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Tinnitus

Tinnitus is derived from Latin word 'to ring and medically means 'ringing in the ears'. One out of every five people in the world is affected by this condition and nearly 33% of senior people living throughout the world suffer from tinnitus.

Continuous exposure to loud and deafening noise can lead to tinnitus. At times a small plug of wax in the ear canal can lead to temporary tinnitus. Otosclerosis, stiffening of bones in the middle ear can also cause tinnitus. Tumor in the middle ear is another cause for tinnitus. Those suffering high or low blood pressure, diabetes, thyroid disorders or injury to head or neck might notice symptoms of tinnitus.


Tinnitus symptoms

A person suffering this disorder is likely to hear noises that others cant. This noise is most often of buzzing or ringing nature. Other tinnitus symptoms include ear pain and headache. Dizziness and hearing loss might result. Consult an otolaryngologist who can determine the right type of treatment for the condition.

Improve your circulation with daily exercise. Reduce excessive salt in the diet. Keep away from tobacco, tea, cola, coffee and other stimulants. Keep your blood pressure under check. Stay away from loud noises and sounds.


Tinnitus remedy

Concentration and relaxation exercise can help gain control over the muscles and blood circulation in the body. Hearing aids help reduce the head noise and aid in hearing too. Set the right volume to prevent worsening the condition.

Acoustic Neuroma

An Acoustic Neuroma also known as Vestibular Schwannoma is a slow growing tumor that develops on the cranial nerve that connects the ear to the brain. Cranial nerves are those nerves that arise directly from the brain. An acoustic Neuroma is a benign (non-cancerous) growth that forms on the sheath covering of the eighth cranial nerve called vestibulocochlear nerve. The eighth cranial nerve has two divisions, the vestibular nerve that controls the balance and the cochlear nerve that takes care of the hearing function. These two nerves are lined by Schwann cells and acoustic neuroma occurs when there is a large production of Schwann cells forming into a tumor.


Schwannoma that occurs in other peripheral nerves are largely benign unless it is a Neurofibrosarcoma - a malignant form of cancer.


Symptoms of acoustic neuroma


  • The early signs of the condition include hearing impairment in the affected ear and the balancing difficulties. Since nerves of eighth cranial are responsible for hearing and balance, the problems related to these functions are the first to surface in the initial stages of acoustic neuroma. Patient may also feel heavy or fullness in the affected ear. Hearing loss either progressively or suddenly in the affected ear is the most obvious symptom of acoustic neuroma.

  • Tinnitus is an ear condition where the patient experiences constant buzzing or ringing sounds in the ear. Though Tinnitus is a common symptom associated with acoustic neuroma, not all the cases will develop this symptom. It is also to be noted that all those who experience tinnitus do not have tumor growing on the ear nerve.

  • Vertigo and unsteadiness is the common symptom with acoustic neuroma.

  • When the tumor becomes large, it may compress the brainstem and result in headaches.

  • Though not very common, acoustic neuroma may cause facial numbness and paralysis. Large tumors may compress the fifth cranial nerve (facial nerve) called trigeminal nerve, resulting in facial numbness, pain and facial paralysis.

Diagnosis and Treatment

Diagnosing acoustic neuroma is a daunting task as the symptoms explained above are associated with many other medical conditions and it could easily be mistaken for middle ear disorder. Once suspected, doctor will advise MRI, the only test conducted to prove the presence of acoustic neuroma. Few of the hearing (audiometry) and balancing (nystagmus) tests are also conducted to assess the hearing and balance functions.


There are three options available to treat acoustic neuroma. The choice of treatment depends upon the size of the tumor, it's location and patient's age and fitness.

Micro surgery involves removing the tumor either partially or totally through surgery. Partial removal is considered when the tumor is large and the total removal leads to the damage of the facial nerve. In case of partial removal, the patient has to undergo repeated MRI scans at regular intervals to ensure that tumor is not growing again. When the tumor does not pose a risk to the adjacent nerves, one can opt for a total removal of the tumor. Though surgery is the most preferred choice of addressing the acoustic neuroma, utmost care should be taken to preserve the hearing function and the facial nerve of the patient.


