That ringing sound in your head is not imaginary

As a young doctor with limited experience, I panicked when my mother called one morning. 

She sounded disturbed. She had not slept for days there was a ringing sound in her head. She sounded exhausted.
In the heat of the moment, I did not quite process what she was describing.

 All I wanted was to get her to the city, so she could get help. I called my extremely busy neurology professor for a clinic appointment that is booked for weeks. 

After all, she did say the problem was in the head, right? The amazing professor squeezed us in for a booking the next day based on the level of anxiety in my voice.

Even before breakfast, my brother was already at the door, having hit the road at three o’clock in the night to the village to bring mum over. We never thought about the panic we caused her with the rush to get her here for treatment. 

MRI scan
By the time the professor was seeing my mother, she had been subjected to a round of tests to make sure she did not have a brain tumour. If she was distressed by the inability to sleep, the magnetic resonance imaging (MRI) scan pushed her over the edge.

At 3pm we were seated in the professor’s reception with the test results waiting for his interpretation.

 He patiently listened to me give an account of what was wrong with my mother before gently turning back to her to explain what she was experiencing.

By the time he was done, I was left feeling rather sheepish. There is a reason doctors are advised against treating their family members. The expensive MRI scan proved unnecessary even though the professor was too polite to tell me so directly. 

A thorough history-taking revealed that my mother was suffering from tinnitus.
A sound
Tinnitus is perception of sound in the head or in the ears. This perception may be objective, where both the patient and the examining doctor can hear it, or may be subjective, where only the patient hears it. 

The condition affects one in six people and is more common with age. Tinnitus is not an illness by itself, but rather a symptom of an underlying problem.

The sound in the head may be variably described by the patient, as humming, ringing, whistling, roaring, buzzing or hissing. Objective sounds result from a physical problem that may tend to be rhythmically pulsatile in nature like a continuous drumming. These sounds are more obvious and hence more distressing to the patient when it is quiet. This explains the difficulty in falling asleep as the night is quiet.

Loud noises
The commonest cause of tinnitus is loud noises such as blaring music like is common in public service vehicles and at live concerts, gunshots and heavily mechanised industrial setups or construction sites. 

These loud noises lead to sensorineural (affecting the nervous system responsible for hearing) hearing loss that will manifest as tinnitus.

Another cause of tinnitus is conduction (affecting the part of the ear responsible for transmitting sound) hearing loss caused by thick ear wax, ear infections or foreign bodies in the ear, especially in children. 

In older age, a condition known as otosclerosis (abnormal growth of bone in the middle ear) may occur and cause tinnitus with hearing loss.
Drugs
Many drugs will always come with a warning sign for tinnitus and so it helps when the drug is prescribed for short term use as discontinuation of the drug will bring relief. For chronic use medication, there may be need to change the prescription where alternatives exist. In addition, marijuana has been documented to cause tinnitus.

Patients with abnormal blood flow through vessels in the head and neck region will experience pulsatile tinnitus in keeping with the heartbeat. The doctor may actually be able to hear these sounds using special examination equipment.

 Pulsatile tinnitus may also be a hallmark of tumours of the brain or the middle ear hence my MRI scan may not have been totally in vain. For many patients, the cause of tinnitus may never be identified.
Hearing aids
Tinnitus can be psychologically debilitating for many patients, especially the elderly folk. It interferes with sleep, resulting in insufficient rest, anxiety and resultant depression.

 This is the reason it warrants proper evaluation by the appropriate specialist, the ENT surgeon, with the involvement of an audiologist.

Treatment options vary with the cause. Withdrawal of offending drugs, treatment of infections and underlying medical conditions such as thyroid disorders, hypertension and marijuana addiction will resolve the problem. Surgical treatment is indicated for middle and inner ear problems, tumours or blood vessel disorders.

Where the above treatment methods do not work or are not indicated, non-invasive options are offered in an attempt to dull the impact of the tinnitus. These include hearing aids, cochlear implants, counselling, wearable or table top noise generators, and acoustic neural stimulators.

In addition, anxiolytic medication and antidepressants may be necessary to alleviate the morbidity caused by the tinnitus.

Dr Bosire is an   obstetrician/gynaecologist