By: Dr. John Conde Special to the Boca and Delray newspapers
Tinnitus is a perception of sound in proximity to the head in the absence of an environmental source. It can occur in one or both ears, in or around the head, and even in the distance in rarer occasions. Typically the sound is described as a hissing, buzzing, or ringing that may be constant or intermittent. Hearing loss is quite often a comorbidity to this condition. According to the American Tinnitus Association, over 50 million people living in the United States suffer with chronic tinnitus which is described as tinnitus persisting for greater than 6 months. For 12 million people in the United States it significantly interferes with activities of daily living.
The most common pathological cause of tinnitus is an acoustic neuroma, which is a benign tumor of the coating of the hearing nerve. This should always be ruled out through an examination, history, and imaging if necessary. However, the genesis of tinnitus is overwhelmingly more often associated with a dysfunction in the central auditory system, which in laymen terms means a dysfunction in the neuro-circuitry for hearing in the brain. There are many areas within the central auditory system that are referenced in the literature but the most common is an area termed the dorsal cochlear nucleus in the brainstem. This area seems to generate neurological activity spontaneously. Another common thread that is seen in the literature associated with the genesis of tinnitus are non-auditory areas in the brain such as the frontal lobe, cerebellum, and the limbic system. These areas are thought to provide the emotional, anatomical, and perceptual aspects of the noise that the person hears.
In the assessment and treatment of tinnitus, a thorough neurological battery is necessary to target the most dysfunctional regions in the central auditory and non-auditory systems of the brain. The battery should consist of a comprehensive bedside neurological physical examination, VOG (video-oculography), audiometric testing (hearing tests), a computerized assessment of postural systems (CAPS) for balance, and imaging if necessary such as MRI. The goal of the assessment is to establish a functional diagnosis by which the concepts of neuroplasticity (re-mapping the brain according to environment stimulus) can be applied.
Subsequently, therapeutic interventions are executed aimed at stabilizing these unhealthy regions of the brain. These interventions may involve Notched Sound Therapy, oculomotor (eye movements) exercises, unilateral vestibular exercises, visual positional awareness exercises for the head with lasers, Dynavision D2 (64 LED board), Interactive Metronome (brain timing exercise), and manipulation just to name a few. Every patient presents differently so there is not a single “technique” that benefits all. Unique, customized programs are the norm when addressing tinnitus. In reference to food stuffs or vitamins and minerals, as to date there are no pharmacological agents or dietary supplements that have been proven to benefit patients with tinnitus.
Dr. John Conde is a Board Certified Chiropractic Neurologist, one of only one thousand in the country. He holds diplomate status through the American Chiropractic Neurology Board. He provides specialized care for difficult cases of back neck pain, numbness-tingling, vertigo-dizziness balance disorders, fibromyalgia, migraines, AD/HD, autism, and dyslexia. His office is located at the Atlantic Grove in Delray Beach, FL and can be reached at 561-330-6096, firstname.lastname@example.org, and at www.thecondecenter.com