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Ringing in the Ears: Understanding Tinnitus · Meaningful Medicine with Novant Health

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  Carl Maronich (Host): Welcome to Meaningful Medicine, the Novant
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  Health podcast, bringing you access to leading doctors who answer
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  questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm Carl Maronich, and today I'm joined by neurosurgeon Dr.
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  Kevin Shah.
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  Doctor, welcome to the podcast.
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  Kevin Shah, MD: Hi, Carl Thank you for having me.
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  Host: Today we're going to be talking about tinnitus from
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  the neurosurgeon's perspective.
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  So maybe we could start by having you kind of give a definition as to what tinnitus
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  is and, and what we know about the causes.
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  Kevin Shah, MD: Tinnitus is just a sound that someone might hear in
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  their ear that's repetitive, but there's no external sound source.
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  There's lots of different causes for it.
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  I mean, it's basically some sort of dysfunction in the hearing
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  pathway of the body that starts everywhere from the eardrum to all
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  the sensors and nerve fibers that connect that eardrum to the brain.
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  And there's many different causes, as you can imagine, that can
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  affect each little component.
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  There's also sounds that people hear that are occurring from within their body,
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  like blood flow around the ear or maybe fluid in the ear that can cause tinnitus.
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  Host: Is it a permanent condition could make it go away?
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  Are types of tinnitus
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  Kevin Shah, MD: Well, you might have experienced tinnitus in your own life.
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  sometimes when you exercise, you know, very strenuously, you
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  might hear a pounding in your head or a pulsating in your head.
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  That sort of sound is temporary, generally goes away after you've recovered.
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  You can also have tinnitus from infections in the ear.
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  So oftentimes, most people experience transient or temporary tinnitus, but
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  occasionally you can have tinnitus that lasts for weeks, months, maybe
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  even permanently, and that points to a more serious issue, I guess
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  Host: Are there different types of tinnitus And then how do they differ
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  in what patients might experience?
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  Kevin Shah, MD: I generally break it up into two separate types.
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  there's tinnitus that can sound like a ringing or a high-pitched sound that
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  usually points to some sort of issue with the nerve or the hearing apparatus.
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  And then there's, a pulsating sound that people can hear called pulsatile
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  tinnitus, which can sound like a whooshing or a humming, and that
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  points to a more vascular cause.
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  I generally, as a vascular neurosurgeon, see more of the latter.
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  So I deal with blood vessels of the brain, and that includes blood vessels
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  of the inner ear, and these are the patients that actually can have a
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  cure, from their tinnitus depending on what is specifically causing it.
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  Host: I'm going to ask about diagnosis.
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  And, and the first thing would be, well, if somebody's hearing something in
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  their ear, then that must be tinnitus.
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  But that may not always be the case.
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  So how do you go about diagnosing tinnitus?
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  Kevin Shah, MD: Well, it starts with a very detailed physical exam and history.
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  I ask, you know, "When did it start?
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  Are there any provoking factors?
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  What makes it go away?"
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  sometimes, you know, something very benign can be the cause, occasionally they will
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  need an audiological test, meaning a, a test where an ENT tests their hearing
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  or any, for hear- any hearing loss.
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  Occasionally we do imaging like an MRI.
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  Sometimes even more serious conditions like brain tumors can cause tinnitus,
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  and that can mean that, you might need to see a neurosurgeon like me.
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  and specifically for people with pulsatile tinnitus, we usually do
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  more specific vascular type imaging, so looking at the blood vessels that
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  run in and around that inner ear.
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  Host: Now
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  if someone's
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  been around with loud noise for a bit, and then following that they
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  have, you know, they have some ringing or some sound in their ear, that
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  may not necessarily be tinnitus.
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  Is that correct?
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  So diagnosing it specifically is, is what the process you just
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  defined really goes, works to do.
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  Kevin Shah, MD: Well, it's very subjective actually.
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  I guess if you work around, you know, loud noises or heavy machinery, you might
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  come home from a loud concert and you hear that ringing in your ears for a few days.
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  That essentially is tinnitus, and it generally goes away.
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  But obviously if you're exposed to loud sounds consistently, it might not go away
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  Host: So let's talk a little bit about treatment.
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  what options exist and, you know, from lifestyle or to medical
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  interventions, what, what kinds of things can people expect if
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  they are diagnosed with tinnitus?
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  Kevin Shah, MD: It depends on the cause, like I said, there's
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  lots of different causes.
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  What I will say is, you know, s- for those patients who see me, a vascular surgeon,
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  with pulsatile tinnitus, then there's a very good treatment which usually involves
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  changing the pattern of blood flow inner, in the inner ear to reduce the turbulence,
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  which is what people are hearing.
