, usually in time with your heartbeat. A doctor may be able to hear it by pressing a stethoscope against your neck or by placing a tiny microphone inside the ear canal. This kind of tinnitus is most often caused by problems with blood flow in the head or neck. Pulsatile tinnitus also may be caused by brain tumors or abnormalities in brain structure.

Even with all of these associated conditions and causes, some people develop tinnitus for no obvious reason. Most of the time, tinnitus isn’t a sign of a serious health problem, although if it’s loud or doesn’t go away, it can cause fatigue, depression, anxiety, and problems with memory and concentration. For some, tinnitus can be a source of real mental and emotional anguish.

Why do I have this noise in my ears?

Although we hear tinnitus in our ears, its source is really in the networks of brain cells (what scientists call neural circuits) that make sense of the sounds our ears hear. A way to think about tinnitus is that it often begins in the ear, but it continues in the brain.

Scientists still haven’t agreed upon what happens in the brain to create the illusion of sound when there is none. Some think that tinnitus is similar to chronic pain syndrome, in which the pain persists even after a wound or broken bone has healed.

Tinnitus could be the result of the brain’s neural circuits trying to adapt to the loss of sensory hair cells by turning up the sensitivity to sound. This would explain why some people with tinnitus are oversensitive to loud noise.

Tinnitus also could be the result of neural circuits thrown out of balance when damage in the inner ear changes signaling activity in the auditory cortex, the part of the brain that processes sound. Or it could be the result of abnormal interactions between neural circuits. The neural circuits involved in hearing aren’t solely dedicated to processing sound. They also communicate with other parts of the brain, such as the limbic region, which regulates mood and emotion.

What should I do if I have tinnitus?

The first thing is to see your primary care doctor, who will check if anything, such as ear wax, is blocking the ear canal. Your doctor will ask you about your current health, medical conditions, and medications to find out if an underlying condition is causing your tinnitus.

If your doctor cannot find any medical condition responsible for your tinnitus, you may be referred to an otolaryngologist (commonly called an ear, nose, and throat doctor, or an ENT). The ENT will physically examine your head, neck, and ears and test your hearing to determine whether you have any hearing loss along with the tinnitus. You might also be referred to an audiologist who can also measure your hearing and evaluate your tinnitus.

What if the sounds in my ear do not go away?

Some people find their tinnitus doesn’t go away or it gets worse. In some cases it may become so severe that you find it difficult to hear, concentrate, or even sleep. Your doctor will work with you to help find ways to reduce the severity of the noise and its impact on your life.

Are there treatments that can help me?

Tinnitus does not have a cure yet, but treatments that help many people cope better with the condition are available. Most doctors will offer a combination of the treatments below, depending on the severity of your tinnitus and the areas of your life it affects the most.

  • Hearing aids often are helpful for people who have hearing loss along with tinnitus. Using a hearing aid adjusted to carefully control outside sound levels may make it easier for you to hear. The better you hear, the less you may notice your tinnitus. Read the NIDCD fact sheet Hearing Aids for more information.
  • Counseling helps you learn how to live with your tinnitus. Most counseling programs have an educational component to help you understand what goes on in the brain to cause tinnitus. Some counseling programs also will help you change the way you think about and react to your tinnitus. You might learn some things to do on your own to make the noise less noticeable, to help you relax during the day, or to fall asleep at night.
  • Wearable sound generators are small electronic devices that fit in the ear and use a soft, pleasant sound to help mask the tinnitus. Some people want the masking sound to totally cover up their tinnitus, but most prefer a masking level that is just a bit louder than their tinnitus. The masking sound can be a soft “shhhhhhhhhhh,” random tones, or music.
  • Tabletop sound generators are used as an aid for relaxation or sleep. Placed near your bed, you can program a generator to play pleasant sounds such as waves, waterfalls, rain, or the sounds of a summer night. If your tinnitus is mild, this might be all you need to help you fall asleep.
  • Acoustic neural stimulation is a relatively new technique for people whose tinnitus is very loud or won’t go away. It uses a palm-sized device and headphones to deliver a broadband acoustic signal embedded in music. The treatment helps stimulate change in the neural circuits in the brain, which eventually desensitizes you to the tinnitus. The device has been shown to be effective in reducing or eliminating tinnitus in a significant number of study volunteers.
  • Cochlear implants are sometimes used in people who have tinnitus along with severe hearing loss. A cochlear implant bypasses the damaged portion of the inner ear and sends electrical signals that directly stimulate the auditory nerve. The device brings in outside sounds that help mask tinnitus and stimulate change in the neural circuits. Read the NIDCD fact sheet Cochlear Implants for more information.
  • Antidepressants and antianxiety drugs might be prescribed by your doctor to improve your mood and help you sleep.
  • Other medications may be available at drugstores and on the Internet as an alternative remedy for tinnitus, but none of these preparations has been proved effective in clinical trials.

