Mayo Clinic Q&A: tinnitus causes, treatments; liquid biopsies

Ear pain. (Shutterstock)
Ear pain. (Shutterstock)
Published July 6 2018

TAMP DOWN TROUBLING TINNITUS SENSATION

What causes tinnitus, and is there anything that can be done to get rid of it?

Tinnitus, the sensation of hearing a sound when no external sound is present, often is described as a ringing, buzzing, roaring, clicking, humming, pulsing or hissing sound, or any combination of these sounds. You may hear it in one or both ears. The sound may be present all the time or off and on.

If you have tinnitus that doesnít go away, a hearing evaluation is recommended. In most cases, tinnitus can be managed fully. But, for some, itís a chronic condition that can affect sleep and everyday function. Fortunately, there are options to reduce its effects.

The cause of tinnitus is unknown. One idea is that tinnitus results from damage to the cells of the inner ear. This stems from the fact that about 90 percent of people with tinnitus have some hearing loss caused by noise.

The tiny, delicate hairs in your inner ear move in relation to the pressure of sound waves. This movement triggers the release of an electrical signal through your auditory nerve to your brain. Your brain normally interprets these signals as sound. If the hairs inside your inner ear are damaged, bent or broken, they may release random electrical impulses to your brain, resulting in tinnitus.

In many people, tinnitus has been linked to hearing loss ó both age- and noise-related. It can occur from earwax blockage, bone changes in the middle ear (otosclerosis) and as a side effect of a number of medications. Other conditions associated with tinnitus include head trauma or a concussion; inner ear conditions, such as Meniereís disease or an acoustic neuroma; head or neck injuries; or problems with the joint where your lower jawbone meets your skull (temporomandibular joint). High blood pressure and factors that increase blood pressure, such as stress, alcohol use and caffeine consumption, can make tinnitus more noticeable.

Although thereís no known cure for most cases of tinnitus, many people can manage it. For most, the goal is to lessen their awareness of tinnitus. If tinnitus is due to a health condition, your health care provider may be able to recommend steps that could reduce the noise. This may involve removing excess earwax, treating an underlying vascular condition or changing medications if one is contributing to the problem.

Hearing aids also can help. Properly fitting hearing aids can address hearing loss. And tinnitus sometimes can be reduced if you can better hear sounds around you. In some cases, white noise (masking) may help suppress tinnitus so that itís less bothersome.

In addition, there are several promising therapy options for management of tinnitus. These include music therapy devices and methods for managing tinnitus; tinnitus retraining therapy, which involves using devices to "train the brain" to ignore tinnitus; and cognitive behavioral therapy, which focuses on replacing negative thoughts with positive ones to change your reaction to tinnitus.

Although there is no approved drug to cure tinnitus, in some cases, medications, such as certain antidepressants, may reduce the severity of symptoms. Ongoing, research-focused tinnitus suppression and management solutions are underway.

Finally, a licensed therapist can help you develop coping techniques. Support groups also are available in person and online. Exercise and relaxation therapy also may help, as stress can worsen tinnitus.

Gayla L. Poling, Ph.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn. (Adapted from the Mayo Clinic Health Letter)

LIQUID BIOPSIES SHOW PROMISE

What is a liquid biopsy? Can it be used in place of a tumor biopsy to find cancer?

A liquid biopsy involves examining cancer-related material (like DNA) from a blood sample. At this time, a liquid biopsy canít replace a tumor biopsy. But researchers are studying the benefits of, and best uses for, liquid biopsies. They show promise in guiding individualized approaches to cancer management. Eventually, liquid biopsies also may be able to help health care providers screen for some forms of cancer.

Cancer is characterized by cell changes, including mutations and other genetic alterations, which lead to the development of abnormal cells that divide uncontrollably. Identifying the specific alterations can help health care providers determine the best treatment.

The diagnosis and characterization of cancers require tissue sampling through a tumor biopsy. This involves taking a sample of the cancerous tissue or cells through an invasive procedure and examining the sample in a lab. Tumor biopsies offer a wealth of information for health care providers to use when developing a cancer treatment plan.

But biopsies have limitations. First, a tumor changes over time as it grows, spreads and is exposed to anticancer medications. That means tumor biopsies taken when the disease is first diagnosed may not reflect the current state of the cancer. Second, repeating biopsies to get updated information is invasive and associated with potential complications, including pain. Third, cancer cells that spread to different areas of the body may differ somewhat from the cancer at the site where it started. As a result, a tumor biopsy from one part of the body is unlikely to adequately represent cancer throughout the body.

Going through multiple biopsy procedures is not practical and can be hard on patients. Liquid biopsies may offer an alternative for monitoring cancer over time that is less expensive and less invasive than tumor biopsies. In addition, genetic material from all sites of disease is released into the circulation, so blood sampling may provide a real-time, representative view of the evolving cancer throughout the body.

Information gained from liquid biopsies should help health care providers select the best therapy for a patient at a given time in the course of metastatic disease. Blood-based monitoring also may indicate the need to switch to a different treatment regimen before changes appear on an imaging exam. In the setting of early-stage cancer, periodically checking the blood for cancer signals after potentially curative therapy could identify patients who are at risk for recurrence. Some research suggests that liquid biopsies may be able to detect when cancer returns long before a tumor reappears.

With continued research and technological improvements, the liquid biopsy ultimately may become a tool for cancer screening. Early detection is expected to improve cancer-related outcomes. This is particularly important for those cancers currently without effective methods of screening and prevention.

Although liquid biopsies still are being researched, the potential they offer to provide a new way to monitor the presence of cancer, track cancerís response to treatment and watch for a recurrence of cancer using a blood test could be a significant step forward in cancer care.

Minetta C. Liu, M.D., Medical Oncology, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesnít replace regular medical care. Email a question to MayoClinicQ&A@mayo.edu. For more information, visit mayoclinic.org. © 2018 Mayo Foundation for Medical Education and Research. Distributed by Tribune Content Agency, LLC. All rights reserved.

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