Tonsil Stones (Tonsoliths)
Your tonsils are gland-like structures in the back of your throat made of tissue that contains lymphocytes — cells in your body that prevent and fight infections. It is believed that the tonsils play a role in the immune system and are meant to function like nets trapping incoming bacteria and virus particles that are passing through your throat.
Sometimes the crevices and pockets in your tonsils get filled with bacteria food debris dead cells mucus and other materials that can get trapped. These materials can eventually build up and calcify.
Tonsil stones or tonsoliths are formed when this trapped debris hardens or calcifies. This tends to occur most often in people who suffer from chronic inflammation in their tonsils or repeated bouts of tonsillitis
What Are the Symptoms of Tonsil Stones?
Many small tonsil stones do not cause any noticeable symptoms. Even when they are large some tonsil stones are only discovered incidentally on X-rays or CT scans. Some larger tonsoliths however may have multiple symptoms:
- Bad breath. One of the prime indicators of a tonsil stone is exceedingly bad breath or halitosis that accompanies a tonsil infection. One study of patients with a form of chronic tonsillitis used a special test to see if volatile sulfur compounds were contained in the subjects’ breath. The presence of these foul-smelling compounds provides objective evidence of bad breath. The researchers found that 75% of the people who had abnormally high concentrations of these compounds also had tonsil stones. Other researchers have suggested that tonsil stones be considered in situations when the cause of bad breath is in question.
- Sore throat. When a tonsil stone and tonsillitis occur together it can be difficult to determine whether the pain in your throat is caused by your infection or the tonsil stone. The presence of a tonsil stone itself though may cause you to feel pain or discomfort in the area where it is lodged.
- White debris. Some tonsil stones are visible in the back of the throat as a lump of solid white material. This is not always the case. Often they are hidden in the folds of the tonsils. In these instances they may only be detectable with the help of non-invasive scanning techniques such as CT scans or magnetic resonance imaging.
- Difficulty swallowing. Depending on the location or size of the tonsil stone it may be difficult or painful to swallow foods or liquids.
- Ear pain. Tonsil stones can develop anywhere in the tonsil. Because of shared nerve pathways they may cause a person to feel referred pain in the ear even though the stone itself is not touching the ear.
- Tonsil swelling. When collected debris hardens and a tonsil stone forms inflammation from infection (if present) and the tonsil stone itself may cause a tonsil to swell or become larger.
How Are Tonsil Stones Treated?
The appropriate treatment for a tonsil stone depends on the size of the tonsoliths and its potential to cause discomfort or harm. Various options include:
- No treatment. Many tonsil stones especially ones that have no symptoms require no special treatment.
- At-home removal. Some people choose to dislodge tonsil stones at home with the use of picks or swabs.
- Salt water gargles. Gargling with warm salty water may help alleviate the discomfort of tonsillitis which often accompanies tonsil stones.
- Antibiotics. Various antibiotics can be used to treat tonsil stones. While they may be helpful for some people they cannot correct the basic problem that is causing tonsoliths. Also antibiotics can have side effects.
- Surgical removal. When tonsil stones are exceedingly large and symptomatic it may be necessary for a surgeon to remove them.
Can Tonsil Stones Be Prevented?
There are certain things you can do to prevent tonsil stones from developing in the first place or coming back once they get removed. Some of these things include:
- Removing bacteria that builds up at the back of your tongue once you get done brushing your teeth. The best way to do this is to utilize a tongue scraper each night before you go to bed each night.
- Brush your teeth regularly so that you can get rid of food debris that get trapped in between your teeth. Brush your teeth and tongue at least 2 times everyday.
- Combine 1 tablespoons of salt and 1 cup of water and gargle it. Gargling salt water will help disinfect your mouth and help remove bacteria that could cause tonsil stones. Do this a few times everyday.
- Increasing your water intake is a good way to prevent this problem as it will help keep your mouth moisturized. Stay away from sugared drinks likes sodas and a diet high in simple sugars because they are known to contribute to the development of tonsil stones.
- Try to stop smoking and drinking alcohol as much. Drinks with alcohol in it can leave your mouth dry which isn’t good if you often experience tonsil stones. Smoking won’t help your situation either.
Tonsillitis refers to inflammation of the pharyngeal tonsils (glands at the back of the throat visible through the mouth). The inflammation may involve other areas of the back of the throat including the adenoids and the lingual tonsils (tonsil tissue at the back of the tongue). There are several variations of tonsillitis: acute recurrent and chronic tonsillitis and peritonsillar abscess.
Viral or bacterial infections and immunologic factors lead to tonsillitis and its complications. Nearly all children in the United States experience at least one episode of tonsillitis. Due to improvements in medical and surgical treatments complications associated with tonsillitis including mortality are rare.
Who gets tonsillitis?
Tonsillitis most often occurs in children but rarely in those younger than two years old. Tonsillitis caused by bacteria (streptococcus species) Streptococcus species typically occurs in children aged 5 to 15 years while viral tonsillitis is more common in younger children. A peritonsillar abscess is usually found in young adults but can occur occasionally in children. The patient's history often helps identify the type of tonsillitis present (i.e. acute recurrent chronic).
What causes tonsillitis?
The herpes simplex virus Streptococcus pyogenes (GABHS) Epstein-Barr virus (EBV) cytomegalovirus adenovirus and the measles virus cause most cases of acute pharyngitis and acute tonsillitis. Bacteria cause 15-30 percent of pharyngotonsillitis cases; GABHS is the cause for most bacterial tonsillitis. (i.e. “strep throat”).