Can I do anything to prevent tinnitus or keep it from getting worse?

Noise-induced hearing loss, the result of damage to the sensory hair cells of the inner ear, is one of the most common causes of tinnitus. Anything you can do to limit your exposure to loud noise—by moving away from the sound, turning down the volume, or wearing earplugs or earmuffs—will help prevent tinnitus or keep it from getting worse.

What are researchers doing to better understand tinnitus?

Along the path a hearing signal travels to get from the inner ear to the brain, there are many places where things can go wrong to cause tinnitus. If scientists can understand what goes on in the brain to start tinnitus and cause it to persist, they can look for those places in the system where a therapeutic intervention could stop tinnitus in its tracks.

In 2009, the National Institute on Deafness and Other Communication Disorders (NIDCD) sponsored a workshop that brought together tinnitus researchers to talk about the condition and develop fresh ideas for potential cures. During the course of the workshop, participants discussed a number of promising research directions, including:

  • Electrical or magnetic stimulation of brain areas involved in hearing. Implantable devices already exist to reduce the trembling of Parkinson’s disease and the anxieties of obsessive-compulsive disorder. Similar devices could be developed to normalize the neural circuits involved in tinnitus.
  • Repetitive transcranial magnetic stimulation (rTMS). This technique, which uses a small device placed on the scalp to generate short magnetic pulses, is already being used to normalize electrical activity in the brains of people with epilepsy. Preliminary trials of rTMS in humans, funded by the NIDCD, are helping researchers pinpoint the best places in the brain to stimulate in order to suppress tinnitus. Researchers are also looking for ways to identify which people are most likely to respond well to stimulation devices.
  • Hyperactivity and deep brain stimulation. Researchers have observed hyperactivity in neural networks after exposing the ear to intense noise. Understanding specifically where in the brain this hyperactivity begins and how it spreads to other areas could lead to treatments that use deep brain stimulation to calm the neural networks and reduce tinnitus.
  • Resetting the tonotopic map. Researchers are exploring how to take advantage of the tonotopic map, which organizes neurons in the auditory cortex according to the frequency of the sound to which they respond. Previous research has shown a change in the organization of the tonotopic map after exposing the ear to intense noise. By understanding how these changes happen, researchers could develop techniques to bring the map back to normal and relieve tinnitus.

Where can I find additional information about tinnitus?

The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.

Use the following keywords to help you find organizations that can answer questions and provide information on tinnitus:

Prevalence of Chronic Tinnitus: Chart

This figure shows age and sex-specific trends in chronic tinnitus, i.e., ringing, roaring, or buzzing in the ears or head that has lasted for 3 months or longer in the past year. 
This information was collected in household interviews conducted as part of the 1994–1995 Disability Supplement to the U.S. National Health Interview Survey; the data are self-reported and exclude proxy responses. 
The overall trend with age shows a marked increase for both sexes, beginning about age 40, peaking between 65 to 79 years, and then declining after 80 years of age.

Study on tinnitus shows it is in many parts of the brain.

In this study, the researchers contrasted brain activity during periods when tinnitus was relatively stronger and weaker. They found the expected tinnitus-linked brain activity, but they report that the unusual activity extended far beyond circumscribed auditory cortical regions to encompass almost all of the auditory cortex, along with other parts of the brain.

The discovery adds to the understanding of tinnitus and helps to explain why treatment has proven to be such a challenge, the researchers say.

“The sheer amount of the brain across which the tinnitus network is present suggests that tinnitus may not simply ‘fill in the gap’ left by hearing damage, but also actively infiltrates beyond this into wider brain systems,” Phillip Gander adds.

Phillip Gander, postdoctoral research scholar in the University of Iowa Department of Neurosurgery.

SOURCE: In search of tinnitus, that phantom ringing in the ears




TINNITUS and SJOGREN'S
Tinnitus, or ringing in the ears, also occurs more frequently in patients with Sjögren’s.  In patients with sensorineural hearing loss, tinnitus also frequently occurs.  However, even Sjögren’s patients with normal hearing complain of tinnitus.  The reason for this in unknown.  

