OVERVIEW

What is neurological tinnitus?

Currently, neurological tinnitus is believed to be caused by abnormal activity in the auditory cortex of the brain that processes sound. It mainly manifests as sounds perceived by the patient's ears or head without external sound stimulation, such as ringing, buzzing, clicking, pulsating sounds, or other noises.

Neurological tinnitus can occur on one or both sides of the head, and this sensation may originate from inside or outside the skull.

There are no medications with definitive efficacy for neurological tinnitus, but clinical symptoms can be improved through sound therapy and cognitive behavioral therapy. Patients with hearing loss may use hearing aids to enhance their quality of life.

Neurological tinnitus is not a severe condition, and its impact varies from person to person. Persistent tinnitus can cause distress in patients' lives.

Are there many patients with neurological tinnitus?

Yes.

Statistics show that in the United States, 25.3% of the population has experienced tinnitus, while 7.9% frequently experience it (often or at least once daily). This proportion may be underestimated, as only 10%–15% of patients seek medical treatment for persistent tinnitus.

Currently, there is no epidemiological survey on neurological tinnitus in China.

Is neurological tinnitus caused by nerve inflammation?

Nerve inflammation can lead to tinnitus, but tinnitus is not equivalent to nerve inflammation.

SYMPTOMS

What are the symptoms of neurological tinnitus?

• Tinnitus: Annoying tinnitus refers to those that cause distress to patients, affecting their quality of life and/or health status. As a result, patients often actively seek treatment and intervention strategies to alleviate tinnitus.

• Ear pain: Acute otitis media may cause persistent dull ear pain or occasional sharp pain, while chronic otitis media patients usually experience less noticeable ear pain.

What harm (complications) can neurological tinnitus cause to patients?

In addition to potentially affecting hearing, tinnitus can significantly impact a patient's quality of life. While most patients experience only mild effects, some may feel anxious, depressed, or even undergo major life changes.

Tinnitus may also affect a patient's cognitive functions, such as difficulty concentrating. Other common impacts include insomnia, social phobia, and adjustment disorders (maladaptive reactions to one or more stressors).

CAUSES

What are the possible causes of neural tinnitus?

• Common causes include presbycusis, ototoxic drugs (such as high-dose aspirin), noise exposure, Ménière's disease, etc.

• Some cases may be related to auditory neuropathy.

• It can occur after labyrinth or auditory nerve surgery, or be triggered by factors like stress.

• Other common causes include tumors, inflammation, etc.

Which groups are more prone to neural tinnitus?

• The incidence of tinnitus increases with age, peaking in the 60-69 age group at 31.8%.

• Higher incidence is observed in males, non-Hispanic whites, individuals with a BMI ≥ 30 kg/m², or those with conditions like hypertension, diabetes, hyperlipidemia, or anxiety disorders.

• Patients with a history of gunfire, occupational, or recreational noise exposure have a higher incidence of tinnitus.

DIAGNOSIS

What tests are needed to diagnose neurological tinnitus?

Diagnosing tinnitus requires ruling out ear or other conditions that may cause it. Possible tests include hearing tests, vestibular function tests, otoscopy, psychological assessments, head CT or MRI scans, etc.

TREATMENT

What medications can be used for neurogenic tinnitus?

Currently, there are no definitive medications to alleviate tinnitus. Some drugs (such as gabapentin, lidocaine, clonazepam, carbamazepine, ginkgo extract, etc.) and certain dietary supplements (such as bioflavonoids, garlic, homeopathy, etc.), as well as various vitamins and minerals, have been used for tinnitus treatment. However, these methods lack high-level evidence support and may cause adverse reactions, so guidelines do not recommend their routine use.

For patients with complications, such as tinnitus-related anxiety or depression, active management should be provided. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine, or benzodiazepines, such as alprazolam, may be used.

Is acupuncture effective for neurogenic tinnitus?

Currently, acupuncture is generally considered a relatively safe treatment when performed by experienced practitioners, but its effectiveness for tinnitus remains uncertain. Existing randomized controlled trials on acupuncture for tinnitus are limited in number, with small sample sizes and methodological flaws, making the evidence insufficient to draw conclusions about its efficacy.

Therefore, guidelines recommend that acupuncture should not be used as a routine treatment for tinnitus.

Is transcranial magnetic stimulation (TMS) effective for neurogenic tinnitus patients?

Transcranial magnetic stimulation (TMS) is a technique that stimulates specific areas of the brain through the scalp and was first used in humans in 1985. Repetitive transcranial magnetic stimulation (rTMS) is one such method, capable of inducing prolonged excitation or inhibition of the cerebral cortex.

Some studies have shown improvement in tinnitus after rTMS treatment, while others have found no sustained suppression of tinnitus or improvement in patients' quality of life. The results of various studies are contradictory.

Therefore, until more definitive evidence is obtained, guidelines do not recommend TMS as a routine treatment for tinnitus.

Is sound therapy effective for neurogenic tinnitus?

Sound therapy for neurogenic tinnitus refers to the use of any sound to alter the perception of tinnitus and/or the response to it, thereby benefiting the patient. Sound therapy often requires the assistance of devices, such as hearing aids, sound generators, or environmental sound optimization devices.

Sound therapy can alleviate tinnitus symptoms and reduce emotional distress caused by tinnitus.

Thus, guidelines recommend that clinicians may offer sound therapy to patients with persistent bothersome tinnitus.

When do neurogenic tinnitus patients need hearing aids?

Hearing aids can improve patients' quality of life by addressing hearing loss and reducing focus on tinnitus.

Guidelines recommend that patients with hearing loss and bothersome tinnitus should undergo hearing aid evaluation and consider using hearing aids.

Why should neurogenic tinnitus patients undergo cognitive behavioral therapy (CBT)?

Cognitive behavioral therapy involves guiding patients to recognize stress-inducing negative thoughts and transform them into beneficial ones.

For example, a tinnitus patient might think, "I can't sleep well because the tinnitus is too loud and disturbing." This thought may lead to behaviors like avoiding sleep and feelings of pessimism ("Why am I so unlucky?").

Through CBT, the patient may adopt a different perspective: "The tinnitus might be loud, but it doesn’t prevent me from sleeping." This leads to a change in behavior—sleeping peacefully. By altering their perception of the condition, their behavior changes, resulting in a different outcome.

A series of studies have shown that CBT is beneficial for tinnitus treatment.

Therefore, guidelines recommend that clinicians must offer CBT to patients with persistent bothersome tinnitus.

Which department should neurogenic tinnitus patients consult?

It is recommended to visit the otolaryngology (ENT) department.

Does all neurogenic tinnitus require treatment?

Not all tinnitus requires clinical intervention. Only "bothersome tinnitus," "persistent tinnitus," or suspected "secondary tinnitus" necessitate active clinical management.

DIET & LIFESTYLE

What should patients with neurogenic tinnitus pay attention to in their daily life and diet?

The following aspects should be noted:

• Reduce caffeine and salt intake;

• Quit smoking and drinking;

• Maintain regular sleep schedule; Increase physical exercise; Keep a happy mood;

• Avoid high-noise environments;

• Maintain a balanced and healthy diet;

• Combine meat and vegetables reasonably, increase whole grain intake;

• Eat more vegetables and fruits.

PREVENTION

How to prevent neurological tinnitus?

• Maintain good ear care in daily life.

• Avoid the bad habit of digging or picking ears.

• Get enough sleep and avoid strong tea, coffee, cocoa, or similar drinks before bedtime.

• Prevent water from entering the ears.

• Avoid the use of ototoxic medications.

• Minimize exposure to noise, especially for those with mild hearing loss.