Tinnitus is a condition where an individual perceives a sound in absence of external acoustic stimulation. Wilson & Sutton (1981) point out that the perceived sound varies enormously in quality ranging from to humming to rather complex sounds that cause devastating distraught to the patients. This kind of disorder is usually referred to as subjective. This is due to the fact that it is only the patient who can really hear and explain their experiences and in most cases the second parties are ignorant of their ordeals. This disorder has caused tremendous suffering and depression among the patients who suffer from it. Philippot et al. (2012) highlight that it is reported that tinnitus can be perceived by one ear or both and it can perceive a single sound or multiple sounds. There are other cases where tinnitus are objective i.e. they can be detected by medical practitioners attending to the patients.
To some aspects, tinnitus is divided into smaller groups regarding their significances. They include pathological tinnitus and normal tinnitus. Fackrell et al. (2017) assert pathological tinnitus can be heard for a period longer that five minutes. It can take place more than twice a week and they usually results to hearing impairment among the patients that suffer from this type of disorder. However, Maes et al. (2014) illustrate that normal tinnitus affects majority of the patients. It is less detrimental compared to the pathological one. It occurs not more than once in a year and when it occurs, it hardly lasts for five minutes. Various theories regarding the dysfunctional nature of the human earing system have been hypothesized but it should be noted that none of them have stood the test of time since they lack any supportive evidence to back their suppositions. Theories that try to explain the pathophysiology of subjective tinnitus remains mere speculations since they cannot be scientifically validated (Veile et al., 2018).
It is estimated that in the year 2010, there were rapid increase in the cases of hearing disorders and 80% of those disorders were characterized by tinnitus. Dawes et al. (2014) further demonstrate that it was also noted that elder people were the worst hit as young people from the age of 15-50 years had only 15% reported and documented cases of such occurrences. Due to asymmetric noise exposure, individuals who suffered from tinnitus complained that their left year was the most affected and 60% perceived the sounds of high frequencies.
Cases of Tinnitus in the United Kingdom
It should be noted that the prevalence of tinnitus increases with the age of an individual. In the United Kingdom, cases of tinnitus have been reported since early 1990s. However, one outstanding discovery that was made was that the disorder highly affects individuals who are above 50 in age. Martinez et al. (2015) report that cases of this disorder in children is hardly reported and young adults seldom complain of suffering from such disorders. The research conducted by various scholars in trying the age bracket in which the disease is highly prevalent established that those adults who are in the age bracket of 60-69 to octogenarians have the highest prevalence and susceptibility when it comes to tinnitus (Martinez et al., 2015).
There are several researches that have been conducted in pursuant to the above subject and the most conclusive report that was made is that tinnitus was perceived to be self-reported and that it lasted for not more than 5 minutes. Martinez et al. (2015) further estimate that there was also a discovery that more than 70 million European habitats have reported the cases of this disorder and more than 50 million people in the United States are victims of tinnitus. It was also established that the prevalence of tinnitus in males are higher than in females (Martinez et al., 2015). This disparity have been attributed to the fact that most males are exposed to industrial noise than the female counterparts. However, some researchers are of the opinion that the cause of the disparity is because the females are more sensitized when it comes to issues relating to tinnitus than the males.
Factors contributing to Tinnitus
There are various factors that have been pointed out as the causal agents of this disorder. These factors range from self-induced issues to environmental factors that are detrimental to the hearing system of an individual. Udubi et al. (2013) deduce that self-induced factors include exposure to loud sounds in the pretext of enjoying music. It is noted that loud music causes immeasurable harm to eardrums and the hearing system as a whole which opens avenues for tinnitus to thrive. Further researches established that poor waxing of the ear over a long period of time causes possess a great risk for the eardrum. This practice compounded with activities which will expose an individual to scratch the internal organs of the ear.
Theodoroff et al. (2017) note that environmental factors have been pointed out as those factors that contribute immensely to the prevalence of tinnitus. These include explosion, gunfire, exposure to recreational music which is loud enough and amplified as well as exposure to occupational noise. Among them all, exposure to amplified recreational music has been touted as one of the factor that has the highest rate in tinnitus prevalence than any of the factors listed. On the hand, Moore et al. (2017) affirms that it is noted that tinnitus can result from medication or drugs, head trauma and acoustic neuroma. These medical related causes stems from dysfunctional neural activity that are as a result of medical pathologies.
Traditional Methods of Treating Tinnitus
Apart from using antidepressants to try to curb tinnitus, there are some other practices that have been employed over a given period of time with an aim of trying to eradicate the disorder. Sereda et al. (2015) emphasize that hearing aids or other sound masking mechanisms have been employed to ensure that those patients that have hearing impairments have been given remedies to their conditions. These devices have been applauded for aiding hearing and helping people with hearing disabilities but their effectiveness have not been conclusively established since there are some patients that still complain about their effectiveness. There are other pharmacological agents that are as well used in trying to eradicate the disorder (Sereda et al., 2015). These pharmacological agents include vasodilators, anti-spasmodic drugs, calcium antagonists, local anesthetics, and anticonvulsants. These drugs have been frequently used in trying to contain tinnitus. However, when negligible tests were administered on the patients, there were instances where efficacy continued to appear and that rendered the effectiveness in their usage inconclusive.
