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Tinnitus Explained: Symptom vs Diagnosis · This Is Why with Dr. Busti

• 0:00
  Speaker: All right. Well, welcome to this episode on medical terminology where we're going to
• 0:00
  Speaker: well, welcome to this episode on medical terminology where we're going to break down the term tinnitus.
• 0:06
  Speaker: Or is it tinnitus?
• 0:08
  Speaker: Or wait a minute, is it both?
• 0:11
  Speaker: Ah, no worries.
• 0:13
  Speaker: I'm going to explain why that matters later, but for now, we're going to pronounce it as tinnitus because the American Tinnitus Association, ATA, states that both are actually acceptable.
• 0:25
  Speaker: However, in some academic and research settings, you may hear it as tinnitus to avoid the confusion surrounding the potential underlying cause.
• 0:35
  Speaker: Some of you are like, wow, okay, I'm not sure I've ever heard that before.
• 0:41
  Speaker: Does it really matter?
• 0:42
  Speaker: No worries.
• 0:44
  Speaker: It is odd, but I am just being honest about it, and I'll make sure we all understand why its pronunciation can vary.
• 0:52
  Speaker: I'll also make sure that what the word actually means, why it matters clinically.
• 0:57
  Speaker: Okay?
• 0:58
  Speaker: And if that isn't enough, and as some of you know, I will show you how it shows up outside of medicine, including one of the most famous movie series, known for the phrase, may the odds be ever in your favor.
• 1:13
  Speaker: I'm Dr.
• 1:14
  Speaker: Busnai, and welcome to This Is Why, a show dedicated to helping healthcare professionals understand why they do what they do and what we talk about in everyday clinical practice.
• 1:25
  Speaker: So the question becomes: why does the term tinnitus actually matter?
• 1:30
  Speaker: Because this is something patients report all the time, and how we interpret that directly influences what we do next clinically.
• 1:41
  Speaker: All right, now tinnitus is not a diagnosis, it's a symptom, and that is defined according to the American tinnitus association, but also the American Academy of Otolaryngology, specifically head and neck surgery, NIH, and even others.
• 1:56
  Speaker: Okay.
• 1:57
  Speaker: Knowing that immediately changes the conversation from what is it to what is causing it.
• 2:04
  Speaker: Now think about the patient that many a times is sitting in front of us who says, I hear this constant ringing in my ear.
• 2:16
  Speaker: That one statement can range from something relatively benign to something that requires further evaluation depending on how we frame it.
• 2:25
  Speaker: So let's start with the word itself.
• 2:28
  Speaker: Okay.
• 2:29
  Speaker: Tinnitus comes from the Latin word teneri, which means to ring or tinkle.
• 2:35
  Speaker: Okay, and that origin actually reflects how the condition was originally described, this idea of a ringing sound.
• 2:44
  Speaker: But clinically, we know it's much broader than that.
• 2:46
  Speaker: Patients don't just say ringing, they'll also sometimes say buzzing, hissing, uh, clicking, roaring, and even a kind of static noise.
• 2:58
  Speaker: So the term has expanded beyond its original meaning, but the root still helps us anchor on what's going on.
• 3:05
  Speaker: Now, from a definition standpoint, tinnitus is the perception of sound in the absence of an external auditory stimulus.
• 3:14
  Speaker: Okay, now think about this for a second.
• 3:17
  Speaker: The patient is hearing something real to them, but there is no external source actually producing that sound.
• 3:28
  Speaker: So, where is it coming from?
• 3:30
  Speaker: Well, that's where the clinical reasoning begins.
• 3:34
  Speaker: Okay, now to really understand tinnitus, we should briefly understand how normal hearing actually works.
• 3:42
  Speaker: So let's look at the inner ear for a second.
• 3:45
  Speaker: Okay, I'd like to orient you to this basic cross-section of the ear, right?
• 3:50
  Speaker: Obviously, sound comes in from over on this left side, and then you see tissue, then you see the bone of the skull, but then there's that eardrum or that tympanic membrane.
• 4:00
  Speaker: And then in between that and that purple structure, which is the vestibular and the cochlea, right, there is the malleus, incus, and stapes, which are actually bone structures that move.
• 4:12
  Speaker: We'll see that here in a second.
• 4:14
  Speaker: Right?
• 4:14
  Speaker: Then those converge and the cochlea and that structure in the inner ear converge to form the vestibular cochlear nerve that transmits the information to the brain, especially as the hairs move inside the cochlea.
