Ask Dr. Etingin: Treatment for tinnitus; Causes of low red blood cell count

I recently started hearing chirping noises, and my doctor said it’s tinnitus. Are there any effective treatments for this?

It depends on the cause. Tinnitus—a sound that can be heard although no external source of sound is present—may be caused or worsened by a number of health conditions and other factors. If the cause is identified, treating the underlying cause may improve or eliminate the sounds. However, in many cases, a cause of tinnitus cannot be identified.

For example, if hair cells in the inner ear are damaged, they can send random electrical signals to your brain and produce sounds. Various ear conditions, including age-related hearing loss, excessive earwax, and changes in the bones of the middle ear, may result in tinnitus. Exposure to loud noise, whether short-term (from a concert) or long-term (from working in a noisy environment) can damage the ears and cause tinnitus. Rarely, tinnitus is caused by a blood vessel disorder such as atherosclerosis (hardening of the arteries) or high blood pressure.

Some medications have been linked with tinnitus, including antibiotics, cancer medications, diuretics (“water pills”), some antidepressants, and aspirin taken in very high doses. In addition, some herbal supplements, nicotine, and caffeine may contribute to tinnitus.

People who have tinnitus report hearing a variety of sounds, including buzzing, humming, clicking, hissing, ringing, and roaring. Usually, people find tinnitus bothersome but not serious. But for some, the sound is so loud that it interferes with the ability to concentrate or to hear external sounds.

In some cases, white noise—low-volume background noise—may help. Some white noise machines produce sounds of a fan, while others allow you to choose from a variety of sounds. Masking devices that are worn in the ear, much like hearing aids, can produce a continuous, low noise. If hearing loss is a possible cause, wearing hearing aids can improve your hearing and your tinnitus. A few medications, including tricyclic antidepressants (Elavil, Pamelor) and Xanax, may help reduce the severity of tinnitus.

If you have tinnitus, mention it to your doctor if you’d like to investigate the cause and possible treatments. If you experience a sudden onset of tinnitus and/or hearing loss or dizziness accompanies the tinnitus, consult your doctor as soon as possible.

My recent blood test shows I have a low red blood cell count. What might be causing this?

A low red blood cell count may have several causes, including conditions that reduce the production of red blood cells and blood loss. The common term for a low red blood cell count is anemia. Symptoms of anemia include dizziness, fatigue, and shortness of breath.

Blood tests can point to the source of your anemia by measuring iron, folate, and vitamin B12, which are nutrients needed for red blood cell production.

If your low count is due to a deficiency of vitamin B12, a condition that is common in older adults, include more B12-rich foods, such as fish and shellfish, lean meat and poultry, low-fat dairy products, and eggs, in your diet. Your doctor also may recommend a B12 supplement or monthly B12 shots. Folate is present in leafy, green vegetables such as spinach, broccoli, Brussels sprouts, and mustard greens, as well as fortified breakfast cereals. If you have an iron deficiency, your anemia might be caused by internal blood loss.

If your doctor suspects this, he or she may request an endoscopy (which looks for signs of bleeding in the stomach), colonoscopy (which can identify bleeding in the colon), or a stool occult test that can detect hidden blood. Health conditions that are associated with a low red blood cell count include ulcers in the digestive tract, chronic kidney disease, underactive thyroid, and some types of cancer.

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