In some extents, Hoare & Hall (2011) note that psychological techniques were employed in an effort to try to curb this disorder. The neurophysiological model was established and this increased a method of treatment which was widely known as tinnitus restraining therapy (TRT). This technique employed the use of counselling, low level and wide band sound was used to promote adjustment. These method was backed by other complementary methods such as aromatherapy, reflexology, and acupuncture. There were cases where the use of Ginkgo biloba which was based on cognitive behavioural therapy and oxygen therapy were employed though they were subjected to great degree of scrutiny.
Having improved understanding of the role of the auditory system when managing tinnitus has led to the formulation of various modalities that are located and channeled at the auditory pathways of the brain. Hall et al., (2013) counsel that this has been facilitated by the use of repetitive transcranial magnetic stimulation (rTMS). This method has not proved very successful owing to the fact it involves a broader use of technology which most people might not be acquainted to unless they are skilled. All these methods have simply elicited the need for diverse approaches to be developed when tackling this hearing disorder.
The Use of Antidepressants in Managing Subjective Tinnitus
Antidepressants have been employed to help in the treatment of tinnitus. For a clear understanding, antidepressants are categorized into Tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs). There are independent researches that have been undertaken regarding the types of the antidepressants that have been employed in trying to curb tinnitus. This section will separately explore various drugs that have been administered to the patients as per the topics.
Tricyclic Antidepressants (TRC)
Park (2016) notes that antidepressant such as notriptyline demonstrates a reduced level of depression when used. It further reduces the loudness of the tinnitus and functional disability in patients that have been adversely affected by the disorder. It was noted that this has come as a great reprieve to the patients who are greatly depressed by this disorder. However, there were reported cases of insomnia among the women and men who used the medication to curb their situation. Sullivan et al. (1993) report that the drug was also having some adverse side effects such as dry mouth, dyspepsia and constipation. Therefore, inasmuch as the drug can be used to reduce cases of depressions that are brought about by tinnitus, its use is characterized with various side effects that can further give rise to other unwanted complications among the patients.
When Bayar et al. (2001) administered a higher dosage of amitriptyline was used in a single blind randomized placebo for one week, the study highlighted a significant reduction in the severity of tinnitus in most of the test subjects that made part of the study. Initial use of the same antidepressant showed that there was minimum side effects. The dose administered was 10mg thrice a day for ten consecutive weeks. When the dose was adjusted to 50 mg thrice a day in six weeks, there was increased dryness in the mouth and sedation was noticed. The study subjects did not show any form of depression.
Laird (1989) established that there were instances where tricyclic antidepressants stimulated the development of tinnitus. It was established in a random research conducted by Laird (1989) that if ten individuals will take imipramine of between 150mg to 250 mg daily, there was a decrease in depression but the development of tinnitus increased in the next five days from the date the drug was administered. This condition took a different turn when continuous treatment of tinnitus using the same drug showed that tinnitus disappeared in the next few days.
Mendis (2008) investigated a handful subjects who were subjected to trimipramine. The procedure involved a double blind, placebo controlled trial of 26 test subjects. The findings of the study concluded that there was remarkable improvement in 19 test subjects who finished the treatment. Other 40% of the test subjects reported that they experience some changes at a given point during the medication using trimipramine. The data analysis of the researcher was faulted and it was noted that the data obtained must be treated with caution since the information given regarding the dose administered were imprecise and riddled with ambiguity.
Selective Serotonin Reuptake Inhibitors
In a double-blind placebo-controlled trial, by Robinson et al. (2005) through the use of paroxetine, it was established that there was no significant improvement in anxiety or those depressions that are associated with tinnitus. This study was basically aimed at establishing the differences between the depressed and the non-depressed subjects. Instances of depression was still reported in few test subjects that were used. It was further highlighted that the drug administered came with many adverse side effects such as sexual dysfunction, headache, dry mouth and extreme need to sleep. However, Christensen (2001) reports that the same subjects were subjected to treatments using paroxetine, the females noticed remarkable changes than they were when they used imipramine.
Zoger et al. (2006) conducted random double blind, placebo controlled study using sertraline at 25mg per day that has been increased to 50mg. It was noted that the increase made the antidepressant more superior than the placebo. There were also remarkable improvements that were noticed. This manifested itself through reduced tinnitus severity, loudness, depression and anxiety. He further reported that 70% of his test subjects discontinued the treatment hence the improvement noted was only reported on those who completed their treatments. However, Pandon (2009) highlights that there were some side effects such as sexual dysfunction that were reported during the studies. Scholars such as claimed that the behavior of the drug is just exactly as that of venflaxine that was used on a 35 year-old patient.
Gaps of the Literature
Various scholars have researched on various antidepressants that have been subjected to tests to weigh their effectiveness in combating the depression that is caused by tinnitus. Most of the test drugs highlighted have shown that even though the antidepressants that have some significant effect in alleviating tinnitus. However, most of them have side effects that further worsen the condition of the patients while others does not show any significant improvement. This study therefore aims at identifying various antidepressants which can help control tinnitus with a low side effects. This has not been captured by the existing literatures and the tests conducted by various researchers.
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