What are the symptoms of tonsillitis?
The type of tonsillitis determines what symptoms will occur.
• Acute tonsillitis: Patients have a fever sore throat foul breath dysphagia (difficulty swallowing) odynophagia (painful swallowing) and tender cervical lymph nodes. Airway obstruction due to swollen tonsils may cause mouth breathing snoring nocturnal breathing pauses or sleep apnea. Lethargy and malaise are common. These symptoms usually resolve in three to four days but may last up to two weeks despite therapy.
• Recurrent tonsillitis: This diagnosis is made when an individual has multiple episodes of acute tonsillitis in a year.
• Chronic tonsillitis: Individuals often have chronic sore throat halitosis tonsillitis and persistently tender cervical nodes.
• Peritonsillar abscess: Individuals often have severe throat pain fever drooling foul breath trismus (difficulty opening the mouth) and muffled voice quality such as the “hot potato” voice (as if talking with a hot potato in his or her mouth).
What happens during the physician visit?
Your child will undergo a general ear nose and throat examination as well as a review of the patient’s medical history. A physical examination of a young patient with tonsillitis may find:
- Fever and enlarged inflamed tonsils covered by pus.
- Group A beta-hemolytic Streptococcus pyogenes (GABHS) can cause tonsillitis (“strep throat”) associated with the presence of palatal petechiae (tiny hemorrhagic spots of pinpoint to pinhead size on the soft palate). Neck nodes may be enlarged. A fine red rash over the body suggests scarlet fever. GABHS pharyngitis usually occurs in children 5-15 years old.
- Open-mouth breathing and muffled voice resulting from obstructive tonsillar enlargement. The voice change with acute tonsillitis usually is not as severe as that associated with peritonsillar abscess.
- Tender cervical lymph nodes and neck stiffness (often found in acute tonsillitis).
- Signs of dehydration (found by examination of skin and mucosa).
- The possibility of infectious mononucleosis due to EBV in an adolescent or younger child with acute tonsillitis particularly when cervical axillary and/or groin nodes are tender. Severe lethargy malaise and low-grade fever accompany acute tonsillitis.
- A grey membrane covering tonsils that are inflamed from an EBV infection. (This membrane can be removed without bleeding.) Palatal petechiae (pinpoint spots on the soft palate) may also be seen with an EBV infection.
- Red swollen tonsils that may have small ulcers on their surfaces in individuals with herpes simplex virus (HSV) tonsillitis.
- Unilateral bulging above and to the side of one of the tonsils when peritonsillar abscess exists. A stiff jaw difficulty opening the mouth and pain referred to the ear may be present in varying severity.
Tonsillitis is usually treated with a regimen of antibiotics. Fluid replacement and pain control are important. Hospitalization may be required in severe cases particularly when there is airway obstruction. When the condition is chronic or recurrent a surgical procedure to remove the tonsils is often recommended. Peritonsillar abscess may need more urgent treatment to drain the abscess.
Reference: American Academy of Otolaryngology. http://www.entnet.org/HealthInformation/tonsillitis.cfm
Insight into tonsillectomy and adenoidectomy
Tonsils and adenoids are the body’s first line of defense as part of the immune system. They “sample” bacteria and viruses that enter the body through the mouth or nose but they sometimes become infected. At times they become more of a liability than an asset and may even cause airway obstruction or repeated bacterial infections. Your ear nose and throat (ENT) specialist can suggest the best treatment options.
What are tonsils and adenoids?
Tonsils and adenoids are similar to the lymph nodes or “glands” found in the neck groin and armpits. Tonsils are the two round lumps in the back of the throat. Adenoids are high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth or nose without special instruments.
What affects tonsils and adenoids?
The two most common problems affecting the tonsils and adenoids are recurrent infections of the nose and throat and significant enlargement that causes nasal obstruction and/or breathing swallowing and sleep problems.
Abscesses around the tonsils chronic tonsillitis and infections of small pockets within the tonsils that produce foul-smelling white deposits can also affect the tonsils and adenoids making them sore and swollen. Cancers of the tonsil while uncommon require early diagnosis and aggressive treatment.
When should I see a doctor?
You should see your doctor when you or your child experience the common symptoms of infected or enlarged tonsils or adenoids.
Your physician will ask about problems of the ear nose and throat and examine the head and neck. He or she may use a small mirror or a flexible lighted instrument to see these areas.
Other methods used to check tonsils and adenoids are:
- Medical history
- Physical examination
- Throat cultures/Strep tests – helpful in determining infections in the throat
- X-rays – helpful in determining the size and shape of the adenoids
- Blood tests – helpful in diagnosing infections such as mononucleosis
- Sleep study or polysomnogram-helpful in determining whether sleep disturbance is occurring because of large tonsils and adenoids.
Tonsillitis and its symptoms
Tonsillitis is an infection of the tonsils. One sign is swelling of the tonsils. Other symptoms are:
- Redder than normal tonsils
- A white or yellow coating on the tonsils
- A slight voice change due to swelling
- Sore throat sometimes accompanied by ear pain.
