Cochlear tinnitus is the subjective noise associated with sensorineural hearing loss that usually involves the high frequencies. This is not always true.

The most common diseases and injuries are listed in the table below.

 Any disease of the auditory system and auditory nerve pathway or any decrease in auditory perception has the potential to produce tinnitus.

In this table Drugs and Substances that can causes tinnitus

Carlo Govoni MD : meeting on diagnosis and therapy of tinnitus      

   Milan - Columbus Clinic Center - via Buonarroti, 48 - City Life zone

   Tinnitus - Ear Ringing

   Causes and Treatment

   Carlo Govoni MD  Otolaryngologist
  

  Columbus Clinic Center - new building

See also:

       - Sudden deafness

Carlo Govoni MD - Activities

- Vertigo and tinnitus

- Tinnitus Conference 2024

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Roaring or ringing or tinnitus is a sound that does not exist in the environment, but is within us, it can be continuous or intermittent, it is always a noise that is difficult to accept. Tinnitus causes sleepless nights, mood swings, anxiety, depression, exhaustion and stress. The sound is in the head with no external source.

Tinnitus is not a disease.  This concept is more important: Tinnitus is a symptom.

It means that it is a feature of a number of diseases. Many ear diseases present with tinnitus. It is a symptom of ear infections, sudden hearing loss, Meniére's syndrome, otosclerosis, ototoxic drugs, diseases of the inner ear, vestibular neuritis, glomus tumors and many other pathologies. Tinnitus is also a symptom of diseases that do not affect the ear such as hypertension, headache, diabetes, etc.

When dealing with a patient with tinnitus it is necessary to address both the physiological and psychological impact. Overall health, nutrition, emotional health and habits play an important role. These factors must always be acted upon if the negative effect of tinnitus is to be reduced. There is and will never be a one-size-fits-all method. It is essential to understand the disease that generated the ringing. It is almost always an ear disease. Only in a few cases the cause is extraotological (arterial hypertension, drugs, temporomandibular joint disorders, intracranial diseases, etc.).

Once the disease causing the tinnitus has been identified, then a therapy can be proposed for that disease and for that single patient.

 Drawing of the afferent and efferent acoustic pathways.
In almost all cases, tinnitus is the expression of damage
to the cochlea and / or the acoustic pathways.
By Procaccini A, Govoni C, Cavalca V, Caroggio A. 
Dati preliminari sull'impiego della Tocainide Cloridrato nella terapia degli acufeni.
(Preliminary data on the use of Tocainide Hydrochloride in the treatment of tinnitus.)
La nuova audiométrie 2, 4-8, 1986.

Milan - Columbus Clinic Center -
via Michelangelo Buonarroti, 48

  Tinnitus - Ear Ringing

  Causes and Treatment

  Carlo Govoni MD
  

See also:

- Sudden deafness

- Tinnitus Conference 2024

 Curriculum vitae Carlo Govoni MD    

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This study was published in Italy in 1986 (*) and the efficacy and side effects of Tocainide Hydrochloride on tinnitus were verified. In 1980 Emmett J.R. and Shea J.J. (**) studied the use of Tocainide HCl in patients with chronic tinnitus and sensitive to the Lidocaine test.

Five patients where studied in order to verify the effect of  Tocainide Hydrochloride in chronic tinnitus. All cases uderwent several clinical tests to avoide every external, middle and inner ear deseases and tried a treatment by traditional drugs without success. The patients were selected by a test based on intravenous injection of Lydocaine. On the base of this preliminary report it is possible to grant the theraputic effect of Tocainide against tinnitus  but further about collateral effects and efficacy will be needed.

Lidocaine and Tocainide Hydrochloride are drugs more effective on multisynaptic systems. The acoustic pathway, as can be seen from this image, is a multisynaptic sensory pathway.

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(*)  Procaccini A, Govoni C, Cavalca V, Caroggio A.  Dati preliminari sull'impiego della Tocainide Cloridrato nella terapia degli acufeni. La nuova audiométrie 2, 4-8, 1986.

(**) Emmett JR. Shea JJ.  Treatment of Tinnitus with Tocainide Hydrochloride. Otolaryngol Head Neck Surg. Jul-Aug 1980;88(4):442-6.

 Tinnitus Clinic Milan  -  Columbus Clinic Center . (+39) 3358040811
                                   48, Buonarroti Michelangelo street - Milan

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.Carlo Govoni MD in update meeting on tinnitus for ENT specialists       

Milan - Columbus Clinic Center - via Buonarroti, 48

  Tinnitus - Buzzing - Ear Ringing

  Causes and Treatment

  Carlo Govoni MD
  

See also:

- Searching for the audiometric threshold, a fundamental examination of audiology

                - Sudden deafness

- Developing news strategies for therapeutic interventions in otorhinolaryngology

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Having tinnitus means hearing an annoying sound that is not there, this definition is strange, but for many people it is real and is a serious problem. Tinnitus is a buzz, a hiss, a rustle that constantly or occasionally makes the lives of many people unhappy. It is not possible to establish exactly how many people are affected by this disorder. I believe it is reliable to think of 8% in the adult population and I believe that it reaches 15% if we consider the elderly population (over 65 years). There is no substantial difference between males and females.

The diseases that cause tinnitus or ringing
almost always affect the MIDDLE and INTERNAL EAR.
Very rarely the external ear.
Tinnitus often occurs in the cochlea (8) or in the cochlear nerve (10).

Vestibular neve (9) diseases can also generate tinnitus.
Acoustic neuroma is typical.

I am convinced that in most cases this symptom is a consequence of a disease of the hearing system. My approach is to evaluate the auditory function already in the first approach. Tonal audiometry, impedancemetry and acuphenometry.  Extraotological tinnitus is very rare.
At the Columbus Clinic Center in Milan I met several people affected by this problem and I believe that with the equipment I have it is possible to carry out a good evaluation. In many cases it is possible to hypothesize a precise clinical diagnosis. A correct diagnosis is not always able to identify a correct therapy.

In the following image my diagnostic approach to the patient whose main symptom is tinnitus.

Columbus Clinic Center entrance

The difficulties in eliminating tinnitus are mainly proportional to the time of onset. If the tinnitus has arisen recently and there are evident audiological signs, there are possibilities to achieve an attenuation or even disappearance.

  Milan - Columbus Clinic Center - via Buonarroti, 48 - City Life - Phone +39 3358040811

  Tinnitus - Ear Ringing

  Causes and Treatment

  Carlo Govoni MD  - Otolaryngologist
  

See also:

- Ringing, tinnitus, whistling, buzzing are noise in the ear

 - Tinnitus and sensorineural hearing loss.

- Searching for the audiometric threshold, a fundamental examination of audiology

- Sudden deafness

- Tocainide Hydrochloride in the treatment of tinnitus

- Fondation Pormann - Course on ear surgery and temporal bone dissection

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