History of Tinnitus

Tinnitus is as old as humanity. The first written record of tinnitus as a medical condition comes from Mesopotamia in the seventh CBC. Tinnitus was still considered a punishment from the Gods and treatment consisted of charms. This changed with Hippocrates, in the fifth CBC who believed diseases were caused naturally and provided a brain-based explanation for tinnitus, as part of a constellation of symptoms, typical for infections. Several physicians and scientists proposed treatments, consisting of diet and herbal medicine, all of which seem to have an anti-inflammatory, anti-infectious effect and, being antioxidants, were neuroprotective. Later, sound therapy was added and opioids, targeting the tinnitus-associated suffering. After the advances made in the second century AD, the centre of medical science shifted to Byzantium, with Alexander de Tralles in the sixth century proposing tinnitus as the result of a raised irritability of the auditory sense. The Islamic golden age, between the eighth and fourteenth centuries, moves the centre of medicine to the Near East, North Africa, and Spain. Avicenna in the tenth century relates tinnitus to a hangover, trauma, or medication. Yet, treatments and explanations largely remained unchanged. The first cadaveric dissections in Italy during the Renaissance in the fifteenth and sixteenth centuries increased anatomical knowledge dramatically, yet, this detailed anatomical knowledge did not lead to novel insights nor treatments. In the Renaissance, Paracelsus claimed that not the illustrious ancients were to be followed, but nature itself. He was the first to describe that noise trauma like riffles or bells could generate tinnitus. His treatment added scarifications to the ear and venesection under the tongue. In the sixteenth century, the French physician Jean Fernel was the first to propose that deafness, tinnitus, and pain have a common origin, a very prescient insight. The scientific revolution in the seventeenth century with Descartes and Du Verney added a mechanistic auditory nerve and brain-centred explanation for tinnitus. In the early eighteenth century, Rivinus and Cotugno described tinnitus caused by convulsive contractions of the Eustachian muscle or stapedial muscle. The nineteenth century saw the birth of science as a profession, and Itard differentiated between true (objective) and false (subjective) tinnitus based on carotid compression. He further distinguished between idiopathic, based on noise trauma, and symptomatic false tinnitus, associated with other diseases. The German otologists classified tinnitus in detail and the first journal paper dedicated exclusively to tinnitus was published in 1841 in Germany. In the twentieth century, new audiological techniques permitted to describe frequency and loudness matching, as well as masking procedures, and in the twenty-first century novel brain imaging techniques identified many of the brain structures involved in the generation of tinnitus and its associated suffering. Yet, no treatment has emerged, based on this detailed knowledge, that can successfully treat tinnitus and tinnitus disorder.