- Uncomfortable or painful swallowing
- Swollen lymph nodes (glands) in the neck
- Bad breath
Enlarged tonsils and/or adenoids and their symptoms
If your or your child’s adenoids are enlarged it may be hard to breathe through the nose. If the tonsils and adenoids are enlarged breathing during sleep may be disturbed. Other signs of adenoid and or tonsil enlargement are:
- Breathing through the mouth instead of the nose most of the time
- Nose sounds “blocked” when the person speaks
- Chronic runny nose
- Noisy breathing during the day
- Recurrent ear infections
- Snoring at night
- Restlessness during sleep pauses in breathing for a few seconds at night(may indicate sleep apnea).
How are tonsil and adenoid diseases treated?
Bacterial infections of the tonsils especially those caused by streptococcus are first treated with antibiotics. Removal of the tonsils (tonsillectomy) and/or adenoids (adenoidectomy) may be recommended if there are recurrent infections despite antibiotic therapy and/or difficulty breathing due to enlarged tonsils and/or adenoids. Such obstruction to breathing causes snoring and disturbed sleep that leads to daytime sleepiness and may even cause behavioral or school performance problems in some children.
Chronic infections of the adenoids can affect other areas such as the eustachian tube–the passage between the back of the nose and the inside of the ear. This can lead to frequent ear infections and buildup of fluid in the middle ear that may cause temporary hearing loss. Studies also find that removal of the adenoids may help some children with chronic earaches accompanied by fluid in the middle ear (otitis media with effusion).
In adults the possibility of cancer or a tumor may be another reason for removing the tonsils and adenoids. In some patients especially those with infectious mononucleosis severe enlargement may obstruct the airway. For those patients treatment with steroids (e.g. prednisone) is sometimes helpful.
How to prepare for surgery
- Talk to your child about his/her feelings and provide strong reassurance and support
- Encourage the idea that the procedure will make him/her healthier.
- Be with your child as much as possible before and after the surgery.
- Tell him/her to expect a sore throat after surgery and that medicines will be used to help the soreness.
- Reassure your child that the operation does not remove any important parts of the body and that he/she will not look any different afterward.
- It may be helpful to talk about the surgery with a friend who has had a tonsillectomy or adenoidectomy.
- Your otolaryngologist can answer questions about the surgical procedure.
Adults and children
For at least two weeks before any surgery the patient should refrain from taking aspirin or other medications containing aspirin. (WARNING: Children should never be given aspirin because of the risk of developing Reye’s syndrome). Your doctor may ask to you to stop taking other medications that may interfere with clotting.
- Tell your surgeon if the patient or patient’s family has had any problems with anesthesia or clotting of blood. If the patient is taking medications has sickle cell anemia has a bleeding disorder is pregnant or has concerns about the transfusion of blood the surgeon should be informed.
- A blood test may be required prior to surgery.
- A visit to the primary care doctor may be needed to make sure the patient is in good health at surgery.
- You will be given specific instructions on when to stop eating food and drinking liquids before surgery. These instructions are extremely important as anything in the stomach may be vomited when anesthesia is induced.
When the patient arrives at the hospital or surgery center the anesthesiologist and nursing staff may meet with the patient and family to review the patient’s history. The patient will then be taken to the operating room and given an anesthetic. Intravenous fluids are usually given during and after surgery.
After the operation the patient will be taken to the recovery area. Recovery room staff will observe the patient closely until discharge. Every patient is unique and recovery time may vary.
Your ENT specialist will provide you with the details of preoperative and postoperative care and answer your questions.
There are several postoperative problems that may arise. These include swallowing problems vomiting fever throat pain and ear pain. Occasionally bleeding from the mouth or nose may occur after surgery. If the patient has any bleeding your surgeon should be notified immediately. It is also important to drink liquids after surgery to avoid dehydration.
Any questions or concerns you have should be discussed openly with your surgeon.
Reference: American Academy of Otolaryngology. http://www.entnet.org/HealthInformation/tonsilsAdenoids.cfm
Tips for Keeping Humidifier Clean:
To keep humidifiers free of harmful mold fungi and bacteria follow the guidelines recommended by the manufacturer
These tips for portable humidifiers also can help:
- Use distilled or demineralized water. Tap water contains minerals that can create deposits inside your humidifie r that promote bacterial growth. And when released into the air these minerals often appear as white dust on your furniture. You may also breathe in some minerals that are dispersed into the air. Distilled or demineralized water contains a much lower mineral content compared with tap water. In addition use demineralization cartridges or filters if recommended by the manufacturer.
- Change humidifier water often. Don’t allow film or deposits to develop inside your humidifiers. Empty the tanks dry the inside surfaces and refill with clean water every day if possible.
Clean humidifiers every three days. Unplug the humidifier before you clean it.
Remove any mineral deposits or film from the tank or other parts of the humidifier with a 3 percent hydrogen peroxide solution which is available at pharmacies. Some manufacturers recommend using chlorine bleach or other disinfectants.Always rinse the tank after cleaning to keep harmful chemicals from becoming airborne — and then inhaled.
- Change humidifier filters regularly. If the humidifier has a filter change it at least as often as the manufacturer recommends — and more often if it’s dirty.
- Keep the area around humidifiers dry. If the area around a humidifier becomes damp or wet — including windows carpeting drapes or tablecloths — turn the humidifier down or reduce how frequently you use it.
- Prep humidifiers for storage. Drain and clean humidifiers before storing them. And then clean them again when you take them out of storage for use.
- Throw away all used cartridges cassettes or filters.
- Follow instructions for central humidifiers.If you have a humidifier built into your central heating and cooling system read the instruction manual or ask your heating and cooling specialist about proper maintenance.
