Tinitus: Avances en fisiopatología y tratamiento

Tinnitus and auditory hallucinations are delusional sound perceptions in absence of a real external sound, affecting as much as 15% of the general population. It can be completely disabling. Three main types have been identified: objective tinnitus, caused by sounds generated somewhere in the body. There is no 100% effective treatment for this type. Subjective tinnitus, defined like the perception of sounds without present physical sounds, resembles neuropathic or deafferentation pain, which may be the result of cortical somatotopic reorganisation (in the case of the neuropathic pain) or tonotopic in the case of tinnitus, by neuronal plasticity, that causes new perceptions, thus generating symptoms. Auditory delusions, is defined as non sense, musical o language sound perception. A non classic auditory pathway seems to be involved in tinnitus pathophysiology, which we use in childhood, that connects cochlear with limbic structures, before being modulated by the auditory cortex, which leads to the associated tinnitus symptoms. Diagnosis is therefore complex and consists of looking for morphologic and functional causes, from the external auditory conduct to the cortex, bearing in mind the effect of sistemic diseases like arterial hypertension in the generation of tinitus. Treatment is not standardized. In objective tinnitus consists of removal of causative agent of the abnormal perception, and in the subjective one, there is an ample range of possibilities that vary from medical formulation, through behavioral therapies, till transcortical magnetic and electric stimulation.