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the natural history of tinnitus in older adults found that, for women, tinnitus
increased for 25%, decreased in 58%, leaving 17% unchanged. The study found tha
t, for men, tinnitus increased in 8%, decreased in 39%, leaving 53% unchanged. I
nformation about the course of tinnitus would benefit from prospective studies i
nvestigating change over time as these studies may potentially be more accurate.
[13]
Psychological
Persistent tinnitus may cause irritability, fatigue and, on occasions, clinical
depression[14][15] and musical hallucinations.[16]
Tinnitus annoyance is more strongly associated with psychological condition than
loudness or frequency range.[17][18][19] Other psychological problems such as d
epression, anxiety, sleep disturbances and concentration difficulties are common
in those with worse tinnitus.[20][21][22] 45% of people with tinnitus have an a
nxiety disorder at some time in their life.[23]
As part of the idea that the central-auditory-system may be implicated into the
tinnitus development, serotonin has also been implicated. Indeed, serotonin has
been postulated to be involved in plastic changes in the brain. Serotonin re-upt
ake inhibitors (such as some anti-depressant drugs) have often been used for thi
s reason.[24] However those medications do not benefit in a consistent fashion o
n non-depressant people.[25]
Psychological research has looked at the tinnitus distress reaction (TDR) to acc
ount for differences in tinnitus severity.[20] Research has stigmatized people w
ith severe tinnitus by implying they have personality disorders, such as neuroti
cism, anxiety sensitivity, and catastrophic thinking, which all predispose incre
ased TDR.[26][27][28] These findings suggest that at the initial perception of t
innitus, conditioning links tinnitus with negative emotions, such as fear and an
xiety from unpleasant stimuli at the time. This enhances activity in the limbic
system and autonomic nervous system, thus increasing tinnitus awareness and anno
yance.[29]
Causes
There are two types of tinnitus: subjective tinnitus and objective tinnitus.[3]
Tinnitus is usually subjective, meaning that others cannot hear it.[3] Subjectiv
e tinnitus has been also called "tinnitus aurium" "nonauditory" and "nonvibrator
y" tinnitus. Occasionally, tinnitus may be heard by someone else using a stethos
cope: in which case, it is objective tinnitus.[3] Objective tinnitus has been ca
lled "pseudo-tinnitus" or "vibratory" tinnitus.
Subjective tinnitus
Subjective tinnitus is the most frequent type of tinnitus. It can have many poss
ible causes but, most commonly, results from hearing loss. A frequent cause of s
ubjective tinnitus is noise exposure which damages hair cells in the inner ear c
ausing tinnitus. Subjective tinnitus can only be heard by the affected person an
d is caused by otology, neurology, infection or drugs.[30]
There is a growing body of evidence suggesting that tinnitus is a consequence of
neuroplastic alterations in the central auditory pathway. These alterations are
assumed to result from a disturbed sensory input, caused by hearing loss.[31] H
earing loss could indeed cause a homeostatic response of neurons in the central
auditory system, and therefore cause tinnitus.[32]
Despite the opinion amongst researchers that tinnitus is primarily a central ner
vous system pathology, there certainly exists a class of people whose tinnitus i
s peripherally based.[33]
Hearing loss
The most common cause of tinnitus is noise-induced hearing loss. Hearing loss ma
y be implicated even for people with normal audiograms.[32]
Hearing loss may have many different causes; but among tinnitus subjects, the ma
jor cause is cochlear damage.[31]
Ototoxic drugs (such as aspirin) can also cause subjective tinnitus, as they may
cause hearing loss, or increase the damage done by exposure to loud noise. Thos
e damages can occur even at doses that are not considered ototoxic.[34] Tinnitus
is also a classical side effect of quinidine, a Class IA anti-arrhythmic. Over
260 medications have been reported to cause tinnitus as a side effect.[35] In ma