- Consider replacing old humidifiers. Over time humidifiers can build up deposits that are difficult or impossible to remove and encourage growth of bacteria.
Temporomandibular joint and muscle disorders (TMJ disorders) are problems or symptoms of the chewing muscles and joints that connect your lower jaw to your skull.
There are two matching temporomandibular joints — one on each side of your head located just in front of your ears. The abbreviation “TMJ” literally refers to the joint but is often used to mean any disorders or symptoms of this region.
Many TMJ-related symptoms are caused by the effects of physical stress on the structures around the joint. These structures include:
- Cartilage disk at the joint
- Muscles of the jaw face and neck
- Nearby ligaments blood vessels and nerves
For many people with temporomandibular joint disorders the cause is unknown. Some causes given for this condition are not well proven. These included:
- A bad bite or orthodontic braces
- Stress and tooth grinding. Many people with TMJ problems do not grind their teeth and many who have been grinding their teeth for a long time do not have problems with their TMJ joint. For some people the stress associated with this disorder may be caused by the pain as opposed to being the cause of the problem.
Poor posture can also be an important factor in TMJ symptoms. For example holding the head forward while looking at a computer all day strains the muscles of the face and neck.
Other factors that might make TMJ symptoms worse are stress poor diet and lack of sleep.
Many people end up having “trigger points” — contracted muscles in your jaw head and neck. Trigger points can refer pain to other areas causing a headache earache or toothache.
Other possible causes of TMJ-related symptoms include arthritis fractures dislocations and structural problems present since birth.
Symptoms associated with TMJ disorders may be:
- Biting or chewing difficulty or discomfort
- Clicking popping or grating sound when opening or closing the mouth
- Dull aching pain in the face
- Jaw pain or tenderness of the jaw
- Locking of the jaw
- Difficulty opening or closing the mouth
Exams and Tests
You may need to see more than one medical specialist for your TMJ pain and symptoms. This may include a primary care provider a dentist or an ear nose and throat (ENT) doctor depending on your symptoms.
A thorough examination may involve:
- A dental examination to show if you have poor bite alignment
- Feeling the joint and muscles for tenderness
- Pressing around the head to locate areas that are sensitive or painful
- Sliding the teeth from side to side
- Watching feeling and listening to the jaw open and shut
- X-rays or MRI of the jaw
Sometimes the results of the physical exam may appear normal.
Your doctor will also need to consider other conditions such as infections ear infections or nerve-related problems and headaches as the cause of your symptoms.
Simple gentle therapies are usually recommended first.
- Learn how to gently stretch relax or massage the muscles around your jaw. Your doctor dentist or physical therapist can help you with these.
- Avoid actions that cause your symptoms such as yawning singing and chewing gum.
- Try moist heat or cold packs on your face.
- Learn stress-reducing techniques.
- Exercising several times each week may help you increase your ability to handle pain.
Read as much as you can as opinion varies widely on how to treat TMJ disorders. Get the opinions of several doctors. The good news is that most people eventually find something that helps.
Ask you doctor or dentist about medications you can use:
- Short-term use of acetaminophen (Tylenol) or ibuprofen (Advil Motrin) naproxen (Aleve Naprosyn) or other nonsteroidal anti-inflammatory drugs
- Muscle relaxant medicines or antidepressants
- Rarely corticosteroid shots in the TMJ to treat inflammation
Mouth or bite guards also called splints or appliances have been used since the 1930s to treat teeth grinding clenching and TMJ disorders.
- While many people have found them to be useful the benefits vary widely. The guard may lose its effectiveness over time or when you stop wearing it. Other people may feel worse pain when they wear one.
- There are different types of splints. Some fit over the top teeth while others fit over the bottom teeth.
- Permanent use of these items may not be recommended. You should also stop if they cause any changes in your bite.
Failure of more conservative treatments does not automatically mean you need more aggressive treatment. Be cautious about any nonreversible treatment method such as orthodontics or surgery that permanently changes your bite.
Reconstructive surgery of the jaw or joint replacement is rarely required. In fact studies have shown that the results are often worse than before surgery.
For more information see The TMJ Association — www.tmj.org
For many people symptoms occur only sometimes and do not last long. They will go away in time with little or no treatment. Most cases can be successfully treated. Some cases of pain go away on their own without treatment. TMJ-related pain may return again in the future. If the cause is nighttime clenching treatment can be very tricky because it is a sleeping behavior that is hard to control.
Mouth splints are a common treatment approach for teeth grinding. While some splints may silence the grinding by providing a flat even surface they may not be as effective at reducing pain or stopping clenching. Splints may be effective in the short-term but could become less effective over time. Some splints can also cause changes in your bite. This may cause a new problem.
- Chronic face pain
- Chronic headaches
When to Contact a Medical Professional
See your health care provider right away if you are having trouble eating or opening your mouth. Keep in mind that a wide variety of possible conditions can cause TMJ symptoms from arthritis to whiplash injuries. Experts who are specially trained in facial pain can help diagnose and treat TMJ.
Many of the home-care steps to treat TMJ problems can prevent such problems in the first place:
- Avoid eating hard foods and chewing gum.
- Learn relaxation techniques to reduce overall stress and muscle tension.
- Maintain good posture especially if you work all day at a computer. Pause often to change position rest your hands and arms and relieve stressed muscles.
- Use safety measures to reduce the risk of fractures and dislocations.
