Victor Goodhill

The management of tinnitus

Hearing loss in the elderly is a frequently acknowledged problem. Prevalence of hearing loss clearly increases with age, to as high as 50% of persons older than 70 years.1 Less recognised is an often-related problem, tinnitus. Tinnitus is the perception of sounds that seem to come from the ears or from within the head but which have no external source. The great majority of people experience low-level tinnitus from time to time, but this is not problematic and may not lead to troublesome ear noises. In some people, however, it can become a disturbing phenomenon. Tinnitus is often triggered by intense sound exposure or may be associated with pathological conditions within the cochlea. Tinnitus also might be associated with cardiovascular disorders, and Nondahl, et al. suggested that high total cholesterol might influence tinnitus.2 Some medications commonly taken by older people have been associated with tinnitus, including anti-inflammatories (including aspirin), antibiotics, antidepressants, antihistamines and antihypertensives.3 Considering many of these causes, it would be expected that the incidence of tinnitus would rise with increasing age. Tinnitus can be debilitating, and can be associated with other symptoms such as depression, insomnia, reduced concentration and headache.4 Dauman and Tyler used the terms “normal tinnitus” and “pathological tinnitus” as a classification system.5 We are concerned here with only pathological tinnitus: that which lasts more than five minutes more than once a week. In this article we review the prevalence of tinnitus as a function of age, and its causes and mechanisms. We also describe problems commonly associated with chronic tinnitus and some treatment options. We conclude with some special considerations for the elderly.