October 6 to 8, 2016, general practitioners and specialists head to the Entretiens de Bichat medical conference in Paris, France, to take stock of developments in the profession. One subject on the agenda this year is the treatment of tinnitus, a ringing or buzzing noise in the ears that can considerably affect patients in their daily lives. Around 65% of cases result from exposure to very loud noise (such as a concert). Although new treatments are currently under clinical trial, Dr Didier Bouccara, an ENT specialist at Hôpital de la Pitié Salpêtrière in Paris, recommends multidisciplinary treatment to improve quality of life for sufferers.
What is tinnitus?
Tinnitus is a buzzing, humming, ringing or crackling sound in the ears which lasts for several days, even when in quiet environments. It is a sign of dysfunction in the hearing system. Levels of intensity and discomfort are low in the majority of cases. However, tinnitus can sometimes be more intense and debilitating.
Exposure to loud noise is one of the most common triggers. What are the other possible causes?
There are a great many possible causes. Tinnitus is a symptom that requires thorough investigation to identify a potential pathology affecting the ear or the entire hearing system. An ear infection, a buildup of earwax, an obstruction near the eardrum or a tumor can all cause tinnitus. Audiometry can be used to evaluate whether patients are suffering from hearing loss. If no cause is identified, we sometimes resort to brain scanning techniques -- MRI and CT scans -- to analyze the brain. Pulsatile tinnitus -- a sound that beats in time with the heart -- is a particular concern, as it can be a sign of a vascular problem.
What treatments are currently available for tinnitus sufferers?
In the event of acoustic trauma, comprehensive treatment includes vasodilator and corticosteroid drugs, potentially a hearing aid, and stress management techniques (relaxation, sophrology, acupuncture). Stress increases anxiety- and sometimes depression-related disorders experienced by some people who are significantly affected in their daily lives. The TRT (Tinnitus Retraining Therapy) technique has been found to be effective. This "retrains" the hearing system through immersion in an alternative acoustic environment, with nature sounds between passages of gentle music, to divert attention from tinnitus. This method is generally used along with cognitive-behavioral techniques which help patients manage their anxiety.
Are there any future treatments in the pipeline?
New drugs are currently in phase III of clinical trials. There is one drug in particular for acoustic trauma, which could be injected locally to act directly on damage to the ear.