Tinnitus is noise or ringing in the ears. A common problem tinnitus affects about 1 in 5 people. Tinnitus isn’t a condition itself — it’s a symptom of an underlying condition such as age-related hearing loss ear injury or a circulatory system disorder.
Although bothersome tinnitus usually isn’t a sign of something serious. Although it can worsen with age for many people tinnitus can improve with treatment. Treating an identified underlying cause sometimes helps. Other treatments reduce or mask the noise making tinnitus less noticeable.
Tinnitus involves the annoying sensation of hearing sound when no external sound is present. Tinnitus symptoms include these types of phantom noises in your ears:
The phantom noise may vary in pitch from a low roar to a high squeal and you may hear it in one or both ears. In some cases the sound can be so loud it can interfere with your ability to concentrate or hear actual sound. Tinnitus may be present all the time or it may come and go.
There are two kinds of tinnitus.
- Subjective tinnitus is tinnitus only you can hear. This is the most common type of tinnitus. It can be caused by ear problems in your outer middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).
- Objective tinnitus is tinnitus your doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem an inner ear bone condition or muscle contractions.
When to see a doctor
If you have tinnitus that bothers you see your doctor.
Make an appointment to see your doctor if:
- You develop tinnitus after an upper respiratory infection such as a cold and your tinnitus doesn’t improve within a week.
See your doctor as soon as possible if:
- You have tinnitus that occurs suddenly or without an apparent cause.
- You have hearing loss or dizziness with the tinnitus.
A number of health conditions can cause or worsen tinnitus. In many cases an exact cause is never found.
A common cause of tinnitus is inner ear cell damage. Tiny delicate hairs in your inner ear move in relation to the pressure of sound waves. This triggers ear cells to release an electrical signal through a nerve from your ear (auditory nerve) to your brain. Your brain interprets these signals as sound. If the hairs inside your inner ear are bent or broken they can “leak” random electrical impulses to your brain causing tinnitus.
Other causes of tinnitus include other ear problems chronic health conditions and injuries or conditions that affect the nerves in your ear or the hearing center in your brain.
Common causes of tinnitus
In many people tinnitus is caused by one of these conditions:
- Age-related hearing loss. For many people hearing worsens with age usually starting around age 60. Hearing loss can cause tinnitus. The medical term for this type of hearing loss is presbycusis.
- Exposure to loud noise. Loud noises such as those from heavy equipment chain saws and firearms are common sources of noise-related hearing loss. Portable music devices such as MP3 players or iPods also can cause noise-related hearing loss if played loudly for long periods. Tinnitus caused by short-term exposure such as attending a loud concert usually goes away; long-term exposure to loud sound can cause permanent damage.
- Earwax blockage. Earwax protects your ear canal by trapping dirt and slowing the growth of bacteria. When too much earwax accumulates it becomes too hard to wash away naturally causing hearing loss or irritation of the eardrum which can lead to tinnitus.
- Ear bone changes. Stiffening of the bones in your middle ear (otosclerosis) may affect your hearing and cause tinnitus. This condition caused by abnormal bone growth tends to run in families.
Other causes of tinnitus
Some causes of tinnitus are less common including:
- Meniere’s disease. Tinnitus can be an early indicator of Meniere’s disease an inner ear disorder that may be caused by abnormal inner ear fluid pressure.
- TMJ disorders. Problems with the temperomandibular joint the joint on each side of your head in front of your ears where your lower jawbone meets your skull can cause tinnitus.
- Head injuries or neck injuries. Head or neck trauma can affect the inner ear hearing nerves or brain function linked to hearing. Such injuries generally cause tinnitus in only one ear.
- Acoustic neuroma. This noncancerous (benign) tumor develops on the cranial nerve that runs from your brain to your inner ear and controls balance and hearing. Also called vestibular schwannoma this condition generally causes tinnitus in only one ear.
Blood vessel disorders linked to tinnitus
In rare cases tinnitus is caused by a blood vessel disorder. This type of tinnitus is called pulsatile tinnitus. Causes include:
- Head and neck tumors. A tumor that presses on blood vessels in your head or neck (vascular neoplasm) can cause tinnitus and other symptoms.
- Atherosclerosis. With age and buildup of cholesterol and other deposits major blood vessels close to your middle and inner ear lose some of their elasticity — the ability to flex or expand slightly with each heartbeat. That causes blood flow to become more forceful making it easier for your ear to detect the beats. You can generally hear this type of tinnitus in both ears.
- High blood pressure. Hypertension and factors that increase blood pressure such as stress alcohol and caffeine can make tinnitus more noticeable.
- Turbulent blood flow. Narrowing or kinking in a neck artery (carotid artery) or vein in your neck (jugular vein) can cause turbulent irregular blood flow leading to tinnitus.
- Malformation of capillaries. A condition called arteriovenous malformation (AVM) abnormal connections between arteries and veins can result in tinnitus. This type of tinnitus generally occurs in only one ear.