• 4:31
  Speaker: Okay?
• 4:31
  Speaker: So under normal circumstances, sound waves enter the ear canal.
• 4:37
  Speaker: That results in the vibration of the tympanic membrane that then moves through ossicles, those bones in the middle, and eventually creates fluid movement inside the cochlea.
• 4:51
  Speaker: And inside the cochlea are specialized hair cells, and those hair cells convert mechanical sound energy into electrical signals.
• 5:01
  Speaker: And when the cochlear nerve carries those signals to the brain, that is where it's ultimately being interpreted.
• 5:09
  Speaker: Okay?
• 5:10
  Speaker: And now that's where tinnitus becomes clinically interesting.
• 5:14
  Speaker: If those hair cells become damaged right here, as the sound is moving through, especially if it's really loud, these hair cells are bending, right?
• 5:25
  Speaker: They're bending, they can get damaged.
• 5:27
  Speaker: And as long as they're present and fluid, they will be able to transmit electrical impulses that again eventually get interpreted.
• 5:36
  Speaker: But if you think about things like aging, chronic noise exposure, certain medications, or other injury, the normal auditory input into the brain begins to change.
• 5:50
  Speaker: And when the brain receives reduced or distorted input, it may essentially compensate by increasing neuronal activity within those auditory pathways.
• 6:03
  Speaker: Okay?
• 6:04
  Speaker: So even though there's no external sound being generated, the brain perceives that sound.
• 6:13
  Speaker: And that perceived signal may be experienced as ringing, buzzing, hissing, or other noises that the patients described as tinnitus.
• 6:23
  Speaker: And this is one of the reasons tinnitus is so commonly associated with sensoral neural hearing loss.
• 6:30
  Speaker: The hairs die, like literally from over stimulation and exhaustion.
• 6:36
  Speaker: So when a patient says, I hear ringing, okay, what they are actually describing may reflect altered signaling somewhere along that auditory pathway between the cochlea, the cochlear nerve, and the brain itself.
• 6:56
  Speaker: Now, one helpful way to think about this is that when there is some degree of hearing loss, the brain is essentially trying to compensate.
• 7:06
  Speaker: It's filling in the missing auditory input.
• 7:09
  Speaker: And what gets perceived is that internal sound.
• 7:13
  Speaker: Now let's take this one step further and add a few clinical descriptors that actually change what we think about in tinnitus.
• 7:21
  Speaker: One of the most important is pulsatile tinnitus.
• 7:24
  Speaker: This is when the patient describes the sound as rhythmic, often in sync with their heartbeat.
• 7:31
  Speaker: Okay, now that's very different clinical conversation because the question becomes is that really related to blood flow?
• 7:39
  Speaker: All right?
• 7:40
  Speaker: Is there a vascular component that helps them to we we need to think about?
• 7:46
  Speaker: Well, compare that to a constant high-pitched ringing that has been present for years.
• 7:52
  Speaker: Okay.
• 7:52
  Speaker: Those are not the same clinical scenarios, are they?
• 7:56
  Speaker: All right, another simple but high-yield distinction is unilateral versus bilateral tinnitus.
• 8:03
  Speaker: If it's happening in one ear, that raises a different level of concern compared to something that is bilateral and more consistent with age-related or noise-related hearing changes.
• 8:16
  Speaker: And again, we're not diagnosing anything in isolation, but these descriptors help guide your thinking.
• 8:22
  Speaker: Now let's bring this into something very practical: medication-induced tinnitus.
• 8:29
  Speaker: This is one of those areas where, as a healthcare professional, we should immediately be thinking about what the patient is taking on a regular basis.
• 8:38
  Speaker: Certain medications are well known for this, right?
• 8:41
  Speaker: Amino glycosides, lube diuretics, especially high doses, high dose salicylates.
• 8:46
  Speaker: Okay.
• 8:47
  Speaker: So when a patient patient reports tinnitus, one of the important questions is not just what does it sound like, but also what are they also taking?
• 8:58
  Speaker: Because sometimes the cause is sitting right there in the medication list.
• 9:04
  Speaker: Now, before we move on, let's clarify something that comes up all the time.
• 9:08
  Speaker: That's the pronunciation.
• 9:10
  Speaker: You often hear people say tinnitus, all right?
• 9:14
  Speaker: Kind of the blending of the words.