Radiation is the second best option for treating acoustic neuroma. Radiation is a non-invasive treatment that uses precisely focused, narrow beams of radiation to shrink the acoustic neuroma. Currently, radiation is either delivered as single fraction stereotactic radio surgery (SRS) or as multi-session fractionated stereotactic radiotherapy (FSR). These techniques deliver high doses of radiation to the tumor and also ensure that surrounding areas and organs like brain, skull and skin receive minimum or no radiation.

SRS involves a single dose of radiation wherein multitude of radiation beams are delivered to the tumor in one single sitting. Patient need not return for treatment except for a follow up. Though SRS is very effective, it may not preserve the hearing function in most cases.

In FSR, smaller doses of radiation are given every day, over a period of three to four weeks. FSR method has better chances of preserving the hearing function compared to SRS method.


Sometimes doctors may just ask the patient to wait and watch than begin a treatment for acoustic neuroma. Holding back the treatment is most ideal when the tumor is not producing any symptoms and is small in size (less than 2 cm). Acoustic Neuroma does not require any medical intervention if the tumor is not growing rapidly. The growth of the tumor is normally observed by going for repeated MRI on a regular basis for few years. Wait and watch approach also best suits older patients with small tumors that have stopped growing. They will only be monitored periodically with the help of diagnostic tests.



Misophonia

Just few years back, in 2010, Misophonia was recognized as an emerging rare disorder. It continues to be so. Till date, Misophonia is a relatively unknown disorder. Misophonia is a disorder related to hearing particular sounds. Psychologists call these individuals as Misophones. Their relationship with sounds isn't normal. Hearing particular sounds send Misophones into an unbearable frenzy.


Misophonia Unclassified

Research on Misophonia is limited. The classification is still discussed. Studies are conducted by neurosurgeons, cognitive neurologists, clinical psychologists, neuro psychiatrists and animal psychics. Is Misophonia a Neurological, Psychiatric, or Auditory Disorder? There is an ongoing debate whether Misophonia can be classified as its own psychological disorder or it is just a symptom of underlying psychiatric disorder such as Obsessive Compulsive Disorder or generalized anxiety.


Misophonia is mostly regarded as a neurological disorder and is termed as selective sound sensitivity syndrome (4S) - a condition in which a person reacts extremely negatively to certain sounds that don't bother most people.


Upsetting, Annoying, Enraging Sounds



Literal meaning of Misophonia is 'hatred to sounds'. 'Miso' means dislike or hatred, 'phonia' means sounds. The sounds are everyday sounds. Nothing exceptional. The sounds can be loud or soft ones. Hearing these sounds make individuals with Misophonia angry, irritated, anxious, agitated, – all negative responses. From feeling moderate discomfort, the sounds can set in an intense panic and full-fledged rage.


  • Awful tickling noise
  • Tapping feet on floor
  • Annoying chomping noise
  • Sound of nails on a chalkboard
  • Rumbling of a snoring person
  • Crunching on snacks
  • Clinking of silverware
  • Rubbing of chalk against the blackboard
  • Sound of heavy breathing
  • Shifting of a table
  • Candy wrapper crushing
  • Throat clearing
  • Slurping on soups
  • Excited squeals
  • Leg fidgeting
  • Clocks tickling
  • Teeth brushing
  • Snapping fingers
  • Clicking keys in computer
  • Pen clicking
  • Car alarms
  • Chewing
  • Coughing
  • Scratching
  • Typing

Reasons for behavior

There are 4000 plus Misophones who post on web forums. Misophonia behavior is still being researched. In all probability, people with Misophonia could have unusually strong neural connections between sound-processing parts of their brains and their limbic systems (emotional systems) which regulate emotion. Simply put, it is due to criss-crossing of wires - the wires that affect hearing get crossed with wires that affect emotions.

Also, there seems to exist a connection with psychiatric conditions like anxiety, depression and obsessive-compulsive disorder. People with Misophonia develop a negative reaction to annoying sounds and gradually it becomes a natural behavior/reaction/response to these sounds.


