General Medical Information

Tinnitus

Byron J. Bailey

The incidence of tinnitus increases with age. It is present in about 20% of people over age 50. Severe tinnitus has been defined as that which “plagues me all day along” and has an incidence of about 4% in people over 50. Many studies have reported an association between tinnitus and psychological diagnoses such as neurosis, neurotic conversion, borderline personality, depressive range, and anxiety. Dobie reported finding depression in 24 of 40 patients with severe tinnitus, indicating that tinnitus may be a factor in causing older people to become depressed.

Confirming causality in these patients is difficult because depressive episodes appear to precede the tinnitus about as often as not. Preliminary results indicate that nortriptyline, a tricyclic antidepressant, seems to effectively reduce the severity of tinnitus in these patients. Severe tinnitus and chronic pain are similar in their effects on people over an extended time. Medication, counseling, psychological support, and training in various coping strategies are important components in the therapy of this condition. Tinnitus-masking devices provide relief in some patients, but their general value in large patient populations remains controversial.