• 9:17
  Speaker: But here's the key concept to understand.
• 9:19
  Speaker: In medical terminology, when you hear itis, right, that typically refers to something of involving inflammation, doesn't it?
• 9:31
  Speaker: Right?
• 9:31
  Speaker: Think of dermatitis, arthritis, otitus media, right?
• 9:38
  Speaker: But in tinnitus, it is pronounced with a short eye, right?
• 9:43
  Speaker: And it refers to an experience, not inflammation.
• 9:48
  Speaker: And if you even look at the ending, it's US, not IS.
• 9:53
  Speaker: So even the way we pronounce the word reflects a different meaning.
• 9:57
  Speaker: And that level of precision actually matters when we're communicating with our colleagues and documenting things clinically.
• 10:05
  Speaker: Now let's shift gears for a moment and let's look at how it shows up outside of medicine, right?
• 10:10
  Speaker: The fun point.
• 10:11
  Speaker: Because this is where things kind of get interesting, and honestly, sometimes it makes it more memorable.
• 10:17
  Speaker: Alright, so some of you may be familiar with the movie called Baby Driver from 2017 when the main character has tinnitus from childhood accidents, right?
• 10:28
  Speaker: Throughout the film, he's constantly listening to music through earbuds.
• 10:33
  Speaker: And that's not just a stylistic choice for the movie, it's actually a realistic representation of what many patients actually do.
• 10:41
  Speaker: They use external noise to mask the internal noise.
• 10:46
  Speaker: So what you're seeing in that film is a form of a coping strategy that aligns with how tinnitus is experienced in real life.
• 10:56
  Speaker: Now, for an even more famous movie that provides some real insight of how this might sound or be experienced for some patients, right?
• 11:06
  Speaker: Think about the third movie of the Hunger Games, Mocking Jay, part one.
• 11:10
  Speaker: You know, there's that scene where Katniss and Gail are in District 8 to film a prop for the revolution, right?
• 11:16
  Speaker: Bombers are coming in from the north because President Snow saw them on the camera.
• 11:21
  Speaker: They launched an attack, right, where they where they were at, right?
• 11:26
  Speaker: And it was in a huge explosion.
• 11:28
  Speaker: Remember that tall structure came barreling down.
• 11:32
  Speaker: And there was this moment in the movie where there is this sense of silence.
• 11:37
  Speaker: At the same time, you so you couldn't hear other things that were obviously still happening, right?
• 11:44
  Speaker: But there's a humming sound without the ability to hear those things.
• 11:49
  Speaker: And that's rather close to what many people will describe it as.
• 11:53
  Speaker: So this condition represents something persistent, something intrusive, something that you can't just turn off, unfortunately.
• 12:02
  Speaker: And that's the really interesting extension of that concept, okay?
• 12:06
  Speaker: Because even outside of medicine, the idea of tinnitus has come to represent ongoing internal noise, whether that's physical or psychological.
• 12:18
  Speaker: So you can see how the word moves from a clinical symptom into a broader cultural meaning, but still holds on to the core idea of something persistent and difficult to ignore.
• 12:29
  Speaker: Now, bringing this back to the clinical practice, the real issue is not just recognizing the term tinnitus, but understanding how to interpret it.
• 12:36
  Speaker: Because again, it's not the final answer, it's the starting point.
• 12:39
  Speaker: So when the patient tells you they have tinnitus, the next step is to characterize it.
• 12:45
  Speaker: What does it sound like?
• 12:46
  Speaker: Is it constant, intermittent, is it pulsatile, is it unilateral, bilateral?
• 12:51
  Speaker: What medications are they taking?
• 12:54
  Speaker: And now you've moved from simply hearing the word to actually thinking through the clinical problem, and that's the difference.
• 13:02
  Speaker: Now, medical terminology is not just a vocabulary, guys, it's a tool for clinical reasoning.
• 13:08
  Speaker: And when we use it correctly and understand what it represents, we think more clearly and ultimately we are going to likely take care of our patients better.
• 13:18
  Speaker: And I hope that that was interesting and helpful, and maybe even a little bit more engaging than you expected from a single medical term.
• 13:27
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• 13:31
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• 13:32
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• 13:37
  Speaker: I'm Dr.
• 13:38
  Speaker: Bustaye.
• 13:39
  Speaker: Never stop learning the why because that helps us master the how.
• 13:43
  Speaker: Take care, we'll see you next time.