Tinnitus: yes, you can take action!

Although tinnitus cannot always be cured, the way these sounds, audible only in the ear or head of the person affected, are managed has evolved considerably. A specialist assessment and solutions tailored to each situation can help reduce their impact and improve quality of life. MonacoSanté keeps you informed.

What is it?

Whistling, buzzing, pressure-cooker hisses, clicking or even heartbeat-like thumping: tinnitus refers to sounds that occur suddenly or gradually. They can be perceived in one ear, in both, or in the head, without originating from any external source and without any way of stopping them. Tinnitus affects men and women alike, most commonly between the ages of 50 and 55. Its frequency increases with age and with declining hearing. According to data from Santé Publique France, it is thought to affect between 10% and 19% of adults. In all cases, these are phantom sounds that can cause moderate to severe discomfort. Their intensity can also vary depending on the circumstances and the time of day. "But resignation should not be the answer", insists Dr Pierre Lavagna, an ear, nose and throat (ENT) surgeon and founder of the Otoneuro clinic in Monaco. "Too often, patients with tinnitus are told that it's all in their head and that nothing can be done, when this is simply not true. Healthcare professionals have a duty to move away from this negative mindset." The otoneurologist stresses that the diversity of these sound perceptions must be examined rigorously in order to identify ways of easing them.

Disabling effects

Whether it occurs spontaneously or as a result of an ear condition, tinnitus has characteristics that vary from one individual to another . "There is not one type of tinnitus, but several", notes the healthcare professional. "75% of patients have whistling tinnitus of stable intensity, 12% describe fluctuating buzzing, and 3% experience clicking of random intensity. Finally, so-called 'pulsatile' tinnitus accounts for 3% to 5% of cases", explains Dr Cécile Puel, an ENT specialist who recently visited the Principality to present these symptoms at a symposium for specialists in the field. Some people also report more complex sounds, likened to music or voices, which mainly occur in the evening, as fatigue sets in. Their impact can be particularly disabling. "Anxiety does not cause tinnitus. However, having it makes you anxious and can lead to depression", explains Professor Jean-Luc Puel, a neuroscience professor who was also a guest at this scientific symposium. Other consequences are possible, including difficulty falling asleep, insomnia, problems understanding speech, particularly in noisy environments, and difficulty concentrating.

The causes are varied

Consulting a specialist is an essential step: "Above all, you need to listen to the patient, give them the opportunity to describe their symptoms, and work with them to assess how this affects their daily life. You then need to offer a considered and realistic treatment plan, without promising the impossible, that is, the complete disappearance of tinnitus, but above all helping them understand that we can help them live better with it", stresses Dr Lavagna. In around 90% of cases, strong>tinnitus is associated with hearing loss , even a very mild one. This can be detected using advanced tests, such as speech-in-noise audiometry or high-frequency testing. However, identifying the causes requires an in-depth assessment that goes beyond hearing alone. "The ENT specialist carries out a comprehensive examination, from the ear right through to the brain, while also looking at the patient's environment: exposure to medication or chemical substances that may damage the structures of the inner ear, noise exposure, diet, lifestyle habits, emotional stress factors or muscular tension." The causes may therefore be linked to peripheral ENT conditions, such as an earwax blockage or an ear infection. They may also stem from presbycusis, the gradual and natural decline in hearing associated with ageing, Ménière's disease, a chronic inner ear condition causing vertigo" target="_blank">vertigo, buzzing and hearing loss, or the after-effects of acoustic trauma. They may also be linked to general or neurological factors, such as fluctuations in blood pressure, metabolic disorders, the after-effects of a stroke or certain neurodegenerative diseases.

How to choose the right treatment

Thanks to this comprehensive assessment, tailored, multidisciplinary care can be offered to help reduce discomfort and improve quality of life. Five types of treatment are currently recommended: hearing and sound-based therapy , using a personalised device fitted by a hearing aid audiologist; cognitive behavioural approaches; medication; somatosensory treatment; and bimodal neurostimulation. Because the mechanism behind tinnitus is identical to that of pain, Dr Gérald Fain, an ENT specialist at Otoneuro, may, for example, prescribe medication for between 15 days and six weeks, drawing on seven different families of molecules, depending on the level of discomfort and any associated treatments. These medications, however, are unsuitable during pregnancy and must be stopped if muscle pain or itching occurs. "It's true that it's a battle, but in 80% of cases, we manage to bring our patients relief." In exceptional cases, treatment can even be continued indefinitely, provided blood and kidney test results remain satisfactory. Dr Philippe Peignard, a psychotherapist who also contributed to the scientific symposium, uses cognitive behavioural therapy. The aim is to regulateauditory salience, that is, a sound that stands out from its surrounding acoustic environment and naturally captures our attention, as well as to reduce intolerance to it. "We see an improvement in discomfort in 70% of patients." Finally, Dr Lavagna is the only healthcare professional accredited in Monaco and France to offer bimodal neurostimulation, "an innovative treatment that appears promising in light of the results of the initial studies carried out to assess its effectiveness". It acts on "the abnormal activation of the brain's auditory areas caused by tinnitus, making it possible to reprogramme them". For patients for whom no treatment works, simply having their suffering acknowledged is often a positive first step. "Even when treatment is unsuccessful, patients are grateful to us for taking care of them and taking them seriously. But this requires us to be available to address their many concerns, because some patients don't need treatment at all: they mainly come to be reassured and to understand what is happening", concludes Dr Pierre Lavagna.