Medications that can cause tinnitus
A number of medications may cause or worsen tinnitus. Generally the higher the dose of these medications the worse tinnitus becomes. Often the unwanted noise disappears when you stop using these drugs. Medications known to cause or worsen tinnitus include:
- Antibiotics including polymyxin B erythromycin vancomycin and neomycin
- Cancer medications including mechlorethamine and vincristine
- Water pills (diuretics) such as bumetanide ethacrynic acid or furosemide
- Quinine medications used for malaria or other health conditions
- Certain antidepressants may worsen tinnitus
- Aspirin taken in uncommonly high doses (usually 12 or more a day)
Anyone can experience tinnitus but these factors may increase your risk:
- Loud noise exposure. Prolonged exposure to loud noise can damage the tiny sensory hair cells in your ear that transmit sound to your brain. People who work in noisy environments — such as factory and construction workers musicians and soldiers — are particularly at risk.
- Age. As you age the number of functioning nerve fibers in your ears declines possibly causing hearing problems often associated with tinnitus.
- Gender.Men are more likely to experience tinnitus.
- Smoking.Smokers have a higher risk of developing tinnitus.
- Cardiovascular problems. Conditions that affect your blood flow such as high blood pressure or narrowed arteries (atherosclerosis) can increase your risk of tinnitus.
Tinnitus can significantly affect quality of life. Although it affects people differently if you have tinnitus you also may experience:
- Sleep problems
- Trouble concentrating
- Memory problems
- Anxiety and irritability
Treating these linked conditions may not affect tinnitus directly but it can help you feel better.
Preparing for your appointment
Be prepared to tell you doctor about:
- Your signs and symptoms
- Your medical history including any other health conditions you have such as hearing loss high blood pressure or clogged arteries (atherosclerosis)
- All medications you take including herbal remedies
What to expect from your doctor
Your doctor is likely to ask you a number of questions including:
- When did you begin experiencing symptoms?
- What does the noise you hear sound like?
- Do you hear it in one or both ears?
- Has the sound you hear been continuous or does it come and go?
- How loud is the noise?
- How much does the noise bother you?
- What if anything seems to improve your symptoms?
- What if anything appears to worsen your symptoms?
- Have you been exposed to loud noises?
- Have you had an ear disease or head injury?
After you’ve been diagnosed with tinnitus you may need to see an ear nose and throat doctor (otolaryngologist). You may also need to work with a hearing expert (audiologist).
Tests and diagnosis
Your doctor will examine your ears head and neck to look for possible causes of tinnitus. Tests include:
- Hearing (audiological) exam. As part of the test you’ll sit in a soundproof room wearing earphones through which will be played specific sounds into one ear at a time. You’ll indicate when you can hear the sound and your results are compared with results considered normal for your age. This can help rule out or identify possible causes of tinnitus.
- Movement. Your doctor may ask you to move your eyes clench your jaw or move your neck arms and legs. If your tinnitus changes or worsens it may help identify an underlying disorder that needs treatment.
- Imaging tests. Depending on the suspected cause of your tinnitus you may need imaging tests such as CT or MRI scans.
- Clicking. Muscle contractions in and around your ear can cause sharp clicking sounds you hear in bursts. They may last from several seconds to a few minutes.
- Rushing or humming. Usually vascular in origin you may notice sound fluctuations when you exercise or change positions such as when you lay down or stand up.
- Heartbeat. Blood vessel problems such as high blood pressure an aneurysm or a tumor and blockage of the ear canal or eustachian tube can amplify the sound of your heartbeat in your ears (pulsatile tinnitus).
- Low-pitched ringing. Conditions that can cause low-pitched ringing in one ear include Meniere’s disease. Tinnitus may become very loud before an attack of vertigo — a sense that you or your surroundings are spinning or moving.
- High-pitched ringing. Exposure to a very loud noise or a blow to the ear can cause a high-pitched ringing or buzzing that usually goes away after a few hours. However if there’s hearing loss as well tinnitus may be permanent. Long-term noise exposure age-related hearing loss or medications can cause a continuous high-pitched ringing in both ears. Acoustic neuroma can cause continuous high-pitched ringing in one ear.
- Other sounds. Stiff inner ear bones (otosclerosis) can cause low-pitched tinnitus that may be continuous or may come and go. Earwax foreign bodies or hairs in the ear canal can rub against the eardrum causing a variety of sounds.
In many cases the cause of tinnitus is never found. Your doctor can discuss with you steps you can take to reduce the severity of your tinnitus or to help you cope better with the noise.
Treatments and drugs
Treating an underlying health condition
To treat your tinnitus your doctor will first try to identify any underlying treatable condition that may be associated with your symptoms. If tinnitus is due to a health condition your doctor may be able to take steps that could reduce the noise. Examples include:
- Earwax removal. Removing impacted earwax can decrease tinnitus symptoms.
- Treating a blood vessel condition. Underlying vascular conditions may require medication surgery or another treatment to address the problem.
- Changing your medication. If a medication you’re taking appears to be the cause of tinnitus your doctor may recommend stopping or reducing the drug or switching to a different medication.
In some cases white noise may help suppress the sound so that it’s less bothersome. Your doctor may suggest using an electronic device to suppress the noise. Devices include:
- White noise machines. These devices which produce simulated environmental sounds such as falling rain or ocean waves are often an effective treatment for tinnitus. You may want to try a white noise machine with pillow speakers to help you sleep. Fans humidifiers dehumidifiers and air conditioners in the bedroom may also help cover the internal noise at night.
- Hearing aids. These can be especially helpful if you have hearing problems as well as tinnitus.
- Masking devices. Worn in the ear and similar to hearing aids these devices produce a continuous low-level white noise that suppresses tinnitus symptoms.
