Tinnitus is the symptom of a malfunction. If it is subjective, its etiology is difficult to establish because it is not linked to a loss of hearing. There are many possible causes. For example, the toxicity of some treatments by antibiotics or anti-inflammatories, some kinds of chemotherapy, auditory trauma (firecrackers, concerts etc.), sudden deafness, hypoacousis, neuroma, mandibular or cervical problems, chronic infections, Meniere’s syndrome, hypertension, severe anemia, stress and depression, extreme tiredness... “One of the problems is that clinical studies tend to put all cases of subjective tinnitus in one basket. Also, from a therapeutic point of view, it’s as if we treated apples pears and bananas in the same way”, explains Philippe Lefèbvre.

There is no objective parameter which makes it possible to measure the intensity of tinnitus. Therefore the doctor has no other choice than to rely on the subjective assessment of the tinnitus sufferer. “If we asked a patient to rate the intensity of his tinnitus on a scale of 0 to 10, his estimate would be more likely to reflect the way he himself sees it, that is to say his ability to distance the problem from his field of consciousness, than the actual noise level itself”, explains Dr. Audrey Maudoux, research fellow at the FNRS, doctoral candidate and resident at the ENT department of the University Hospital of Liège.

The type of noise (buzzing, whistling...) is not characteristic of a particular type of tinnitus nor is it characteristic of the underlying cause of the problem. In addition, it has been demonstrated that its frequency (low-pitched or high-pitched) does not have an impact on whether or not the patient is bothered or not by its presence. “The same pattern is more or less to be found in groups of individuals discommoded by their tinnitus and in those who do not complain about it”, explains Audrey Maudoux.

Phenomenon of habituation

When patients consult a doctor about a case of tinnitus that has just recently appeared, the chances of reversing the problem and making it disappear are good if it is linked to an ear infection, sudden deafness or more broadly pathologies of the ear that are treatable. In the acute phase, corticoids will generally be given as first-line treatment. Tinnitus can also have other medical causes that we can expect to resolve: for example, hypertension, a neurinoma or a cerebral vascular problem.

Often, however, the etiology of tinnitus remains poorly defined and treatments during the acute phase have not been crowned with success. The phenomenon then becomes a chronic one. Is it possible to predict the development of the problem? It is difficult to do so. The tinnitus may disappear one day for an unknown reason, stay with the individual for life and vary in terms of its intensity or form. Once they are reassured as to the benign nature of their tinnitus, which is the most common situation, most individuals are no longer disturbed by the phantom noises that characterize it- the brain succeeds in confining the problem to the unconscious.