While most patients are able to live with the tinnitus, some patients will suffer so greatly that more aggressive treatment such as tinnitus maskers or biofeedback may be necessary.

The Sjögren's Society of Canada

Audiovestibular Symptoms in Systemic Autoimmune Diseases

Vestibular symptoms, tinnitus, and aural fullness can be found in patients with systemic autoimmune diseases; they often mimic primary inner ear disorders such as Menière's disease and mainly affect both ears simultaneously.
Sensorineural hearing loss as the first manifestation of Sjögren's syndrome. 

Dysfunction of inner ear, vestibulocochlear nerve or central brain processing centers leads to sensorineural hearing loss (SNHL). 

Autoimmune inner ear disease (AIED) is a rare but potentially treatable cause of hearing loss, characterized by progressive evolution over weeks to months.

AIED is a diagnosis of exclusion, supported by clinical suspicion and responsiveness to corticosteroids.

It is secondary to an autoimmune disease in one third of the cases.

Neurologic Complications Associated with Sjögren’s Disease: Case Reports 

Sjögren’s syndrome (SS) may be complicated by some neurological manifestations, generally sensory polyneuropathy. 
Furthermore, involvement of cranial nerves was described as rare complications of SS.
Tinnitus (VIII Cranial Nerve) 
An exhaustive revision of the literature was done by including all case reports and case series of SS patients with cervical-cranial neuritis present in the PubMed database prior to 2014.

Neuropathy of the cochlear nerve is rarely reported in the literature.

READ FULL ARTICLE

Conditions that have been linked to tinnitus include the onset of a sinus infection, autoimmune disorders such as Sjogren's,  Vestibular Disorders such as Ménière's Disease,Thoracic Outlet Syndrome, and Otosclerosis, high blood pressure, some medications,
hormonal changes, diabetes, fibromyalgia, Lyme disease, allergies, depletion of cerebrospinal fluid, vitamin deficiency, and exposure to lead. 

Alcohol or caffeine or salt can aggravate tinnitus in some people.

Audiovestibular Symptoms in Systemic Autoimmune Diseases

Primary Sjögren’s syndrome (pSS) is a chronic autoimmune disease characterized by xerostomia and xerophthalmia due to lymphocyte infiltration of both salivary and lacrimal glands. 

It may also occur as a systemic disease involving the kidneys, lungs, liver, vessels, and lymph nodes. pSS mainly affects women in the fourth-fifth decade of life, and presenting symptoms are often oral and ocular. In this context, autoantibodies to cardiolipin and M3 muscarinic receptors (mAchRs) in the serum of pSS patients are suspected to play a pathogenic role in the onset of progressive hearing loss and neurological complications.

Audiovestibular involvement in patients with pSS has been reported in the literature with a prevalence ranging from 22% to 46%. reported in a pSS patient the presence of SNHL affecting preferentially high frequencies. Tumiati et al. [106] reported SNHL in 46% (14/30) of patients with pSS. Ziavra et al. [107] diagnosed SNHL in 22.5% (9/40) of pSS patients. Hearing loss as presenting complaint in pSS is quite uncommon and only limited to case reports [22]; SSNHL was recently reported in a 62-year-old female treated with high-dose methylprednisolone (250 mg) infusion for 5 days with successful hearing restoration.

The high prevalence of cranial neuropathies is a known condition in pSS, mainly with trigeminal and facial nerve involvement.

Although pSS patients tend to have a higher prevalence of SNHL compared to the general population, no evidence of damage to the central auditory pathways was reported. 

However,the prevalence of audiovestibular symptoms in pSS might be underestimated, suggesting that their association with pSS was not previously made because it had not been actively sought.

  • Pain in one or both ears.
  • Dizziness or vertigo.
  • Ringing in the ears, called tinnitus.
  • Pressure or fullness in one or both ears.
WebMD








Sjögren’s syndrome: an autoimmune disorder with otolaryngological involvement



Approximately one-fourth patients suffers from high frequency hearing loss of cochlear origin, as detected by impedance audiometry or auditory brainstem procedures. Deposition of autoantibodies in the antigenic sites of the inner-ear structures and autoreactive T-cells has been implicated in the pathogenesis of this hearing loss. Several issues, however, remain to be elucidated including the relative predominance of B and T cells in the inner-ear structures as well as the identity of the putative inner-ear self-antigen(s).