Brief Answer:
Ototoxicity may be cause for tinnitus

Detailed Answer:
Hi. Thank you for writing to HCM. Your efforts towards health improvements and 30 lb wt loss is truly commendable.

Your tinnitus seems to result from long term usage of ototoxic medications such as Amitriptyline for 23 years, Trazodone (Mildly ototoxic) for about 15 months and on citalopram (Celexa) which is also ototoxic since 2 months.

Ototoxicity is the toxic damage to the hair cells present in the inner ear along with damage to the cochlear nerve hence causing the nerve to be constantly irritable. This nerve in its irritable state continuously fires signals that causes you to hear ringing or buzzing sounds even when there is no external stimuli. It may have also been precipitated with ageing of the nerve as the cochlear nerve tends to weaken around the 6th decade.

In my opinion you need an ENT evaluation to understand the degree of nerve damage due to ototoxicity or presbycusis (decreased hearing due to ageing). The following are recommended ( If you have had these before then please share the results)

1. Hearing test (Pure tone audiogram) - to assess the degree of nerve damage by correlating it with hearing loss at higher frequencies ( Slope at high frequencies)

2. MRI brain - to assess if there is any neurological cause of tinnitus which may be treatable

3. Ear examination with an otoscope or an otoendoscopy - Sometimes middle ear diseases can lead to tinnitus

Tinnitus may be treatable if it is due to reversible causes such as ear wax, eustachian tube dysfunction, middle ear diseases or vascular compressions or mass in the brain pressing on the auditory nerve.

Tinnitus due to ototoxicity, noise exposure and ageing do not usually recover completely but may recover to a large extent with multivitamin supplements (Vitamin B12) and oral antioxidants for a few years. In addition to this prevention of exposure to noise or ototoxic agents is very important. Some hearing aids have white noise masking capabilities or there are separate white noise masking devices that are very useful in masking tinnitus while sleeping.

Do let me know if this helps. Do let me know if you have any further questions.

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Brief Answer:
Review with an ENT specialist

Detailed Answer:
Hi Carole. Thank you for writing back.

Since tinnitus being one of those conditions that requires a thorough evaluation before planning an appropriate management, it is my advise that you see an ENT before making any changes to your existing medications as they may affect other conditions that they are meant to treat.

Here is a link that talks about celexa and ototoxicity http://www.tinnitusformula.com/library/ototoxicity-medications-that-cause-tinnitus/#.VC2k2SmSxGg. Also do note that these side effects occur in a very small proportion of patients but they do occur.

Please keep me posted on your progress. I noticed that your audiologist has mentioned that you may have high frequency hearing loss which does point to ototoxicity or age related nerve weakness. Therefore vitamin supplements, antioxidants and possibly a tinnitus masker (with or without a hearing aid) may be necessary.

Hope this helps.

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