Ear ringing, or telinga berdesing, is a condition medically known as tinnitus, which involves the patient perceiving an acoustic sensation in the absence of an obvious auditory stimulus. It is often described as an uncomfortable sound of ringing, buzzing, whistling or humming. The sound varies in duration and intensity, with some having only mild and intermittent noise while others suffer from constant and loud noise. There are two types of tinnitus; subjective and objective tinnitus. Subjective tinnitus is the most common type in which only the patients can hear the sound, either from one ear, both ears or inside the head. Objective tinnitus is very rare, accounting only 3% of all tinnitus cases. This sound can be perceived by the patient and others (doctors listening with a stethoscope), and usually indicates underlying medical illnesses such as vascular aneurysm or brain tumor.
Subjective tinnitus is believed to be a sign of damaged auditory neurons. This is due to the exposure of severely loud or prolonged loud sound such as an explosion or blasting loudspeaker. Loud noise exposure is the most prevalent and direct cause of injury to the 8th cranial nerve (primary auditory neurons), leading to tinnitus. In addition, tinnitus can be an early sign of tumor, like auditory neoplastic neuromas. However, not all damaged auditory nerves cause tinnitus. Further research suggests that tinnitus has amore central origin, which is plausible as certain lesions in the auditory nerve have changed the brain wiring, resulting in an increased firing of nerves from the brainstem to cortex. Since tinnitus can be of the brain, it is not far-fetched to consider the association between tinnitus and psychiatric illnesses. In fact, studies showed that up to 77% of people with tinnitus also present with psychiatric disorders. Among those psychiatric disorders, anxiety and depressionare the most common complications with tinnitus. It is important to note that, although tinnitus and hearing loss is usually related, hearing loss is NOT the dominant cause of anxiety or depression.
Whether tinnitus is a symptom of psychotic depression is still unclear. This is because tinnitus is not one of the criteria to diagnose depression according to DSM-5. A person is diagnosed as clinically depressed when five out of nine criteria are fulfilled, including depressed mood, loss of interest, change in weight, appetite and sleeping, low energy, slow movement, feeling worthless and guilt, reduced ability to concentrate and suicidal intention. On the other hand, psychosis is defined as a severe mental condition that impairs personality, social functioning and perception of reality. A psychotic person may have auditory hallucination, but that symptom is more typically described as sounds of people talking, and not just a simple ear ringing.
Current research is also still inconclusive on whether tinnitus leads to depression or anxiety, or vice versa. Nonetheless, there is substantial physiological evidence through PET and fMRI scans that suggest negative emotions and the continued perception of tinnitus are amplified in a vicious cycle. In other words, being depressed can cause the person to have longer and worsen tinnitus.
Not all hope is lost. Although there is no absolute cure for tinnitus, research has shown that tinnitus can actually be “masked” by something known as the compensated tinnitus. Scientists found that the perception of tinnitus actually requires the active awareness of the sensation, and by shifting the attention to the sound, the effect of tinnitus is reduced.
This principle has been utilized in the therapy for many tinnitus cases.
In short, the evidence of tinnitus as a symptom of psychotic depression is still unclear, but it is definitely associated with depression and anxiety.