- Tinnitus retraining. A wearable device delivers individually programmed tonal music to mask the specific frequencies of the tinnitus you experience. Over time this technique may accustom you to the tinnitus thereby helping you not to focus on it. Counseling is often a component of tinnitus retraining.
Drugs can’t cure tinnitus but in some cases they may help reduce the severity of symptoms or complications. Possible medications include:
- Tricyclic antidepressants such as amitriptyline and nortriptyline have been used with some success. However these medications are generally used for only severe tinnitus as they can cause troublesome side effects including dry mouth blurred vision constipation and heart problems.
- Alprazolam (Niravam Xanax) may help reduce tinnitus symptoms but side effects can include drowsiness and nausea. It can also become habit-forming.
Lifestyle and home remedies
Often tinnitus can’t be treated. Some people however get used to it and notice it less than they did at first. For many people certain adjustments make the symptoms less bothersome. These tips may help:
- Avoid possible irritants. Reduce your exposure to things that may make your tinnitus worse. Common examples include loud noises caffeine and nicotine.
- Cover up the noise. In a quiet setting a fan soft music or low-volume radio static may help mask the noise from tinnitus.
- Manage stress. Stress can make tinnitus worse. Stress management whether through relaxation therapy biofeedback or exercise may provide some relief.
- Reduce your alcohol consumption. Alcohol increases the force of your blood by dilating your blood vessels causing greater blood flow especially in the inner ear area.
There’s little evidence that alternative medicine treatments work for tinnitus. However some alternative therapies that have been tried for tinnitus include:
- Ginkgo biloba
- Zinc supplements
- B vitamins
Neuromodulation using transcranial magnetic stimulation (TMS) is a painless noninvasive therapy that has been successful in reducing tinnitus symptoms for some people. Currently TMS is utilized more commonly in Europe and in some trials in the U.S. It is still to be determined which patients might benefit from such treatments.
Coping and support
Tinnitus doesn’t always improve or completely go away with treatment. Here are some suggestions to help you cope:
- Counseling. A licensed therapist or psychologist can help you learn coping techniques to make tinnitus symptoms less bothersome. Counseling can also help with other problems often linked to tinnitus including anxiety and depression.
- Support groups. Sharing your experience with others who have tinnitus may be helpful. There are tinnitus groups that meet in person as well as Internet forums. To ensure the information you get in the group is accurate it’s best to choose a group facilitated by a physician audiologist or other qualified health professional.
- Education. Learning as much as you can about tinnitus and ways to alleviate symptoms can help. And just understanding tinnitus better makes it less bothersome for some people.
In many cases tinnitus is the result of something that can’t be prevented. However some precautions can help prevent certain kinds of tinnitus.
- Use hearing protection. Over time exposure to loud noise can damage the nerves in the ears causing hearing loss and tinnitus. If you use chain saws are a musician work in an industry that uses loud machinery or use firearms (especially pistols or shotguns) always wear over-the-ear hearing protection.
- Turn down the volume. Long-term exposure to amplified music with no ear protection or listening to music at very high volume though headphones can cause hearing loss and tinnitus.
- Take care of your cardiovascular health. Regular exercise eating right and taking other steps to keep your blood vessels healthy can help prevent tinnitus linked to blood vessel disorders.
The measurement of the protein Thyroglobulin (abbreviated Tg) in blood is an important laboratory test for checking whether a patient still has some thyroid present. The power of a serum Tg measurement lies in the fact that Tg can only be made by the thyroid gland (either the remaining normal part or the tumorous part). This means that when a patient has had their thyroid completely removed the measurement of Tg in a blood sample can be used to check whether there is any tumor left behind.
Detectable Tg Levels:
When patients have had cancerous growths that make Tg the absence of Tg in a blood sample is usually good news for a patient who has had thyroid surgery to remove their thyroid gland containing a cancerous growth. However many patients still have measurable levels of Tg in their blood after surgery. Often this Tg is coming from a small amount of normal thyroid left behind. This means that a measurable level of Tg does not necessarily indicate the presence of tumor. Often physicians will give a small dose of radioiodine to get rid of the last remaining part of the normal thyroid gland in order to make later Tg measurements a better marker for any tumor left behind.
TSH & Tg:
Thyroid Stimulating Hormone (TSH) is the pituitary (master gland at the base of the brain) hormone that drives the thyroid gland to produce thyroid hormones and as a by-product release Tg into the blood. TSH is believed to cause the growth of most thyroid tumors. This is why it is important to take thyroxine medicine (e.g.: synthroid levoxyl unithroid) to keep TSH levels low. When TSH is high (before scanning) Tg is increased about ten times. You should not compare the Tg level measured while taking thyroxine medicine (when TSH is low) with the Tg level measured when TSH is high.
Tg Measurements before Surgery:
Many physicians still do not recognize the value of a pre-operative Tg measurement. A high Tg level before surgery does not indicate that a tumor is present. However when a biopsy suggests that the growth is cancerous the finding of a high Tg level before surgery is a good sign because it suggests that the tumor makes Tg and that after surgery Tg can be used as a sensitive tumor marker test. In fact Tg will be a more sensitive post-operative tumor marker test when the cancerous growth is small and the pre-operative Tg is high! When a patient has a low Tg pre-operatively the cancerous growth might be unable to efficiently make Tg. In such patients an undetectable Tg level after surgery is less reassuring than if the patient had had a high pre-operative Tg value. Conversely when Tg is detected post-operatively in such patients despite ablation of all normal thyroid this could indicate that a large amount of tumor is still present.
