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Malady of Tinnitus: surgical solutions, tumors, cochlear implants, types of hearing loss
Part 5 |
Tinnitus: a surgical solution?
In the March 2003 edition of Tinnitus Today, Barbara Tabachnick Sanders, ATA Director of Education, addressed the question of surgery for tinnitus relief in her article, Surgical Solutions for Tinnitus? Ms. Sanders addresses much of the information below in her article.
People often ask if there is a surgical solution for tinnitus. Basically, most folks with tinnitus just want a solution to get rid of it, and many with acute tinnitus are willing to do just about anything! We have seen folks in our office who have various degrees of tinnitus. All too often, they have seen an ENT doctor who tells them that they must just learn to live with it. For some with severe cases, this is a most discouraging and disheartening life-sentence. We try to direct tinnitus sufferers towards more constructive avenues of help.
Types of tinnitus and tumors
One type of tinnitus, called pulsatile tinnitus, is the kind that pulses or beats with one's heartbeat. There may be various causes for this: a malformed carotid artery, a glomus tumor, or pressure in the middle ear. In the case of a malformed carotid artery, surgery to correct this can be done. When a glomus tumor is present, that can be removed. Middle ear pressure can be relieved by a surgical perforation of the ear drum. These surgeries can sometimes stop the pulsing sound.
Another kind of tumor, which is rare, is acoustic neuroma. This particular tumor grows in and around the eighth nerve, otherwise known as the auditory nerve. If one has a continuous, one-sided tinnitus along with a hearing loss, it could indicate this type of tumor. Acoustic neuroma is almost always non-cancerous, but if left to grow, it can cause some severe problems such as facial nerve damage, total deafness, and ultimately death if allowed to grow to such a large mass within the brain cavity. For this type of tumor, radiation or surgery is usually recommended. Peace of mind results, though the tinnitus usually remains.
Types of hearing loss and tinnitus
Basically, there are three types of hearing loss: sensorineural, conductive, and mixed (a combination of the former two). Otosclerosis may be present if one has a conductive hearing loss along with tinnitus. A conductive hearing loss means that there is a medical problem within the auditory system causing the loss that can be addressed with the use of medicines or surgery. It is not due to nerve damage within the cochlea as is the case with sensorineural loss. Otosclerosis is a disease that fuses the stapes—the stirrup-like bone in the middle ear—causing it to be immobile. To correct this problem, the diseased stapes is removed and replaced with a prosthesis. This procedure corrects the conductive loss, restoring hearing, and is also often successful in reducing or stopping the tinnitus.
Can a cochlear implant help?
Many of you have probably heard of cochlear implants. This is an electrical device that is surgically threaded into the cochlea of a deaf ear whose hearing nerve is still intact. Over half of those who had tinnitus before their cochlear implant, have reported an improvement in their tinnitus after this surgery. But, there are some who have reported the onset of tinnitus after this procedure! So, it appears that any time the ear is traumatized by disease or surgery, tinnitus can result.
A surgical procedure tailored to tinnitus?
All these situations involve conditions that are not related to tinnitus, though tinnitus may accompany them. So, you are probably asking, "Is there a surgery that just treats tinnitus itself?" Welllllll—yes and no.
There is a mostly obsolete surgical approach to tinnitus that severs the cochlear nerve. The surgery is called cochlear nerve section. A few well-meaning surgeons still perform this procedure, mainly because desperate tinnitus sufferers still ask for this surgery. But, I want to present a BIG CAUTION SIGN here regarding this course of action.
When the cochlear nerve is severed, no sound at all can proceed along the neural pathway to the brain. This means permanent deafness results! On top of that, this surgery is no guarantee that the tinnitus will stop!! Therefore, a patient who takes this extreme approach to dealing with their tinnitus may be left totally deaf in that ear and still have the tinnitus, oftentimes much worse than they had it before! It's a huge gamble to choose this route for treating one's tinnitus.
The reason this surgery is often unsuccessful is that tinnitus probably originates somewhere in the brain, not within the ear mechanism. True, the damage could have begun in the ear with noise trauma or exposure to ototoxic drugs. When damage to the hair cells within the cochlea occur, inconsistent signals are then sent to the brain, and over time, the brain decides to take over and provide its own signal—tinnitus. |
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| (Article 0706, Part 5. Originally published December 2006) |
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