Onset of Misophonia

Research conducted so far indicates that the symptoms often appear in late childhood, pre-teen or just before puberty and worsen with time. In some cases, Misophonia triggers are noticed in early childhood. If not attended to Misophonia persists entire lifetime. Initially the aversion is limited to a specific sound which later can include more sounds.

Reaction to specific sounds

Misophones respond differently to the sounds they hate. Mild feeling or severe response, the reaction could be any one of these. This is referred to as Misophonia Activation Scale.


  • Aware of sounds that annoy them. Have not had any negative experience with those annoying sounds.
  • Experience discomfort. Able to withstand the trigger and strive to move away from the annoying sound, divert self or if possible withstand the situation and related sound.
  • Experience significant negative response. If a polite request to stop the annoying sound is turned down, he/she strives to escape the trigger event as it is difficult to endure it.
  • Experience at least one fight or flight response.
  • Experience a powerful fight or flight response. Feel the trigger event is a deliberate attempt to mock, irritate and insult the individual with Misophonia.
  • Enthused to 'sarcastically' mimic the annoying sound or exhibit anger at the person making the sound. There is an urge to scream. Some people experience physiological reactions.
  • Highly unbearable to hear specific sounds, there is a high possibility of verbal assault. If the offending sound doesn't stop, the Misophones exhibit physical discontent.
  • The hatred of specific sounds is intense. Frantic effort to stop the sound. Express apathy of people in understanding the pain of individuals with Misophonia.
  • More of a physical response phase, there is marked violent behavior towards self or others. Ready to inflict pain on self or others to relieve their pain.

Treating Misophonia

There is no official treatment sanctioned by the American Psychiatric Association. The search for a specific cure is on. There are many potential coping strategies. Effectiveness of these isn't yet proved but has provided the much needed relief. Many have benefited from these. At least, the symptoms are reduced. Before opting for any of the coping strategies, check with a consultant on Misophonia – audiological physician or an ENT surgeon.


Tinnitus retraining therapy (TRT): TRT teaches people with Misophonia how to improve their ability to tolerate the specific annoying noises. The combination of sound therapy and teaching/demystification/learning about mechanisms helps in remaining unprovoked.


Cognitive behavioral therapy: Initial sessions aim at deciphering the specific sounds, individual's thoughts and feelings associated with the sound. Subsequently, people with Misophonia are taught ways to improve thoughts thereby finding relief and feeling better.


Neurofeedback: Here is an expensive therapy that doesn't work for everyone and is not covered by most health insurance plan. Neurofeedback therapists or practitioners are trained to administer neurofeedback therapy. The session lasts 30 minutes. The therapy involves recording the waves of electrical activity emitted by the brain when EEG or Electroencephalography is administered. Electronic sensors attached to the ears and scalp read the brain waves when music and light/images are shown. The feedback is recorded and analyzed. The aim is to help the brain self-regulate or self-correct. Neuro feedback benefits the brain and body like improved sleep, heightened mental clarity and enhanced cognitive performances.


Sound therapy: Clinics that provide sound therapy play background noises to counteract trigger sound. The individual is conditioned to respond in a particular manner. The approach is to decondition the individual's response. Combined with psychological counseling, Sound therapy has proved effective for some individuals with Misophonia.


Clinical hypnosis: The focus is to help relax when the sound troubles the mind.


Check basics: Paying attention to the basics can help. A healthy and balanced diet combined with consistent and adequate exercise help manage stress thereby reducing the intensity of triggers.


Other options


  • Ear plugs and sound masks to block out intriguing and annoying sounds.
  • Music to distract from trigger and reduce reactions.
  • Talk therapy and anti-depressants prescribed by health care provider.
  • A stress ball to squeeze when feeling overwhelmed.
  • Get plenty of sleep, regular exercise and manage stress.
  • Create a room at home with sounds you enjoy to mask triggers.
  • Let people around you know of Misophonia to gain support.
  • Find support from Misophonia Association.
  • Interact online where people share Misophonia coping strategies.

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Bibliography / Reference

Collection of Pages - Last revised Date: July 15, 2019