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  And if that is able to be achieved, then their tinnitus can go away completely,
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  and it's something that's very rewarding and obviously very satisfying, you know,
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  in my own practice, and it's, you know, very s- satisfying for patients too.
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  That specifically applies to, pulsatile tinnitus.
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  Now, if it's tinnitus from other causes like exposure to loud sound,
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  well, the treatment's kind of easy.
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  Just try to avoid loud sounds, and if you can, people wear,
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  you know, earplugs or earmuffs.
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  if it's an infection, antibiotics usually take care of it.
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  so it kind of varies, you know.
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  For those other types of tinnitus that involve the structure of the inner,
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  inner ear, those patients, see typically an ENT surgeon to take care of those.
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  Host: Well, you mentioned something I'm going to ask a bit about,
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  and that is wearing, headphones and, and those types of things.
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  We see more and more, and I, I notice younger kids wearing
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  them, right on their ear.
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  So depending on volume, I'm, I'm guessing that could be potentially be an issue.
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  How do you talk to patients about that and, and, in their children?
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  How do, how do you work to try to prevent these kinds of things?
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  Kevin Shah, MD: you may have noticed, you know, if you ever go to a sports game,
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  all the little kids are wearing, earmuffs.
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  I think that's important to prevent any, you know, damage as, as we're growing to
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  the, to the nerve that controls hearing.
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  what I say is, if there are exposures to loud sounds, then you
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  should take preventative measures to, stop, those loud sounds.
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  I don't really see that many people, in that very early early
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  part of their course, I guess.
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  I usually see people on the back end where they have been already
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  diagnosed with tinnitus, and now they're looking for a solution.
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  The preventative care for tinnitus usually is really, really f- heavily focused on,
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  primary care physicians and ENT physicians
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  Host: Doctor, is it normal for tinnitus to be synchronized with a person's pulse?
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  So you mentioned that the, the, the pulsate, the pulsating type of tinnitus.
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  Is that synchronized with the pulse, and, and what does that mean?
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  Kevin Shah, MD: Yeah there's a specific subtype of pulsatile
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  tinnitus is what it's called.
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  It's, it's a type of sound that synchronizes with your own heartbeat.
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  That's an indication that that sound is actually coming from blood flow or
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  blood vessels around your inner ear.
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  And this is why you would end up seeing a vascular neurosurgeon like me
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  instead of seeing a regular ENT doctor.
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  Host: Beyond the sounds themselves, what, what side effects or impacts can
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  tinnitus have on someone's sleep or their, their mood and, their daily life?
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  Kevin Shah, MD: Well, it interferes with all aspects depending on
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  how severe the, the sound is.
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  You know, it's not just the, the loudness of the sound, it's really just how
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  intrusive it is in your daily life.
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  Most people hear the sound more at night because there's less environmental
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  noise, but it can also affect you when you're trying to concentrate,
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  when you're trying to work, when you're trying to hear very low sounds.
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  and it can significantly, disrupt your mood.
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  You know, imagine just hearing a constant sound in your ear all the time.
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  You can become anxious or irritable.
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  Some people even feel like something bad is going to happen
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  because they don't understand where that sound is coming from.
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  Host: Who is more likely to develop tinnitus if there is, if there is such a
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  group, and are there certain risk factors or underlying conditions to watch for?
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  Kevin Shah, MD: There are some risk factors.
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  as we get older, you know, the, our hearing apparatus gets more and
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  more deteriorated, and so people can start hearing tinnitus or tinnitus.
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  so age is a risk factor.
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  Like I mentioned a little bit earlier, exposure to loud sounds are a risk factor.
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  occupational hazard in some, some jobs, for example.
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  And then there are sounds that just pop up for no reason, if they pop
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  up for no reason and they, and they don't go away, you know, that's
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  when you should go see your doctor.
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  Host: What would you hope people take away from this conversation, and what
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  should they think about going forward when it comes to their hearing and tinnitus?
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  Kevin Shah, MD: Tinnitus is a very common problem.
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  people listening to this podcast may have experienced tinnitus in their own lives.
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  And if it's temporary, it's not something to worry about.
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  But if it lasts weeks to months, and this is something that should warrant
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  further evaluation, you should see your primary care physician about it.
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  Host: Very good.
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  Dr.
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  Kevin Shah, neurosurgeon with Novant Health.
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  We appreciate, all the information you've given us today.
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  Very interesting.
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  Kevin Shah, MD: Thank you.
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  Glad, to be here.
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  Host: For more information and to find a physician, visit novanthealth.org.
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  If you enjoyed this podcast, share it on your social channels and
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  explore our entire podcast library for other topics of interest.
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  this is Meaningful Medicine.
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  Thanks for listening.