Tg Measurements after Surgery:
Changes in the Tg level over time (six months or yearly intervals) are more important than any one Tg result. After surgery blood samples are usually taken for Tg measurement while the patient is taking their daily dose of thyroxine medication (TSH low).
Tg Method-to Method Differences: Unfortunately Tg measurement is technically difficult and different Tg methods produce different results. Tg measurements made by different laboratories on the same blood specimen from a patient can vary as much as two-times! It is important to compare Tg measurements made by the same method if possible performed by the same laboratory. This is because method-to-method differences makes it impossible to tell whether a change in the Tg level means there is a change in the amount of tumor or is just a problem with the way the test is done.
Concurrent Tg Re-measurement:
Some laboratories save all the unused blood left after a Tg test has been completed so that the spare blood can be re-measured side-by-side with a future blood sample. This “concurrent remeasurement” approach is the best way to tell whether a change in the Tg level means that there has been a change in the amount of tumor or is just due to the way the test was done. The concurrent remeasurement approach helps the physician check for tumor re-growth at an earlier stage. Additionally laboratories that bank patient specimens will have them available for any new tumor-marker tests that may be developed in the future.
Tg Antibodies (TgAb):
Approximately 15 to 20 percent of thyroid cancer patients have antibodies to Tg that circulate in their blood. These antibodies are abbreviated as TgAb on laboratory reports. Unfortunately TgAb interferes with the measurement of Tg by most methods. Whether these antibodies cause incorrectly high or low values depends on the type of Tg method used by the laboratory. Most clinical labs use the more modern type of Tg method (called immunometric assays (IMAs) or “sandwich” methods). These methods typically report falsely low Tg values when TgAb is present in a patient’s blood. Falsely low values may lead to a delay in necessary treatment. Alternatively an inappropriately high Tg level which can be a problem with some of the older type of Tg method (called radioimmunoassays RIAs) can cause patient anxiety and lead to unnecessary scans or treatment. There is currently disagreement between professionals regarding the best type of method to use (IMA or RIA) for patients with antibodies. Some laboratories in the United States believe that RIA methods have less TgAb interference and provide more clinically reliable values than IMA methods. In fact these laboratories believe that IMA methods should not be used at all when TgAb is present because an falsely low Tg value is more of a problem than a falsely high Tg one. For example an inappropriately low Tg value reported because of TgAb interference can lead to a delay in treatment. In contrast an inappropriately high Tg value reported because of TgAb interference usually increases vigilance on the part of the physician. Some laboratories now restrict the use of the IMA methods to patients without antibodies and continue to use the older RIA-type methods for patients with antibodies although the RIA test result takes longer to report.
Since interference by Tg Antibodies has serious effects on the reliability of the Tg value reported it is important to use a precise and sensitive Tg antibody test method to detect TgAb. Unfortunately TgAb methods differ even more than Tg methods! Some patients are judged to be antibody-positive by some methods and antibody-negative by others. It is therefore important to compare TgAb measurements made by the same method if possible performed by the same laboratory. It is also important for the laboratory to use a modern sensitive immunoassay test to check for TgAb. You can tell if your TgAb was measured by one of these tests by the units that are reported. If the antibody result is followed by U/mL or IU/mL it is a modern immunoassay test. If the antibody is reported in titers (1:100 1:400 1:1600 etc) this is an insensitive old-style agglutination test.
Serial TgAb Measurements:
It is important for the laboratory to measure TgAb in every specimen sent for Tg measurement. This is both because a patient’s TgAb status may change from positive to negative or vice versa and also because the trend in TgAb values over time (i.e. 6 to 12 months) gives additional information on how well the tumor is responding to treatment. A trend down in TgAb levels overtime (years) is a good sign that treatment is effective. In contrast an increase over time may be an early sign of a recurrence. When a patient has TgAb detected it is not unusual to see a temporary rise in the TgAb level during the first six months following radioiodine therapy. This may even be a sign of the effectiveness of the treatment. Usually TgAb values return to the original value or below after six months.
- Ask for copies of labs / scan/ consultation notes etc. to be sent for review
- Dr. Gordon has reviewed labs/scan etc. and/or has ordered and followed up on additional labs and orders
- Update medication list
- Blood thinners ¡V Plavix aspirin Vitamin E etc.
- Medical History
- Social history
- OR Prep Questions:
- HX of hip knee valve surgery
- Prostetic replacements
- Require antibiotic prior to dental procedures
- Heart murmur irregularity of valve prolapse
- Family history of anesthesia issues
- Hx Malignant Hyperthermia Pre-Op:
- Discuss surgical date
- St. Anthony¡¦s will contact them the day before surgery for arrival time (after 3pm call them)
- Pre/Post Operative instructions get sent out via mail and e-mail
- Stop blood thinners (or any medications as per primary doctor)
- Plavix Aspirin Vitamin E etc.
- NPO Midnight the day before surgery
- Competent adult accompany and drive patient (family friend)
- Medical clearance checklist (based off of recommendations of clearing Dr.)
- Clearance letter
- EKG or any additional workup deemed necessary by primary MD
- (Local Pt) Mention pt needs to return to the medical office 7-10 after surgery for stitches removal Post Operative:
- Post operative letters to referring MD and uploads to EMR
- P.A. ¡V 1 week follow up phone call
- Schedule suture removal 7-10 days post surgery
- Medical office follow up 2 weeks post surgery