[Tinnitus--classification, causes, diagnosis, treatment and prognosis].MMW Fortschr Med. 2004 Jan 15; 146(1-2):23-4, 26-8; quiz 29-30.MF
Up to 45% of all adults in the industrialized countries are afflicted by noises in the ears--approximately one million people require treatment in Germany alone. Classification of tinnitus is oriented to the duration of symptoms and their severity, the latter taking into account the victim's distress both at work and during leisure time. Acute tinnitus is often caused by an ear condition or psychosocial stress. Chronic tinnitus can be caused by persistent exposure to noise, whiplash injuries or functional disorders of the cervical spine. The diagnosis is based on audiometric and otoneurologic investigations, possibly magnetic resonance tomography and serology when an infection is suspected. Acute tinnitus is treated with infusions--mostly with cortisone or pentoxifylline--or a short-term oral medication with these substances. Since no causal therapy is available for chronictinnitus, therapeutic counseling has a particular role to play with emphasis on informing the patient on the results of investigations and suggesting coping strategies. Following an appropriate diagnostic work-up, the patient should be advised of the harmless nature of the noises and encouraged to adopt a positively motivated approach to the symptoms. Tinnitus retraining therapy aims to permanently suppress conscious awareness of the noises in the ear. For this purpose, a noise generator, generally worn within the ear auricle, is employed among other things. The prognosis is dependent not only on the presence or otherwise of organic disease but also--almost always--on such aspects as perception and coping by the individual patient.